Adverse effects of contact isolation

doi:10.1016/S0140-6736(99)04196-3

The Lancet

Volume 354, Issue 9185, 2 October 1999, Pages 1177-1178

https://doi.org/10.1016/S0140-6736(99)04196-3 Get rights and content

Summary

Health-care workers are half as likely to enter the rooms of patients in contact isolation, but are more likely to wash their hands after caring for them than after caring for patients not in isolation

References (5)

Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals
Infect Control Hosp Epidemiol
(1996)
Recommendations for preventing the spread of vancomycin resistance
Infect Control Hosp Epidemiol
(1995)

There are more references available in the full text version of this article.

Cited by (190)

The experiences of children, adolescents and their parents in isolation in a Danish paediatric unit: A qualitative study
2023, Journal of Pediatric Nursing
Previous studies on adult patients in hospital isolation show that it can be highly stressful, with some patients affected by depression and anxiety. This study aimed to explore how children, adolescents, and their parents perceive isolation and how it affects them physically, psychologically, and socially.
A qualitative approach was used comprising semi-structured interviews, participant observations, and field notes.
Two adolescents and 13 parents were selected to participate in the interviews, while three children and their parents participated in participant observation. Besides the participant observation one of the adolescents and one parent also participated in interviews. The children and adolescents were isolated at the hospital due to bacterial or viral infections or were carriers of an antibiotic resistant bacteria. After performing a thematic analysis to identify patterns in the data, four themes emerged: 1. Differing information provided about bacteria, virus, hygiene precautions, and isolation, 2. Dependence on healthcare professionals, 3. Impact of the environment, and 4. Coping and psychological reactions on isolation.
The participants conveyed positive and negative experiences and emotions during isolation in relation to daily activities, psychological well-being, and social life. Adolescents and their parents requested clear comprehensible and consistent information on isolation from healthcare professionals.
To improve hospital isolation for children, adolescents, and their parents, well-written information on isolation and hygiene precautions is crucial, as are evolving strategies to minimise social exclusion and the emotional impact of isolation.
An evaluation of interventions to improve outcomes for hospitalized patients in isolation: A systematic review
2022, American Journal of Infection Control
Isolation is effective in preventing transmission of infectious disease. However, it has been shown to have negative effects including increased anxiety and poor physical outcomes.
To summarize the effects of interventions to improve safety and outcomes for patients in isolation
Systematic review (PROSPERO protocol registration - CRD42020222779).
Acute hospital
Intervention studies including patients in preventative or protective isolation in a single room.
MEDLINE, Global Health, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Excerpta Medica database were searched from 1996-October 2020. Two independent reviewers screened references and assessed risk of bias. One reviewer extracted data and was checked by another. Main outcomes were Quality of Life and mortality.
We identified 16,698 references and included 6 studies with different study designs. Average age ranged from 4-71 years. Samples sizes were small (range 10-49 participants) apart from one non-randomized controlled trial including >600 participants. Interventions were music therapy (n = 3), psychological counseling (n = 2) and exercise training (n = 1). One study reporting on Quality of Life and found no change after exercise. None of the studies reported on mortality. Due to heterogeneous results no meta-analyses were performed.
There is a lack of high-quality evidence for effective comprehensive interventions to manage adverse effects associated with isolation. Future studies should investigate the effect of multi-component interventions using rigorous methods to improve outcomes for hospitalized isolated patients.
Multidrug-Resistant Gram-Negative Bacteria: Infection Prevention and Control Update
2021, Infectious Disease Clinics of North America
Stopping the routine use of contact precautions for management of MRSA and VRE at three academic medical centers: An interrupted time series analysis
2020, American Journal of Infection Control
Contact precautions (CP) are a widely adopted strategy to prevent cross-transmission of organisms, commonly methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Some hospitals have discontinued CP for patients with MRSA or VRE; however, the impact on hospital-acquired infection rates (HAI) has not been assessed systematically.
Retrospective multicenter interrupted time series between 2002 and 2017 at three academic hospitals. Participating hospitals discontinued CP for patients with contained body fluids who were colonized or infected with MRSA or VRE. The primary intervention was stopping the use of CP. Secondary interventions were horizontal infection prevention strategies. The primary outcomes were rates of central line-associated bloodstream infections, catheter-associated urinary tract infections, mediastinal surgical site infection, and ventilator-associated pneumonia due to MRSA, VRE, or any organism using Centers for Disease Control and Prevention National Healthcare Safety Network surveillance definitions.
Central line-associated bloodstream infections, catheter-associated urinary tract infections, mediastinal surgical site infection, and ventilator-associated pneumonia rates trended down at each institution. There were no statistically significant increases in these infections associated with discontinuing CP. Individual horizontal infection prevention strategies variably impacted HAI outcomes.
Stopping the routine use of CP for patients with contained body fluids who are colonized or infected with MRSA or VRE did not result in increased HAIs. Bundled horizontal infection prevention strategies resulted in sustained HAI reductions.
Limited multi-drug resistant organism related stigma in carriers exposed to isolation precautions: an exploratory quantitative questionnaire study
2020, Journal of Hospital Infection
Isolation precautions are applied to control the risk of transmission of multi-drug resistant organisms (MDROs). These precautions have been associated with adverse effects, such as anxiety and depression. This study aimed to quantify stigma among MDRO carriers and its association with perceived mental health and experienced quality of care.
A quantitative questionnaire study was performed in MDRO carriers exposed to ≥3 days of isolation precautions during hospitalization. Items derived from the Consumer Quality Index questionnaire (CQI) were used to assess perception of care. Stigma scores were calculated using the recently modified Berger Stigma Scale for meticillin-resistant Staphylococcus aureus (MRSA). Mental health was measured with the RAND Mental Health Inventory. The Spearman rank correlation test was used to assess the association between stigma score and RAND mental health score.
Of the 41 included carriers, 31 (75.6%) completed both questionnaires. The experienced quality of care was ‘good’ according to CQI score. Twenty-four percent reported not to have received proper explanation about MDRO carriership from healthcare workers (HCWs). MDRO-associated stigma was reported in 1/31 (3.2%). Poor mental health was self-reported in 3/31 (9.7%). There was no correlation between stigma score and RAND mental health score (Spearman correlation coefficient: 0.347).
In this study, MDRO carriers exposed to ≥3 days of isolation precautions did not report stigma. This contrasts with a recent study that investigated MRSA-associated stigma and may be explained by contact plus airborne isolation protocols in MRSA compared with contact isolation alone in most other MDROs. Also, the psychological impact may be of a different magnitude due to as yet unknown reasons.
Depression and anxiety in hospitalized patients on contact precautions for multidrug-resistant microorganisms
2020, Infection, Disease and Health
Citation Excerpt :
Even when they are examined, the duration is shorter than is the case with patients with less severe conditions [14], and preventable adverse events occur more frequently [15]. The necessity of wearing a gown and gloves may impede the physician's ability to perform an appropriate physical exam or discourage health care professionals from entering patient rooms [6,8]. There are significant regional differences in mood disorders.
Contact precautions for patients with multidrug-resistant organisms (MDROs) have been associated with adverse effects. The aim of this study was, therefore, to evaluate the level of anxiety and depression through different standardized scales in patients isolated by MDROs.
This is a case–control study with hospitalized patients on contact precautions for MDROs. A questionnaire survey was conducted to analyse the presence and level of depression and anxiety. A multivariable analysis was performed to define independent questions for anxiety/depression scores to create a short questionnaire facilitating a practical approach to the care of hospitalized patients with MDROs. A receiver operating characteristic (ROC) curve was plotted to determine the diagnostic ability of the simplified score.
A total of 141 patients were included in the study, among whom 68 were isolated because of MDRO colonization while 73 were not isolated (control-group). Forty-five (31.9%) patients had some degree of anxiety. Patients in MDRO contact isolation had a higher level of anxiety than those who were not isolated (55.9% vs. 9.6%, p < 0.001). The equation obtained by multivariated analysis allowed for the construction of a score with ROC area of 0.949 and a sensitivity of 91.1%.
Contact isolation for MDROs is associated with increased depression and anxiety. A simple anxiety score was developed and should be validated for screening.

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Research LettersAdverse effects of contact isolation

Summary

Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals

Infect Control Hosp Epidemiol

Recommendations for preventing the spread of vancomycin resistance

Infect Control Hosp Epidemiol

Research Letters
Adverse effects of contact isolation