Major Article
Adverse outcomes associated with contact precautions: A review of the literature

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Background

Contact Precautions (CP) are a standard method for preventing patient-to-patient transmission of multiple drug-resistant organisms (MDROs) in hospital settings. With the ongoing worldwide concern for MDROs including methicillin-resistant Staphylococcus aureus (MRSA) and broadened use of active surveillance programs, an increasing number of patients are being placed on CP. Whereas few would argue that CP are an important tool in infection control, many reports and small studies have observed worse noninfectious outcomes in patients on CP. However, no review of this literature exists.

Methods

We systematically reviewed the literature describing adverse outcomes associated with CP. We identified 15 studies published between 1989 and 2008 relating to adverse outcomes from CP. Nine were higher quality based on standardized collection of data and/or inclusion of control groups.

Results

Four main adverse outcomes related to CP were identified in this review. These included less patient-health care worker contact, changes in systems of care that produce delays and more noninfectious adverse events, increased symptoms of depression and anxiety, and decreased patient satisfaction with care.

Conclusion

Although CP are recommended by the Centers for Disease Control and Prevention as an intervention to control spread of MDROs, our review of the literature demonstrates that this approach has unintended consequences that are potentially deleterious to the patient. Measures to ameliorate these deleterious consequences of CP are urgently needed.

Section snippets

Methods

We required studies to use the CDC definition of CP: the use of gowns and gloves for all staff who have contact with the patient or patient's environment, as well as housing patients in a single room or a room shared with other patients on CP.12 The terms barrier restriction, source isolation, CP, and contact isolation were used synonymously. For all studies discussed in this review, patients were on CP because of MDROs.

In our literature review, a systematic search for studies or commentaries

Results

We found 15 articles evaluating adverse outcomes related to CP. One was rejected because of unclear indications for CP. Nine articles are described in greater detail because of standardized collection of data and inclusion of a control group.

Four main adverse outcomes related to CP were identified in this review. (1) CP are associated with less patient-health care worker (HCW) contact. (2) CP are associated with delays and more noninfectious adverse events. (3) CP are associated with increased

Conclusion

CP are typically employed to isolate a patient who is colonized or infected with any of a number of MDROs. This intervention has been a mainstay of infection control programs for many decades. However, being placed on CP during an acute care hospitalization has been associated with less HCW contact, more service care errors, decreased satisfaction with care, and higher rate of depression and anxiety. There is no definitive study of adverse outcomes associated with CP, and no studies have

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  • Cited by (0)

    Supported by National Institutes of Health T32 AI07613 (to D.J.M.) and US Department of Veterans Affairs, Health Services Research, and Development Service grants RCD-02-026-2 and IIR-05-123-1 (to E.N.P.).

    Conflicts of interest: No conflicts of interest to report.

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