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Contact isolation in surgical patients: a barrier to care?
Heather L Evans1, Mary M Shaffer, Michael G Hughes
1Department of Surgery, UVA Health System, Charlottesville, VA 22908, USA.
Background:
Contact isolation is commonly used to prevent transmission of resistant organisms. We hypothesized that contact isolation negatively impacts the amount of direct patient care.
Methods:
For 2 hours per day over a 5-week period, a single observer recorded provider/patient contact in adjacent isolated and nonisolated patient rooms on both the surgical intensive care unit (ICU) and surgical wards of a university hospital. Number of visits, contact time, and compliance with isolation were recorded, as was illness severity as assessed by APACHE II score.
Results:
Isolated patients were visited fewer times than nonisolated patients (5.3 vs 10.9 visits/h, P <.0001) and had less contact time overall (29 +/- 5 vs 37 +/- 3 min/h, P =.008), in the ICU (41 +/- 10 vs 47 +/- 5 min/h, P =.03), and on the floor (17 +/- 3 vs 28 +/- 4 min/h, P =.039), in spite of higher mean APACHE II scores in the isolated (10.1 +/- 1.0 vs 7.6 +/- 0.8, P =.05). Among floor patients with APACHE II scores greater than 10, patients in the isolated group had nearly 40% less contact time per hour than patients in the nonisolated group (19 +/- 4 vs 34 +/- 7 min/h, P =.05).
Conclusions:
Because of the significantly lower contact time observed, particularly among the most severely ill of floor patients, we propose a reexamination of the risk-benefit ratio of this infection control method.
Insights
Contact isolation for resistant organisms reduces patient care time. Severely ill patients in isolation received significantly less direct care, questioning the method's benefit.
Area of Science:
- Infection Control
- Patient Care Quality
- Healthcare Management
Background:
- Contact isolation is a standard practice to prevent the spread of resistant organisms.
- The impact of contact isolation on the quantity of direct patient care is not well understood.
Purpose of the Study:
- To investigate the effect of contact isolation on provider/patient contact time.
- To compare patient care time in isolated versus non-isolated rooms.
Main Methods:
- A 5-week observational study in a university hospital's surgical intensive care unit and wards.
- Recorded provider/patient visits and contact duration for isolated and non-isolated patients.
- Assessed illness severity using APACHE II scores.
Main Results:
- Isolated patients received fewer visits and less contact time compared to non-isolated patients.
- This difference was significant in the ICU and on the wards.
- Severely ill isolated patients (APACHE II > 10) experienced nearly 40% less contact time.
Conclusions:
- Contact isolation significantly reduces direct patient care time.
- The reduction in care is particularly pronounced in critically ill patients.
- A reevaluation of the risk-benefit ratio of contact isolation is recommended.