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Bühler AH, Willmund GD. Deployment-related quarantining-a risk or resilience factor for German military service members? A prospective analysis during the third-fifth waves of COVID-19. Front Public Health 2023; 11:1267581. [PMID: 38152661 PMCID: PMC10751356 DOI: 10.3389/fpubh.2023.1267581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/26/2023] [Indexed: 12/29/2023] Open
Abstract
Background Mandatory deployment-related quarantining added further constraints on soldiers during the pandemic. Contrary to overwhelming research documenting an adverse impact of quarantining on mental health, no adverse short-term mental health effects of pre-deployment quarantining for German soldiers were identified. Therefore, we are interested in a potentially delayed onset, the impact of an additional post-deployment quarantine, and quarantine-associated risk and resilience factors predicting mental health post-deployment. Methods In a prospective research design, 928 German soldiers enrolled in the study at the in-processing of pre-deployment quarantine between February 2021 and March 2022. Every German military service member undergoing pre-deployment quarantine could participate. The soldiers were between 18 and 64 years old; 87.5% identified as male and 12.5% as female. Self-reported mental health (Mini-SCL), perceived social support (FSozU-K22), and perceived unit cohesion were assessed three to five times: at the beginning and the end of pre-deployment quarantine (Nt1 = 928, Nt2 = 907), if still mandatory-at the beginning and the end of post-deployment quarantine (Nt3 = 143 and Nt4 = 132), and 3 months post-deployment, on average 7 to 8 months later than pre-deployment quarantine (Nt5 = 308). The analyzed quarantine-associated risk and resilience factors were informedness about COVID-19, infection risk, quarantine benefit, clarity of quarantine protocol, need for intimacy/bonding, norms, stigma, practicality, financial disadvantages, boredom, and health-promoting leadership. Results Despite four different mental health trajectories identified, repeated measures ANOVAs revealed a significant improvement in mental health post-deployment (F[2,265] = 21.54, p < 0.001), a small decrease in social support (F[2,266] = 16.85, p < 0.001), and no significant changes in unit cohesion (F[2,264] = 0.482, p = 0.618) 3 months post-deployment. Using stepwise regression, 24% of variance in mental health symptomatology post-deployment is predicted pre-deployment by a clear quarantine protocol, unit cohesion, intimacy/bonding, and social support (F[4,263] = 22.23, p < 0.001). In total, 30% of mental health at the end of post-deployment quarantine is predicted by stigma and a clear quarantine protocol (F[2,99] = 22.22, p < 0.001). Conclusion Although no overall adverse impact of quarantining on mental health was found, it is recommended to address perceived stigma and clearly communicate the quarantine protocol, and to further follow up on the perceived decrease in social support.
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Affiliation(s)
- Antje H. Bühler
- Bundeswehr Center for Military Mental Health, Military Hospital Berlin, Berlin, Germany
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2
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Fregonese L, Currie K, Elliott L. Hospital patient experiences of contact isolation for antimicrobial resistant organisms in relation to health care-associated infections: A systematic review and narrative synthesis of the evidence. Am J Infect Control 2023; 51:1263-1271. [PMID: 37061166 DOI: 10.1016/j.ajic.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND The alarming growth of antimicrobial resistance organisms (AMRs) and the threat caused by health care-associated infections require hospitalized individuals who are infected or colonized with AMRs to be cared for in isolation, predominantly in single rooms. None of the existing reviews focus on or specifically address the patient's experience of being cared for in contact isolation when affected by AMRs exploring this specific context. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance for the conduct of systematic reviews was applied. Five databases were searched from inception to April 2019, with keywords related to adult patient experiences, AMR, and contact isolation. The evidence was certified by 2 reviewers. Principles of thematic analysis were used to produce a narrative synthesis of the findings. RESULTS Eighteen eligible studies were identified. Narrative synthesis resulted in 3 overarching categories reflecting the patient experience: privacy versus loneliness; emotional responses to isolation; quality of care, recovery, and safety in isolation. CONCLUSIONS This review synthesizes existing evidence reflecting the patient experience of contact isolation. Study findings were often contradictory and may not reflect contemporary health care, such as shorter hospital stays, or societal preferences for greater privacy. Further research focusing on contemporary health care contexts is recommended.
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Affiliation(s)
- Laura Fregonese
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK.
| | - Kay Currie
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK.
| | - Lawrie Elliott
- Department of Nursing and Community Health, School of Health and Life Sciences, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK.
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3
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Lee EH, Lee HS, Lee KH, Song YG, Han SH. Potential causal effect of contact precautions and isolation on Clostridioides difficile infection in the hyperendemic setting: Interrupted time-series analyses before and after implementation. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:1054-1063. [PMID: 37380552 DOI: 10.1016/j.jmii.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/19/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Recent studies disputed the effectiveness of efforts to comply with contact precautions and isolation (CPI) considering relatively low intra-hospital transmission rate of healthcare facility-associated Clostridioides difficile infection (HCFA-CDI). We evaluated the potential causal effect of CPI on HCFA-CDI occurrence by comparing the incidence rate (IR) for different time periods with and without CPI implementation. METHODS Long-term observational time-series data were separated into three periods (pre-CPI: January 2012-March 2016, CPI: April 2016-April 2021, post-CPI: May 2021-December 2022). CPI was suspended owing to the restriction of isolation rooms during the COVID-19 pandemic. We inferred potential causal outcomes by comparing predicted and observed IRs of HCFA-CDI using interrupted time-series analyses, including the Bayesian structural time-series or autoregressive integrated moving average (ARIMA) model in the R-language or SAS software. RESULTS The monthly observed IR (44.9/100,000 inpatient-days) during the CPI period was significantly lower than the predicted IR (90.8) (-50.6% relative effect, P = 0.001). However, the observed IR (52.3) during the post-CPI period was significantly higher than the predicted IR (39.1) (33.6%, P = 0.001). The HCFA-CDI IR decreased during CPI (-14.3, P < 0.001) and increased post-CPI (5.4, P < 0.001) in the multivariable ARIMA model, which controlled for antibiotic usage, handwashing with soap and water, and number of toxin tests. CONCLUSIONS Various time-series models revealed that CPI implementation had a potential causal effect on the reduction of HCFA-CDI incidence.
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Affiliation(s)
- Eun Hwa Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwa Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Goo Song
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Han
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Republic of Korea.
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4
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Gaube S, Däumling S, Biebl I, Rath A, Caplunik-Pratsch A, Schneider-Brachert W. Patients with multi-drug-resistant organisms feel inadequately informed about their status: adverse effects of contact isolation. J Hosp Infect 2023; 133:89-94. [PMID: 36481686 DOI: 10.1016/j.jhin.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Contact isolation of patients with multi-drug-resistant organisms (MDROs) is an essential element of infection prevention strategies in hospitals worldwide. However, this practice may be associated with adverse side effects on patients' health and well-being. AIM This study was the first to assess mental health and well-being variables among isolated patients compared with non-isolated control patients in a German cohort. METHODS We conducted a matched case-control study among N = 267 patients admitted to a tertiary care teaching hospital in Germany. Their levels of anxiety, depression, loneliness, and dissatisfaction with their hospital experience were assessed using a questionnaire. Additionally, among isolated patients, it was evaluated how well they felt informed about their MDRO status. FINDINGS In our cohort, patients under contact isolation were significantly more dissatisfied than non-isolated control patients but did not show higher levels of anxiety, depression, and loneliness. A large proportion of patients felt insufficiently informed about their MDRO status. This lack of information was the strongest predictor of dissatisfaction among isolated patients. CONCLUSION These findings underline the importance of adequate patient communication. It is essential for patients' well-being to receive timely, relevant, and understandable information about the background and consequences of their infection or colonisation with MDROs.
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Affiliation(s)
- S Gaube
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; LMU Center for Leadership and People Management, LMU Munich, Munich, Germany.
| | - S Däumling
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - I Biebl
- LMU Center for Leadership and People Management, LMU Munich, Munich, Germany; Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - A Rath
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - A Caplunik-Pratsch
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - W Schneider-Brachert
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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The effects of social isolation stress and discrimination on mental health. Transl Psychiatry 2022; 12:398. [PMID: 36130935 PMCID: PMC9490697 DOI: 10.1038/s41398-022-02178-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Social isolation and discrimination are growing public health concerns associated with poor physical and mental health. They are risk factors for increased morbidity and mortality and reduced quality of life. Despite their detrimental effects on health, there is a lack of knowledge regarding translation across the domains of experimental research, clinical studies, and real-life applications. Here, we review and synthesize evidence from basic research in animals and humans to clinical translation and interventions. Animal models indicate that social separation stress, particularly in early life, activates the hypothalamic-pituitary-adrenal axis and interacts with monoaminergic, glutamatergic, and GABAergic neurotransmitter systems, inducing long-lasting reductions in serotonin turnover and alterations in dopamine receptor sensitivity. These findings are of particular importance for human social isolation stress, as effects of social isolation stress on the same neurotransmitter systems have been implicated in addictive, psychotic, and affective disorders. Children may be particularly vulnerable due to lasting effects of social isolation and discrimination stress on the developing brain. The effects of social isolation and loneliness are pronounced in the context of social exclusion due to discrimination and racism, during widespread infectious disease related containment strategies such as quarantine, and in older persons due to sociodemographic changes. This highlights the importance of new strategies for social inclusion and outreach, including gender, culture, and socially sensitive telemedicine and digital interventions for mental health care.
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Muharam R, Agiananda F, Budiman YF, Harahap JS, Prabowo KA, Azyati M, Putri YI, Pratama G, Sumapraja K. Menstrual cycle changes and mental health states of women hospitalized due to COVID-19. PLoS One 2022; 17:e0270658. [PMID: 35749547 PMCID: PMC9231764 DOI: 10.1371/journal.pone.0270658] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose
Many studies have evaluated the impact of the COVID-19 pandemic on women’s mental health and menstrual changes. However, most of these studies only included nonhospitalized COVID-19 patients, while information on hospitalized women is very limited. Thus, this study aimed to examine the mental health status and menstrual changes in hospitalized female COVID-19 patients.
Methods
A survey was administered to female COVID-19 patients in the isolation ward of a national referral hospital in Indonesia between January and August 2021, and the women were followed up 3 months after discharge. The survey evaluated menstrual patterns and mental health using the Self Reporting Questionnaire-29 (SRQ-29).
Results
The study enrolled 158 female patients. There was an increase in patients who had a cycle length of > 32 or < 24 days, and significant increases in menstrual irregularity and heavy menstrual bleeding were noted. Overall, 37.3% of the patients reported a change in menstrual pattern after infection with COVID-19. Based on SRQ-29 scores, 32.3% of the women had neurotic symptoms, 12.7% had psychotic symptoms, and 38.0% had symptoms of posttraumatic stress disorder. Patients with symptoms of mental health disorders were twice as likely to report a menstrual change (OR 2.17, 95% CI 1.12–4.22; p = 0.021).
Conclusion
Menstrual changes and increased symptoms of mental health disorders occur in hospitalized female COVID-19 patients. The length of isolation was the key factor affecting overall menstrual changes and mental health in hospitalized female COVID-19 patients.
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Affiliation(s)
- R. Muharam
- Faculty of Medicine University of Indonesia–Cipto Mangunkusumo National Hospital, Division of Reproductive Immunoendocrinology, Department of Obstetrics & Gynecology, Jakarta, Indonesia
- * E-mail:
| | - Feranindhya Agiananda
- Faculty of Medicine University of Indonesia–Cipto Mangunkusumo National Hospital, Division of Consultant Liaison Psychiatry, Department of Psychiatry, Jakarta, Indonesia
| | - Yuri Fitri Budiman
- Faculty of Medicine University of Indonesia–Cipto Mangunkusumo National Hospital, Department of Psychiatry, Jakarta, Indonesia
| | - Juliana Sari Harahap
- Faculty of Medicine University of Indonesia–Cipto Mangunkusumo National Hospital, Department of Obstetrics & Gynecology, Jakarta, Indonesia
| | - Kevin Ardito Prabowo
- Faculty of Medicine University of Indonesia–Cipto Mangunkusumo National Hospital, Department of Obstetrics & Gynecology, Jakarta, Indonesia
| | - Mazaya Azyati
- Faculty of Medicine University of Indonesia–Cipto Mangunkusumo National Hospital, Department of Obstetrics & Gynecology, Jakarta, Indonesia
| | - Yuannita Ika Putri
- Faculty of Medicine University of Indonesia–Cipto Mangunkusumo National Hospital, Department of Obstetrics & Gynecology, Jakarta, Indonesia
| | - Gita Pratama
- Faculty of Medicine University of Indonesia–Cipto Mangunkusumo National Hospital, Division of Reproductive Immunoendocrinology, Department of Obstetrics & Gynecology, Jakarta, Indonesia
| | - Kanadi Sumapraja
- Faculty of Medicine University of Indonesia–Cipto Mangunkusumo National Hospital, Division of Reproductive Immunoendocrinology, Department of Obstetrics & Gynecology, Jakarta, Indonesia
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Bühler A, Willmund GD. Adherence and Psychosocial Well-Being During Pandemic-Associated Pre-deployment Quarantine. Front Public Health 2022; 9:802180. [PMID: 35004600 PMCID: PMC8727777 DOI: 10.3389/fpubh.2021.802180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: With the purpose of preventing SARS-Cov-2 traveling with the troops, pre-deployment and post-deployment quarantine are mandatory for the German military. This study investigates which factors could be addressed in order to facilitate adherence and mental health during isolation. Method: Six hundred three soldiers completed questionnaires at the beginning and at the end of pre-deployment quarantine: Mini-SCL (BSI), Perceived Social Support (FSozU-K22), Unit Cohesion, Military Quarantine Adherence Questionnaire (MQAQ), and quarantine-associated factors including informedness about Covid-19, perceived individual risk, benefit of quarantine, clarity of quarantine protocol, need of intimacy, social norms, stigma, practicality of the quarantine, financial disadvantages, boredom, and health promoting leadership. Results: Using stepwise regression analyses, up to 57% of the quarantine adherence was explained by social norms, boredom, perceived benefit/effectiveness of the quarantine, clear communication of the quarantine protocol and perceived risk of an infection, with social norms explaining 43%. In respect to mental health (Mini-SCL) at the beginning of quarantine, only 15% is explained by being in a partnership, (un)fulfilled need for bonding/intimacy, perceived unit cohesion, and perceived social support. Up to 20 % of the variance in mental health at the end of quarantine is explained by accumulated days of isolation before pre-deployment quarantine, age, clear communication of the quarantine protocol, perceived social support, fulfilled need for bonding/intimacy and perceived stigma. Mental health and quarantine adherence did correlate significantly, but to a slight extent. No differences between the beginning and the end of pre-deployment quarantine were found for the overall group in respect to mental health, quarantine adherence, perceived social support and perceived unit cohesion, while their trajectories differed for different subgroups including age, gender, rank, and accumulated days of quarantine: With increasing accumulated days of isolation prior to pre-deployment quarantine, mental health declined over the course of quarantine, though to a small degree. Conclusion: Findings suggest that addressing the norms of fellow soldiers and dependents alike could contribute to quarantine adherence in pre-deployment quarantine. Ongoing research should examine long-term effects on mental health, including these of accumulated days of quarantine, also taking into account post-deployment quarantine.
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Affiliation(s)
- Antje Bühler
- German Center for Military Mental Health, Military Hospital Berlin, Berlin, Germany
| | - Gerd-Dieter Willmund
- German Center for Military Mental Health, Military Hospital Berlin, Berlin, Germany
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Boumans J, Scheffelaar A, van Druten VP, Hendriksen THG, Nahar-van Venrooij LMW, Rozema AD. Coping Strategies Used by Older Adults to Deal with Contact Isolation in the Hospital during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147317. [PMID: 34299774 PMCID: PMC8304333 DOI: 10.3390/ijerph18147317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022]
Abstract
Due to the COVID-19 pandemic, many older adults have experienced contact isolation in a hospital setting which leads to separation from relatives, loss of freedom, and uncertainty regarding disease status. The objective of this study was to explore how older adults (55+) cope with contact isolation in a hospital setting during the COVID-19 pandemic in order to improve their physical and psychological wellbeing. The realist evaluation approach was used to formulate initial program theories on coping strategies used by (older) adults in an isolation setting. Twenty-one semi-structured interviews with older patients (n = 21) were analysed. This study revealed that both emotion-focused coping strategies as well as problem-focused coping strategies were used by older adults during contact isolation. The study also uncovered some new specific coping strategies. The results have useful implications for hospital staff seeking to improve the wellbeing of older adults in contact isolation in hospitals. Problem-focused coping strategies could be stimulated through staff performing care in a person-centred way. Trust in staff, as part of emotion-focused coping strategies, could be stimulated by improving the relationship between patients and staff.
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Affiliation(s)
- Jogé Boumans
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.S.); (V.P.v.D.); (A.D.R.)
- Correspondence:
| | - Aukelien Scheffelaar
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.S.); (V.P.v.D.); (A.D.R.)
| | - Vera P. van Druten
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.S.); (V.P.v.D.); (A.D.R.)
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands; (T.H.G.H.); (L.M.W.N.-v.V.)
| | - Tessel H. G. Hendriksen
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands; (T.H.G.H.); (L.M.W.N.-v.V.)
| | - Lenny M. W. Nahar-van Venrooij
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands; (T.H.G.H.); (L.M.W.N.-v.V.)
| | - Andrea D. Rozema
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.S.); (V.P.v.D.); (A.D.R.)
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Woong NL, Ekstrom VSM, Xin X, Lim C, Boon ESK, Teo SWJ, Ng PCS, Ang TPS, Lim SH, Lam AYR, Fan EMP, Ang SY, Chow WC. Empower to connect and connect to empower: experience in using a humanistic approach to improve patients' access to, and experience of, care in isolation wards during the COVID-19 outbreak in Singapore. BMJ Open Qual 2021; 10:bmjoq-2020-000996. [PMID: 33408099 PMCID: PMC7789203 DOI: 10.1136/bmjoq-2020-000996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 12/25/2022] Open
Abstract
Patients admitted to the isolation ward during the COVID-19 outbreak face multiple psychosocial stressors including the disruptive experience of being in quarantine, anxiety over contracting a newly emerging infectious disease and limited access to their healthcare team. This quality improvement project aims to leverage on technology to improve patients’ access to, and experience of, care while in isolation. Patients admitted to two isolation wards in Singapore General Hospital (SGH) between 28 February and 19 March 2020 were each provided an iPad loaded with the MyCare application (app), curated materials and mobile games. During this period, 83 of them accessed the device and the app. MyCare app is an app developed by the nursing team in SGH as part of an existing interprofessional collaboration to help patients navigate their care during their inpatient stay. In response to COVID-19, MyCare app was supplemented with materials to address affected patients’ informational and psychosocial needs. These materials included an information sheet on COVID-19, interviews with previous severe acute respiratory syndrome survivors, psychosocial support materials, and uplifting literature, illustrated storybooks and artwork. This paper describes the process of planning for, and executing, the intervention and reports the initial results of its effect. Initial feedback indicated a positive response to the intervention. 9 out of 10 respondents (90%) rated their hospital experience with a maximum of five stars and all 10 respondents (100%) rated the psychosocial support materials with five stars. Doctors managing the patients also observed a reduction in the number of commonly asked questions following the deployment of the iPad. This quality improvement project is ongoing with plans for further research to determine how to better support the psychosocial needs of patients in isolation during a novel disease outbreak. This report is written based on the Standards for Quality Improvement Reporting Excellence guidelines.
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Affiliation(s)
- Natalie Liling Woong
- Internal Medicine, Singapore General Hospital, Singapore .,Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Victoria Sze Min Ekstrom
- Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Xiaohui Xin
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - Crystal Lim
- Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Medical Social Services, Singapore General Hospital, Singapore
| | | | - Shaun Wei Jie Teo
- Integrated Health Information Systems, SingHealth Chief Informatics Officer Office, SingHealth, Singapore
| | - Patrick Chee Sang Ng
- Integrated Health Information Systems, SingHealth Chief Informatics Officer Office, SingHealth, Singapore
| | | | - Shu Hui Lim
- Nursing, Singapore General Hospital, Singapore
| | - Amanda Yun Rui Lam
- Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Endocrinology, Singapore General Hospital, Singapore
| | | | | | - Wan Cheng Chow
- Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
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Seong SJ, Kim HJ, Yim KM, Park JW, Son KH, Jeon YJ, Hwang JY. Differences Between the Psychiatric Symptoms of Healthcare Workers Quarantined at Home and in the Hospital After Contact With a Patient With Middle East Respiratory Syndrome. Front Psychiatry 2021; 12:659202. [PMID: 34335322 PMCID: PMC8322759 DOI: 10.3389/fpsyt.2021.659202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Although quarantine is an effective measure for the prevention of the spread of infectious diseases, it may have negative effects on the mental health of the isolated individual. During the 2015 outbreak of the Middle East Respiratory Syndrome (MERS) in Korea, healthcare workers came in contact with patients with MERS were quarantined either at home or in a hospital ward. In this study, we aimed to compare the psychiatric symptoms of these employees according to the method of quarantine. Methods: All 146 quarantined staff completed self-report questionnaires. Depressive symptoms were measured using the Patient Health Questionnaire-9, anxiety symptoms were assessed using Spielberger's State-Trait Anxiety Inventory, and acute stress disorder (ASD) symptoms were evaluated using the Stanford Acute Stress Reaction Questionnaire. Results: The in-hospital quarantine group had a higher rate of symptoms of depression (p < 0.001) and ASD (p = 0.014) than the group quarantined at home. Logistic regression analysis showed that respondents quarantined in the hospital (OR = 6.342; 95% CI 1.853-21.708) and those quarantined for longer periods (OR = 1.153, 95% CI = 1.036-1.285) had a higher risk of depressive symptoms. Conclusions: In-hospital quarantine and quarantine for longer periods increase the risk of depressive symptoms. When quarantine measures are taken, certain measures are needed to minimize the risk of psychiatric problems. Appropriate interventions should be implemented if psychiatric problems occur.
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Affiliation(s)
- Su Jeong Seong
- Department of Psychiatry, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Hyung Joon Kim
- Department of Psychiatry, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Kyung Mi Yim
- Department of Psychiatry, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Ji Won Park
- Department of Psychiatry, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Kyung Hoon Son
- Department of Psychiatry, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Yeong Ju Jeon
- Department of Psychiatry, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Jae Yeon Hwang
- Department of Psychiatry, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
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11
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Henssler J, Stock F, van Bohemen J, Walter H, Heinz A, Brandt L. Mental health effects of infection containment strategies: quarantine and isolation-a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2021; 271:223-234. [PMID: 33025099 PMCID: PMC7538183 DOI: 10.1007/s00406-020-01196-x] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/17/2020] [Indexed: 01/23/2023]
Abstract
Due to the ongoing COVID-19 pandemic, an unprecedented number of people worldwide is currently affected by quarantine or isolation. These measures have been suggested to negatively impact on mental health. We conducted the first systematic literature review and meta-analysis assessing the psychological effects in both quarantined and isolated persons compared to non-quarantined and non-isolated persons. PubMed, PsycINFO, and Embase databases were searched for studies until April 22, 2020 (Prospero Registration-No.: CRD42020180043). We followed PRISMA and MOOSE guidelines for data extraction and synthesis and the Newcastle-Ottawa Scale for assessing risk of bias of included studies. A random-effects model was implemented to pool effect sizes of included studies. The primary outcomes were depression, anxiety, and stress-related disorders. All other psychological parameters, such as anger, were reported as secondary outcomes. Out of 6807 screened articles, 25 studies were included in our analyses. Compared to controls, individuals experiencing isolation or quarantine were at increased risk for adverse mental health outcomes, particularly after containment duration of 1 week or longer. Effect sizes were summarized for depressive disorders (odds ratio 2.795; 95% CI 1.467-5.324), anxiety disorders (odds ratio 2.0; 95% CI 0.883-4.527), and stress-related disorders (odds ratio 2.742; 95% CI 1.496-5.027). Among secondary outcomes, elevated levels of anger were reported most consistently. There is compelling evidence for adverse mental health effects of isolation and quarantine, in particular depression, anxiety, stress-related disorders, and anger. Reported determinants can help identify populations at risk and our findings may serve as an evidence-base for prevention and management strategies.
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Affiliation(s)
- Jonathan Henssler
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany
| | - Friederike Stock
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Joris van Bohemen
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Berlin School of Mind and Brain, Berlin, Germany
- Bernstein Center of Computational Neuroscience Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin School of Mind and Brain, Berlin, Germany.
- Bernstein Center of Computational Neuroscience Berlin, Berlin, Germany.
| | - Lasse Brandt
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
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Kim H, Park KJ, Shin YW, Lee JS, Chung S, Lee T, Kim MJ, Jung J, Lee J, Yum MS, Lee BH, Koh KN, Ko TS, Lim E, Lee JS, Lee JY, Choi JY, Han HM, Shin WA, Lee NJ, Kim SH, Kim HW. Psychological Impact of Quarantine on Caregivers at a Children's Hospital for Contact with Case of COVID-19. J Korean Med Sci 2020; 35:e255. [PMID: 32686372 PMCID: PMC7371455 DOI: 10.3346/jkms.2020.35.e255] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/01/2020] [Indexed: 12/31/2022] Open
Abstract
Quarantine often provokes negative psychological consequences. Thus, we aimed to identify the psychological and behavioral responses and stressors of caregivers quarantined with young patients after a close contact to a coronavirus disease 2019 case at a children's hospital. More than 90% of the caregivers reported feelings of worry and nervousness, while some of them reported suicidal ideations (4.2%), and/or homicidal ideations (1.4%). Fear of infection of the patient (91.7%) and/or oneself (86.1%) were most frequently reported stressors. A multidisciplinary team including infection control team, pediatrician, psychiatrist, nursing staff and legal department provided supplies and services to reduce caregiver's psychological distress. Psychotropic medication was needed in five (6.9%), one of whom was admitted to the psychiatry department due to suicidality. Quarantine at a children's hospital makes notable psychological impacts on the caregivers and a multidisciplinary approach is required.
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Affiliation(s)
- Harin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Jeong Park
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Wook Shin
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Sun Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Taeyeop Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jina Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Sun Yum
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Hee Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Nam Koh
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Sung Ko
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunyoung Lim
- Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Soo Lee
- Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Yeon Lee
- Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yeon Choi
- Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo Myung Han
- Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Ah Shin
- Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Nam Ju Lee
- Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo Won Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Hossain MM, Sultana A, Purohit N. Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence. Epidemiol Health 2020; 42:e2020038. [PMID: 32512661 PMCID: PMC7644933 DOI: 10.4178/epih.e2020038] [Citation(s) in RCA: 294] [Impact Index Per Article: 73.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/02/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Transmission of infectious diseases is often prevented by quarantine and isolation of the populations at risk. These approaches restrict the mobility, social interactions, and daily activities of the affected individuals. In recent coronavirus disease 2019 (COVID-19) pandemic, quarantine and isolation are being adopted in many contexts, which necessitates an evaluation of global evidence on how such measures impact the mental health outcomes among populations. This umbrella review aimed to synthesize the available evidence on mental health outcomes of quarantine and isolation for preventing infectious diseases. METHODS We searched nine major databases and additional sources and included articles if they were systematically conducted reviews, published as peer-reviewed journal articles, and reported mental health outcomes of quarantine or isolation in any population. RESULTS Among 1,364 citations, only eight reviews met our criteria. Most of the primary studies in those reviews were conducted in high-income nations and in hospital settings. These articles reported a high burden of mental health problems among patients, informal caregivers, and healthcare providers who experienced quarantine or isolation. Prevalent mental health problems among the affected individuals include depression, anxiety, mood disorders, psychological distress, posttraumatic stress disorder, insomnia, fear, stigmatization, low self-esteem, lack of self-control, and other adverse mental health outcomes. CONCLUSIONS This umbrella review found severe mental health problems among individuals and populations who have undergone quarantine and isolation in different contexts. This evidence necessitates multipronged interventions including policy measures for strengthening mental health services globally and promoting psychosocial wellbeing among high-risk populations.
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Affiliation(s)
- Md Mahbub Hossain
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, USA
- Nature Study Society of Bangladesh, Khulna, Bangladesh
| | - Abida Sultana
- Nature Study Society of Bangladesh, Khulna, Bangladesh
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Can we reduce contact precautions days for methicillin-resistant Staphylococcus aureus and vancomycin resistant Enterococcus infected patients? J Infect Public Health 2020; 13:1118-1122. [PMID: 32336607 DOI: 10.1016/j.jiph.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients with MRSA (methicillin-resistant Staphylococcus aureus) and VRE (vancomycin resistant Enterococcus) are placed under contact precautions according to the Center of Disease Control protocol. Contact precautions however increases patient isolation from Health Care Workers, increase overall hospital costs and may increase depression and anxiety. Our aim in this study was to observe the effects of shortening the number of days of contact precautions for patients infected with MRSA and VRE. METHOD We observed patients as two cohorts (Pre-Pilot and Pilot) in one Medical Intensive Care Unit, one Surgical Intensive Care Unit & two medical floors during 2014-2015. In the Pre-pilot period contact precautions were kept throughout admission. In the Pilot period contact precautions were initially placed followed by universal gloving. Comparisons were made for MRSA and VRE infection rates. Total costs were estimated assuming the average cost of 1 gown was $26 per patient per day. RESULTS Mean isolation days were reduced from 11.9 days to 6.8 days for MRSA and 12.8 days to 8.4 days for VRE. There were 86 MRSA infections in the Pre-Pilot period and 73 MRSA infections during the Pilot period (p=0.052). Incidence of hospital acquired MRSA in the wards decreased from 15 to 7 cases and 6 to 2 cases in the Intensive Care Unit in both the Pilot and Pre-Pilot periods respectively. Cost reduced by $2476 and $17,336 per month for VRE and MRSA patients. Number of readmissions also decreased by 39% for MRSA and 50% for VRE. CONCLUSIONS A reduction in contact precautions has reduced patient costs without affecting the rate of MRSA and VRE infection within a one-year period.
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Purssell E, Gould D, Chudleigh J. Impact of isolation on hospitalised patients who are infectious: systematic review with meta-analysis. BMJ Open 2020; 10:e030371. [PMID: 32075820 DOI: 10.1136/bmjopen2019-030371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE To systematically review the literature exploring the impact of isolation on hospitalised patients who are infectious: psychological and non-psychological outcomes. DESIGN Systematic review with meta-analysis. DATA SOURCES Embase, Medline and PsycINFO were searched from inception until December 2018. Reference lists and Google Scholar were also handsearched. RESULTS Twenty-six papers published from database inception to December 2018 were reviewed. A wide range of psychological and non-psychological outcomes were reported. There was a marked trend for isolated patients to exhibit higher levels of depression, the pooled standardised mean difference being 1.28 (95% CI 0.47 to 2.09) and anxiety 1.45 (95% CI 0.56 to 2.34), although both had high levels of heterogeneity, and worse outcomes for a range of care-related factors but with significant variation. CONCLUSION The review indicates that isolation to contain the risk of infection has negative consequences for segregated patients. Although strength of the evidence is weak, comprising primarily single-centre convenience samples, consistency of the effects may strengthen this conclusion. More research needs to be undertaken to examine this relationship and develop and test interventions to reduce the negative effects of isolation.
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Affiliation(s)
- Edward Purssell
- School of Health Sciences, City, University of London, London, UK
| | - Dinah Gould
- School of Health Sciences, City, University of London, London, UK
| | - Jane Chudleigh
- School of Health Sciences, City, University of London, London, UK
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16
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Purssell E, Gould D, Chudleigh J. Impact of isolation on hospitalised patients who are infectious: systematic review with meta-analysis. BMJ Open 2020; 10:e030371. [PMID: 32075820 PMCID: PMC7044903 DOI: 10.1136/bmjopen-2019-030371] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 12/03/2019] [Accepted: 01/30/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To systematically review the literature exploring the impact of isolation on hospitalised patients who are infectious: psychological and non-psychological outcomes. DESIGN Systematic review with meta-analysis. DATA SOURCES Embase, Medline and PsycINFO were searched from inception until December 2018. Reference lists and Google Scholar were also handsearched. RESULTS Twenty-six papers published from database inception to December 2018 were reviewed. A wide range of psychological and non-psychological outcomes were reported. There was a marked trend for isolated patients to exhibit higher levels of depression, the pooled standardised mean difference being 1.28 (95% CI 0.47 to 2.09) and anxiety 1.45 (95% CI 0.56 to 2.34), although both had high levels of heterogeneity, and worse outcomes for a range of care-related factors but with significant variation. CONCLUSION The review indicates that isolation to contain the risk of infection has negative consequences for segregated patients. Although strength of the evidence is weak, comprising primarily single-centre convenience samples, consistency of the effects may strengthen this conclusion. More research needs to be undertaken to examine this relationship and develop and test interventions to reduce the negative effects of isolation.
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Affiliation(s)
- Edward Purssell
- School of Health Sciences, City, University of London, London, UK
| | - Dinah Gould
- School of Health Sciences, City, University of London, London, UK
| | - Jane Chudleigh
- School of Health Sciences, City, University of London, London, UK
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17
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Baubie K, Shaughnessy C, Safdar N. Exploring patient perceptions of contact precautions. Am J Infect Control 2019; 47:225-226. [PMID: 30471977 DOI: 10.1016/j.ajic.2018.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Kelsey Baubie
- Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Catherine Shaughnessy
- Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nasia Safdar
- Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, Madison, WIWilliam S. Middleton Memorial Veterans Hospital, Madison, WI
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18
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Rump B, Timen A, Verweij M, Hulscher M. Experiences of carriers of multidrug-resistant organisms: a systematic review. Clin Microbiol Infect 2018; 25:274-279. [PMID: 30832898 DOI: 10.1016/j.cmi.2018.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES A comprehensive overview of the ways control measures directed at carriers of multidrug-resistant organisms (MDRO) affect daily life of carriers is lacking. In this systematic literature review, we sought to explore how carriers experience being a carrier and how they experience being subjected to control measures by looking at the impact on basic capabilities. METHODS We searched Medline, Embase and PsychINFO until 26 May 2016 for studies addressing experiences of MDRO carriers. Twenty-seven studies were included, addressing experiences with methicillin-resistant Staphylococcus aureus (n = 21), ESBL (n = 1), multiple MDRO (n = 4) and other (n = 1, not specified). We categorized reported experiences according to Nussbaum's capability approach. RESULTS Carriage and control measures were found to interfere with quality of care, cause negative emotions, limit interactions with loved ones, cause stigmatization, limit recreational activities and create financial and professional insecurity. Further, carriers have difficulties with full comprehension of the problem of antimicrobial resistance, thus affecting six out of ten basic capabilities. CONCLUSIONS Applying Nussbaum's capability approach visualizes an array of unintended consequences of control measures. Carriers experience stigmatization, especially in healthcare settings, and have limited understanding of their situation and the complexities of antimicrobial resistance.
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Affiliation(s)
- B Rump
- National Coordination Centre for Communicable Disease Control, RIVM-Centre for Communicable Diseases, Bilthoven, the Netherlands.
| | - A Timen
- National Coordination Centre for Communicable Disease Control, RIVM-Centre for Communicable Diseases, Bilthoven, the Netherlands; Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam, De Boelelaan 1081, 1081 HV Amsterdam, the Netherlands
| | - M Verweij
- Section Communication, Philosophy and Technology, Wageningen University, Wageningen, the Netherlands
| | - M Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Hewlett A, K. Murthy AR, Krasilovsky AM. Behavioral Health Support for Patients, Families, and Healthcare Workers. BIOEMERGENCY PLANNING 2018. [PMCID: PMC7123438 DOI: 10.1007/978-3-319-77032-1_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
During the 2014–2016 Ebola outbreak in West Africa, over 850 healthcare workers contracted Ebola, and over 500 died. These tragic numbers underscore the need for strict adherence to infection control precautions when caring for patients with Ebola and other diseases that are both highly infectious and potentially fatal. In addition to the use of personal protection equipment (PPE), such measures include source isolation of infected patients. In the process of confining infectious pathogens, however, it is essential that health systems do not overlook the psychological needs of patients nor that of the medical staff who care for them. This chapter is divided into two sections. The first explores the experiences of patients cared for in source isolation, highlighting the possible iatrogenic psychological consequences of treatment in a biocontainment unit. Strategies for mitigating the potentially harmful psychological effects of isolation are reviewed, including considerations for children. The second section considers the experiences of healthcare workers. The discussion outlines the psychological impact of treating patients with infectious diseases, risk factors for emotional distress, and strategies to promote psychological well-being and resilience.
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Affiliation(s)
- Angela Hewlett
- grid.266813.80000 0001 0666 4105Division of Infectious Diseases, Nebraska Biocontainment Unit, University of Nebraska Medical Center, Omaha, NE USA
| | - A. Rekha K. Murthy
- grid.50956.3f0000 0001 2152 9905Division of Infectious Diseases, Department of Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, CA USA
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Wessels C, Kugler C, Mattner F. Patient-reported outcome studies in hospitalized patients isolated due to multi-drug-resistant organisms: how representative are they and who can be included in respective studies? J Hosp Infect 2016; 94:52-3. [DOI: 10.1016/j.jhin.2016.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
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Branton F, Cathcart E, Bellamy E. A whole health economy approach to reducing MRSA bacteraemia incidence in diabetic foot ulcer patients. J Infect Prev 2016; 17:108-113. [PMID: 28989465 DOI: 10.1177/1757177416633514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/02/2016] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Ulceration of the foot is a common problem among diabetic patients. Infection is a major risk in diabetic foot ulcers (DFU) and many of these are caused by Staphylococcus aureus, in particular meticillin-resistant strains (MRSA). The control and management of MRSA remains a significant challenge and all healthcare organisations in England are required to meet Zero Tolerance Objectives for cases of MRSA bacteraemia (MRSAB). This paper describes a collaborative approach across the health economy to investigate factors contributing to the acquisition of MRSA and MRSAB among DFU patients and make improvements to care to reduce the risk of healthcare-associated infections. METHODS A collaborative approach between acute and community healthcare providers and commissioners was used to conduct Root Cause Analysis and drive improvement to prevent MRSA transmission in DFU patients. RESULTS Screening of all DFU patients was initiated after 6 MRSAB were found to be associated with in DFU. In total 15 patients with the same MRSA antibiogram were identified. Following the implementation of actions focused on isolation, wound management, screening and cleaning no further cases were identified. CONCLUSION This outbreak has demonstrated the value of cross-sector collaboration in investigating HCAI in patients with DFU, improving patient care and reducing the risk of MRSA transmission in these vulnerable patents.
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Affiliation(s)
| | | | - Elaine Bellamy
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Anderson DJ, Weber DJ, Sickbert-Bennett E. On contact precautions: the good, the bad, and the ugly. Infect Control Hosp Epidemiol 2014; 35:222-4. [PMID: 24521584 DOI: 10.1086/675295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Deverick J Anderson
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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