Date of Publication


Project Team

Dr. Marcia Bosek DNSc, RN


Intervention to Improve Staff Adherence to Transmission Based Precautions in a Long Term

Care Nursing Facility

Purpose: Preventing infection and its spread is paramount in any healthcare setting. This can be challenging in the long term care setting since the regulations governing the use of Transmission Based Precautions in this setting differ from acute care hospitals. State and federal regulations guiding long term care institutions require that patients receive high quality nursing and medical services that is patient-centered while concurrently viewing the facility as the “patient’s home.” Providing high quality services while maintaining a home like quality creates competing expectations. Regulatory guidance on the implementation of TBP in long term care a poorly described phenomenon. This staff development project aims to provide nursing staff with practical and consistent guidance for interpreting regulatory policy into practice when transmission based precautions are required.

Methods: Pre-post test design using an education tutorial booklet for self-study. Nursing staff (RN, LPN, LNA) were recruited from a rehabilitation unit at a skilled long term care, for profit nursing facility in the Northeast.

Results: Forty-five out 56 (80.36%) nursing staff completed the pre-survey with 56% RN/LPNs and 44% LNAs. Forty-three (76.79%) completed the self-study educational booklet too. Forty-two (75%) nursing staff completed the post-education survey. TBP knowledge related to MRSA improved 31.15%, from 68.85% to 100%. TBP knowledge related to C. Diff improved 7.85%, from 92.15% to 100% and Droplet TBP knowledge increased 51%, from 46.6% to 97.6%. Nursing staff identified interpreting regulatory guidance and policy into practice, inconsistent communication, and staff shortages as barriers to compliance with TBP.

Conclusion: An educational tutorial booklet for self-study is an effective strategy for improving nursing staff knowledge related to TBP. Nursing staff are able to identify barriers to implementing TBP in the clinical setting. Further efforts are needed to minimize barriers to TBP practice and regulation consistency in the LTC setting.

Key Words: transmission based precautions, long term care, infection prevention

Document Type


Included in

Nursing Commons