Taking the "Isolation" out of Isolation Precautions
Taking the "Isolation" out of Isolation Precautions
Abstract & Commentary
By Ruth M. Kleinpell, PhD, RN, Director, Center for Clinical Research and Scholarship, Rush University Medical Center; Professor, Rush University College of Nursing, Chicago, is Associate Editor for Critical Care Alert.
Dr. Kleinpell reports no financial relationship to this field of study.
Synopsis: Isolation precautions for preventing the spread of infection to or from hospitalized patients have adverse effects on both the patient and the delivery of appropriate care.
Source: Morgan DJ, et al. Adverse outcomes associated with contact precautions: A review of the literature. Am J Infect Control 2009;37:85-93.
The infection control technique of contact precautions is intended to prevent the spread of pathogens by airborne, droplet, or contact transmission. However, the quality of care received by patients in isolation may be impacted and patients may experience feelings of isolation. This article reports on a systematic literature review examining adverse outcomes from contact precautions.
Fifteen studies published between 1989 and 2008 were identified that reported adverse outcomes related to contact precautions in 4 major areas, including less patient-health care worker contact, changes in systems of care with delays in care, increased symptoms of depression and anxiety, and decreased patient satisfaction with care. The literature review identified that contact precautions can have potentially deleterious effects on patient care, which need to be identified and addressed by health care professionals to ensure the most effective application of infection prevention measures.
Commentary
While hospital infection control policies are aimed at preventing the spread of communicable infections, they may also inadvertently lead to poorer quality of care and adverse events. Isolation policies may place physical barriers between clinicians and patients, are time-consuming to comply with recommended practices for protective equipment (donning gloves, gowns, and masks), and may impede visitors.1 Contact precautions, which require the use of gown and gloves for all staff who have contact with the patient or the patient's room, as well as housing patients in single rooms or in rooms shared with other patients on contact precautions, are a standard practice for managing hospitalized patients who are colonized or infected by drug-resistant organisms. However, research has demonstrated that patients on isolation precautions are less likely to have vital signs recorded, less likely to have daily physician progress notes documented, more likely to experience preventable adverse events such as falls, pressure ulcers, and fluid or electrolyte disorders, and more likely to express dissatisfaction with their care.1
The findings of the Morgan et al systematic literature review demonstrate unintended consequences of contact precautions for patients. While the Centers for Disease Control and Prevention recommend measures to counteract possible adverse effects of contact precautions such as patient anxiety, depression, perceptions of stigma, and reduced contact with clinical staff,2 the results of this literature review indicate that interventions need to be studied in formal research that addresses mitigating both psychological outcomes as well as adverse unintended consequences.
Possible areas of focus include educational interventions for both patients and staff, increased staffing ratios of health care workers caring for patients on contact precautions,3 or the use of novel strategies such as integrating telehealth technologies for patient monitoring and contact. With continued current attention to infection control measures for prevention of disease transmission for infections such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, among others, monitoring the impact of contact precautions on patients' psychological well-being, satisfaction, and outcomes of care, remains an important patient care treatment issue. The results of this systematic literature review highlight the importance of addressing measures to prevent unintended consequences of contact precautions for infection control and to take the "isolation" out of isolation precautions.
References
- Stelfox HT, et al. Safety of patients isolated for infection control. JAMA 2003;290:1899-1905.
- Siegel JD, et al; the Healthcare Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Atlanta: GA: Centers for Disease Control and Prevention; 2007.
- Diekema DJ, Edmond DJ. Look before you leap: Active surveillance for multidrug-resistant organisms. Clin Infec Dis 2007;44:1101-1107.
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