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Published on: June 24, 2019
[Critically ill patient isolation: risk or protection?]
I Gutiérrez-Cía1, C Aibar-Remón2, B Obón-Azuara3
1Hospital Clínico Universitario, Zaragoza, España; Instituto de Investigación Sanitaria Aragón, Zaragoza, España.
Introduction:
Isolation precautions are an effective measure to prevent the spread of multi-resistant microorganisms (MMR). However, its implementation is complex and can increase some risks to the patient. The aim of this study is to determine whether the implementation of isolation precautions increase the risk of patient safety incidents (PSI) in critically ill patients.
Material And Methods:
A retrospective observational study was conducted involving patients admitted to the ICU of a University Hospital, and that required isolation for more than 48h. Period of study: two years (from 2013/03/01 to 2015/03/31). Data source was the electronic medical record. The tools for evaluation were the Modular Review Form questionnaires (MRF1 and MRF2). An analysis was made of PSI and adverse events (AEs) during periods with and without isolation precautions, including the PSI type, severity, and preventability.
Results:
The study included a total of 76 patients, 74 of whom had at least one PSI. A total of 798 PSI were detected (511 during isolation period), 599 were a No harm incident (NHI) and 199 were adverse AEs. The most frequent PSIs were associated with medication (316) and patient health care (279). Most of them were moderately or highly preventable. The incidence of PSI during periods with and without isolation was 27.3 (SD 33.8) and 29 (39.6) per 100 patient-days, respectively.
Conclusions:
PSIs in ICU are frequent, and the most of them are preventable. The adoption of isolation precautions does not constitute a risk factor for PSI. Improving patient safety culture is essential for an adequate prevention strategy.
Insights
Implementing isolation precautions in intensive care units (ICUs) does not increase patient safety incidents (PSIs). This study found that PSIs are frequent but preventable, emphasizing the need for a strong patient safety culture.
Area of Science:
- Critical Care Medicine
- Infectious Disease Control
- Patient Safety
Background:
- Isolation precautions are crucial for preventing the spread of multi-resistant microorganisms (MMR).
- However, their complex implementation may pose risks to patient safety.
- This study investigates the relationship between isolation precautions and patient safety incidents (PSIs) in critically ill patients.
Purpose of the Study:
- To determine if isolation precautions increase the risk of PSIs in critically ill patients.
- To analyze the types, severity, and preventability of PSIs during isolation periods.
Main Methods:
- Retrospective observational study of ICU patients requiring isolation for over 48 hours.
- Data collected from electronic medical records over a two-year period.
- Utilized Modular Review Form questionnaires to assess PSIs and adverse events (AEs).
Main Results:
- 76 patients included; 74 experienced at least one PSI.
- 798 PSIs detected, with 511 during isolation; 199 were adverse events.
- Most frequent PSIs involved medication and healthcare, with high preventability.
Conclusions:
- Patient safety incidents are common in ICUs and largely preventable.
- Isolation precautions were not found to be a risk factor for PSIs.
- Enhancing patient safety culture is vital for effective prevention strategies.
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