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Published on: October 3, 2016
An Australian interpretive description of Contact Precautions through a bioethical lens; recommendations for
Joanna Harris1, Hazel Maxwell2, Susan Dodds3
1Infection Management and Control Service (IMACS), Illawarra Shoalhaven Local Health District (ISLHD), Level 1 Lawson House, Wollongong Hospital, Loftus St NSW, Australia.
Background:
Contact Precautions (CP) were developed to control multi-resistant organisms (MROs) in hospitals. However, MROs persist and harms are associated with CP. Research objectives were to understand the bioethical impact of CP on patients and health-professionals, and make recommendations for ethically-improved management of MRO-colonized patients.
Methods:
Interpretive description methodology scaffolded upon bioethical principles framed this qualitative study. Findings were explored alongside contemporary published reports to make recommendations for practice and research.
Results:
Nine patients and 24 health professionals participated. Four themes were found: Powerlessness moving to acceptance; You feel a bit of a pariah; Others need protection, but I need looking after too; Doing Contact Precautions is not easy.
Discussion:
CP conflict with the principle of respect for autonomy due to non-adherence to informed consent, and sub-optimal communication. Patients experience health care inequality, and discriminatory practices breaching the principle of justice. CP elicit stigma for patients, and moral distress and inter-personal conflict for staff, breaching the principle of non-maleficence. Under the principle of beneficence, pluralistic cost-benefit assessment situates CP as low-value practice.
Conclusions:
CP challenge organizational culture, professional well-being, and person-centered ethical care. Ethical costs of CP outweigh benefits, obliging policy-makers to reconsider CP in managing MRO-colonized patients.
Insights
Contact Precautions (CP) for multi-resistant organisms (MROs) cause ethical harms to patients and healthcare professionals, outweighing their benefits. Policy-makers should reconsider their use in managing MRO-colonized patients.
Area of Science:
- Bioethics
- Infectious Disease Control
- Healthcare Management
Background:
- Contact Precautions (CP) were implemented to control multi-resistant organisms (MROs) in hospitals.
- Despite their use, MROs persist, and CP are associated with significant harms.
- This study investigates the bioethical impact of CP on patients and healthcare professionals.
Purpose of the Study:
- To understand the bioethical impact of CP on patients and healthcare professionals.
- To develop recommendations for ethically improved management of MRO-colonized patients.
- To evaluate the ethical costs versus benefits of CP.
Main Methods:
- Qualitative study using interpretive description methodology.
- Scaffolded upon bioethical principles.
- Findings were explored alongside contemporary published reports.
Main Results:
- Nine patients and 24 health professionals participated.
- Four themes emerged: Powerlessness to acceptance, social isolation, conflicting needs (protection vs. care), and difficulty in implementation.
- CP conflict with autonomy, justice, non-maleficence, and beneficence principles.
Conclusions:
- CP negatively impact patient autonomy and justice, leading to inequality and discrimination.
- CP cause stigma for patients and moral distress for staff.
- The ethical costs of CP outweigh their benefits, necessitating a policy reconsideration for MRO management.
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