Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs

Psychosocial Impact of Quarantines: A Systematic Review with Meta-Analysis

Background: Quarantine is one of the most effective strategies to control outbreaks of communicable diseases. Individuals under isolation or quarantine experience both physical and mental effects. Therefore, given its widespread implementation around the world, it is pertinent to analyze this effect on physical and mental health. The psychosocial impact model, which divides four dimensions into two main points, exposure or protection and positive or negative responses, was used to analyze the psychosocial impact of quarantine. Objectives: The present study aimed to investigate the psychosocial impact of people exposed to or protected from quarantine. Methods: We conducted a search for primary articles in the Web of Science and Scopus databases, and after applying the inclusion and exclusion criteria, we meta-analyzed five of them. Results: Quarantined individuals were more likely to experience anxiety (K = 4; OR = 2.62) and depressive symptoms (K = 6; OR = 1.61) compared to those who did not undergo quarantine. Researchers discuss a twofold increase in the probability of anxiety or depression among those in quarantine. As a result, advancing interventions that reduce this impact is critical for both health and the global economy. Conclusions: In terms of economic variables, the non-moderation of GDP per capita and the moderation of the GINI index stand out, demonstrating that countries must move toward policies that promote the reconstruction of more resilient and inclusive societies.

Original Research: The Lived Experiences of Nurses as Patients: A Qualitative Study

BACKGROUND

An ED admission and hospitalization are scary experiences for anyone, and potentially more so for nurses. Yet there is scant information about nurses as patients in the nursing research literature. This likely reflects a general tendency among researchers to study the needs of patients but not those of nurses.

OBJECTIVE

This qualitative phenomenological study sought to explore the lived experiences of nurses who were admitted as patients to a hospital directly from an ED.

METHODS

A sample of nurse patients 21 years of age and older and including various genders, nursing specialties, and diagnoses were recruited using maximum variation purposive sampling. A semistructured interview guide was created, and data were collected through individual interviews conducted either face-to-face or via telephone. Data were coded manually, and thematic analysis was conducted using Dedoose software.

RESULTS

The analysis revealed that many participants had experienced tremendous undue stress during their hospitalization. Four themes were identified: to tell or not to tell, pulling the nurse card, taking one's care into one's own hands, and having to make medical decisions while sick.

CONCLUSIONS

The study findings indicate that nurses who are hospitalized have different needs than do hospitalized individuals in the lay population. The findings inform our recommendations, which health care organizations, nurse educators, and nurse leaders can use to promote smoother, more compassionate care for nurse patients. Staff nurses can use them to better prepare themselves for caring for a nurse patient-or becoming one. The study findings can also serve to guide future research.

Parents' and nurses' affective perception of a pictorial intervention in a pediatric hospital environment: Quasi-experimental design pre-post-testing

BACKGROUND/AIM

The humanization of the hospital environment of pediatric departments represents an area of research and intervention on improving the quality of life for hospitalized patients, but also that one of relatives and health professionals. The aim of the study was to test, in a sample of nurses and hospitalized children's parents, whether the pictorial intervention impacted the perceptions of affective qualities of hospital environment.

METHODS

This quasi-experimental design study investigated the effects of a pictorial humanization intervention which consisted of some naturalistic and colorful illustrations in the corridor of two pediatric wards of an Italian hospital. A total of 425 parents of hospitalized children and 80 nurses were asked to complete the Italian version of the "Scale of measurement of the affective qualities of places" in two different moments: 1) before the pictorial intervention and 2) three months after its implementation.

RESULTS

For all participants (parents and nurses), results showed a significant effect of pictorial intervention with the four positive dimensions investigated (Relaxing, Exciting, Pleasant, and Stimulating) reporting higher scores after being performed it, and with the four negative dimensions (Distressing, Gloomy, Unpleasant, Sleepy) showing lower scores.

CONCLUSIONS

Data suggest that the pictorial intervention could be particularly useful to create more welcoming hospital environments, reducing distress levels from hospitalized patients, but also of relatives and healthcare professionals.

IMPLICATIONS TO PRACTICE

Pictorial interventions improve the emotional atmosphere in pediatric healthcare settings. Integrating visual elements related to care and healing enhances user experience, creating a more welcoming environment.

The Fondazione Toscana Gabriele Monasterio app: a digital health system to improve wellbeing of inpatients with heart or lung disease

BACKGROUND

An app providing material for education and entertaining is a possible way to support patients and healthcare providers in achieving person-centered care.

METHODS

An app tailored on the Fondazione Toscana Gabriele Monasterio (FTGM), a research hospital treating cardiac and lung disorders, was created. A pilot evaluation project was conducted on consecutive patients hospitalized for heart or lung disorders. Patients were asked to complete an assessment questionnaire.

RESULTS

The FTGM app provides information on diagnostic and therapeutic investigations, hospital and healthcare personnel, and includes content for entertainment and learning. It was tested on 215 consecutive patients (75% men, 66% aged >60 years, and 40% with a primary or middle school degree). Sixty-nine percentage of patients used the FTGM app, including 67% of patients aged >80 years and 65% of those with an elementary education (65%). Patients gave positive feedback on the app layout. Many (76%) looked for information on doctors and nurses in the 'People' section. Sixty-five percent of responders had used at least one of the sections called 'Music' and 'Museum visits'. The app helped many patients perceive the hospital as a more liveable place (68%), and to feel less anxious (76%), and more engaged in the diagnostic and therapeutic workup (65%). Overall, the majority of responders (87%) rated the app as 'excellent' or 'good', and almost all (95%) would have recommended other patients to use the app.

CONCLUSIONS

The FTGM app is a possible tool to improve patient wellbeing during hospitalization.

'Put in a room and left': a qualitative study exploring the lived experiences of COVID-19 isolation and quarantine among rehabilitation inpatients

BACKGROUND

The SARS-CoV-2 (COVID-19) pandemic has resulted in significant changes to health care delivery and the patient's experience in hospital. Changes for those who contracted COVID-19 or were close contacts included isolation and quarantine, visitor restrictions and changes to usual models of care to reduce viral transmission. Traditional models of inpatient rehabilitation utilise communal spaces (e.g. shared gyms and dining rooms) and involve a multidisciplinary team interacting with the patient daily.

OBJECTIVES

To report the experience of COVID-19 related isolation and quarantine among rehabilitation inpatients and their family members who experienced a nosocomial outbreak and to make recommendations for rehabilitation units.

METHODS

A qualitative phenomenological methodology using semi-structured telephone interviews.

RESULTS

19 semi-structured interviews were conducted comprising of 13 general rehabilitation inpatients and 6 family members. Five themes were established: (1) the impact of social and physical isolation; (2) boredom and limited access to therapy; (3) the impact of technology; (4) inadequate information sharing and (5) positive experiences and things done well. Several novel insights were identified including: the desire for increased social interaction from staff to compensate for a lack of visitors; the impact of physical and cognitive deficits on a patient's ability to reach basic items around their room or call for help, and the unique impact of isolation and quarantine on individuals who have a history of trauma, discrimination or mental illness.

CONCLUSIONS

This study establishes key areas that should be considered by rehabilitation units globally to adjust traditional models which are not suitable in this pandemic. Strategies to mitigate the impact of isolation include providing training to increase use of technologies such as tablet devices, increased staff social engagement to reduce isolation and tailoring the environment to suit specific patient groups.KEY MESSAGESCOVID-19 related isolation and quarantine has a significant and unique impact on patients with cognitive and physical impairments such as those in inpatient rehabilitation. Patients who are required to isolate in inpatient settings expressed a desire for compensatory increased social interaction from staff and required specific assistance with basic daily tasks while isolated. The study makes key recommendations for other rehabilitation units to integrate into their approach for managing patients required to isolate or quarantine.

Understanding Experience of Patients With Highly Infectious Diseases During Extended Isolation: A Design Perspective

OBJECTIVES

This study aimed to develop a better understanding of the unique needs of patients with highly infectious diseases and their perceptions of being placed in isolation. We explore the subjective experiences of patients treated for Ebola in a biocontainment unit (BCU) and the healthcare personnel who cared for them.

BACKGROUND

The 2014 Ebola outbreak and the COVID-19 pandemic have brought to focus some major challenges of caring for patients with serious infectious diseases. Previous studies on BCU design have looked at ways to prevent self- and cross-contamination, but very few have examined how the built environment can support an improved patient experience.

METHOD

A qualitative study was conducted with four patients treated for Ebola and two critical care nurses who provided direct care to them at a single BCU in the U.S. Data were collected through in-depth semi-structured interviews to capture the actual patients' perception and experience of isolation. The interviews were analyzed using the thematic analysis approach.

RESULTS

The Ebola patients placed in source isolation perceived the BCU as an artificial environment where they lacked control, agency, autonomy, and independence. The physical separation from other patients, visitor restrictions, and staff wearing PPE contributed to feelings of social and emotional isolation, and loneliness.

CONCLUSIONS

The isolation can take a toll on physiological and psychological well-being. A thoughtful design of isolation units may improve patients' experience by supporting human and social interactions, empowering patients through space flexibility and personalization of space, and supporting a more holistic approach to isolation care.

Social isolation at the end of life: A case report of one person's journey navigating the medical landscape during the COVID-19 pandemic

BACKGROUND

In addition to physical symptom burden, psychological suffering at end of life (EOL) is quite pervasive. As such, the interdisciplinary team in our Palliative and Supportive Care Unit strives to provide quality care sensitive to the physical and psychosocial needs of patients. Involving and allowing for the presence of family members is one way in which we afford our patients some additional comfort. Unfortunately, the current pandemic has placed limitations on this rather fundamental need for both patients and their family members. Here, we present a case illustrating the effects of visitor restrictions/isolation due to COVID-19 on the suffering of a patient at the EOL.

CASE DESCRIPTION

A male in his 20s with a refractory hematologic malignancy decided to pursue a comfort-based approach to care after a rapid clinical deterioration. Due to visitor restrictions, he had to face this decision with limited support at the bedside, which caused significant distress. He was forced to choose among several immediate family members who would be at his side through his hospitalization, to be his advocate, at times his voice, his confidant, and the person to relay all information to those on the outside. He expressed a wish to be married before he died, which occurred in our palliative care unit. This life goal was one we would normally encourage those he loved to gather around him, but this was not possible. He passed peacefully two days after he was married.

CONCLUSION

Although social limitations are necessary to help provide safety to the patients and staff in a hospital, they can have a direct impact on the suffering of patients and families at the EOL. Helping to maintain dignity, reflect on their life, and resolve any conflicts in the presence of family members is a benchmark for providing quality palliative care. Being barred from visitation due to isolation, threatens this care and lays the foundation for complicated grief among family members. Further research is needed to help balance the needs of those at the EOL with public safety. One such measure to help ease distress is to allow for more virtual visitation through electronic measures.

Moderating Effects of Self-Esteem on the Relationship between Communication Anxiety and Academic Performance among Female Health College Students during the COVID-19 Pandemic

Unprecedented quarantine due to COVID-19 exposes individuals to withdraw from face-to-face interactions, which may influence communication and self-esteem (SE). Therefore, the overarching aims of this study are to examine the communication apprehension levels among female college students, and thus to investigate the moderating role of self-esteem on the relationship between communication apprehension and academic achievement. In this cross-sectional study, 287 female college students completed the survey, which was circulated through email. The survey included the following questionnaires: General Health Characteristics, Rosenberg Self-esteem Scale, and Personal Report of Communication Apprehension Scale. The results showed that 28.2% of participants were categorized as having a high level of communication apprehension, and only 9.8% had a low level of communication apprehension. The SE reported an overall score of 24.3 ± 2.14, indicating a high self-esteem level among students. The students' grade point average (GPA) was positively correlated with SE. However, self-esteem as a moderator variable had no significant effect on the relationships between all predictors and GPA. The finding of the study highlights the need to implement different strategies to enhance students' group discussions, meetings, and interpersonal communication to ensure the best learning outcomes. Future studies are required to investigate gender-based disparities in the relationship between communication apprehension and SE.

Measuring perception of mental well-being in patients under isolation precautions: a prospective comparative study

OBJECTIVES

Isolation precautions (IP) are applied to prevent transmission of pathogens in healthcare settings. Potential negative health outcomes experienced by patients have been previously described but results remain conflicting. We aimed at evaluating the psychological impact of IP in adult patients in isolation using a novel psychological assessment tool.

STUDY DESIGN

Prospective matched cohort study.

SETTING

Tertiary care centre in Switzerland.

PARTICIPANTS

Hospitalised patients under IP and non-isolated patients were matched by ward, age and illness severity.

OUTCOME MEASURES

We measured surrogates of mental and social well-being by using the Pictorial Representation of Illness and Self Measure (PRISM) instrument once during hospitalisation. PRISM is a visual psychometric instrument that has been validated as a quantitative measure of suffering. Smaller distance in self-to-illness separation (SIS) signifies higher importance for a patient.

RESULTS

156 patients agreed to participate of which 63 were under IP and 93 were matched controls. Median (IQR) duration of isolation was 5 days (2-10). The median SIS (IQR) for perceived inferior nurses' care was 22.8 (18.5-24.3) and 23.8 (23.3-25.5) for isolated and non-isolated patients, respectively (p<0.001). Similarly, median SIS (IQR) was significantly smaller in isolated than non-isolated patients for avoidance by visitors with 17.5 (7.7-22.0) and 22.2 (21.8-22.6), for loneliness with 7.5 (3.6-16.0) and 18 (10.2-21.6) and for feeling impure with 19 (17.0-21.5) and 21.5 (18.9-22.1), respectively (all p values<0.05).

CONCLUSIONS

IP to prevent transmission of pathogens may negatively impact mental and social well-being. Measures to alleviate adverse effects of IP should be taken routinely.

Patient Reported Experience Measure in Endoscopic Ultrasonography: The PREUS Study Protocol

The evaluation of the patient’s experience is becoming increasingly important as a better patient experience can improve the quality of the health service delivered. Patient-reported experience measures (PREMs) are self-report assessment tools provided to patients about their experience during any health event. There are few PREM instruments in the field of gastrointestinal endoscopy, and none is specific for endoscopic ultrasound (EUS). This study aims to develop a questionnaire to evaluate the experience of patients undergoing EUS, identifying and prioritizing the factors related to the patient’s experience. The study will consist of several phases: (A) tool creation; (B) face and content validity; (C) ranking: to evaluate the relevance of the identified questions in the previous phase; (D) questionnaire creation and validity testing. The final output will be the production of a specific tool that can be used to measure patients’ experience during EUS. This questionnaire may become a relevant part of actions taken to measure the quality of care provided to patients undergoing EUS. Furthermore, correlation between health care providers’ and patients’ views of the relevance of the included items will allow optimization of empathetic and psychological aspects.

Reconnecting: Strategies for Supporting Isolated Older Adults during COVID-19 through Tele-palliative Care

The COVID-19 pandemic has resulted in unprecedented levels of social isolation which has negatively impacted older patients in particular on multiple levels. We present a case of an older patient with several complex psychosocial issues who was hospitalized and died from COVID-19. The social isolation required during the pandemic compounded patient and family stressors and diminished the patient's access to clinicians and to his usual support network and coping strategies. We describe how technology and tele-palliative care were utilized to reconnect the patient with clinicians and family and to provide clinical care that enhanced coping skills and support. Using telemedicine to restructure the approach to care was crucial in improving multiple domains of care and can be considered a resource for caring for older adults, especially during the challenging times brought on by the COVID-19 pandemic.

The effect of hospitalization on patients' emotional and psychological well-being among adult patients: An integrative review

OBJECTIVE

Health care providers need to understand how hospitalization impacts patients' emotional statuses, to provide high quality of care. However, an overview of the literature suggests a dearth of research studies that examine and identify the effects of hospitalization on patients' emotional statuses and their well-being. In addition, no research review has synthesized this evidence before. To close this gap, this integrative review examines and synthesizes prior research findings regarding the effects of hospitalization on adult patients' emotional reactions and psychological well-being.

METHOD

This integrative review has been conducted based on the Whittemore and Knafl (2005) outline, which includes four steps: problem identification, literature search, data analysis, and presentation. Seven databases have been systematically searched, including CINAHL, EMBASE, OVID Medline, PsycINFO, SCOPUS, and Cochrane, with no date limitations through January 2021.

RESULTS

The current review synthesizes the findings of 18 publications to identify patients' experiences and factors that evoked emotional reactions during hospitalization. Factors include the effect of admission to a hospital, length of stay, and readmission; these also influence hospitalization experience, the role of health care providers, and patient's characteristics.

CONCLUSION

The current review's findings yield essential information by confirming that hospitalization negatively affects patients' abilities to cope and adjust. Hospitalization demonstrably exacerbates patients' emotions and increases feelings of depression and anxiety. Understanding these findings may help to support patients throughout their hospital stays. Gaps in the evidence and future research recommendations are also explored and discussed to establish a stronger foundation.

Coping Strategies Used by Older Adults to Deal with Contact Isolation in the Hospital during the COVID-19 Pandemic

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.

A Qualitative Investigation of the Psychological Experiences of COVID-19 Patients Receiving Inpatient Care in Isolation

Coronavirus disease 2019 (COVID-19) has spread rapidly throughout the world. Still, little is known about the psychological experiences of patients who received inpatient isolation treatment in order to improve the well-being of these patients. We randomly recruited 10 COVID-19 patients who received inpatient isolation treatment at a designated hospital in Wuhan from February to March 2020 and were discharged after recovery. The data were collected via a semi-structured interview over WeChat video and analyzed them using Calaizzi's descriptive phenomenological method. COVID-19 patients experienced significant psychological stress during hospitalization that continued after recovery and discharge. This can be categorized into three themes: (1) negative emotions experienced; (2) uncertainty of treatment provided; and (3) worries about readjusting to daily life. The insight into a patient's psychological experiences can support the timely implementation of personalized nursing interventions within hospitals and the community to improve the patient's mental well-being and recovery trajectory.

Association of Visitor Contact Precautions With Estimated Hospital-Onset Clostridioides difficile Infection Rates in Acute Care Hospitals

IMPORTANCE

Visitor contact precautions (VCPs) are commonly used to reduce the transmission of Clostridioides difficile at health care institutions. Implementing VCPs requires considerable personnel and personal protective equipment resources. However, it is unknown whether VCPs are associated with reduced hospital-onset C difficile infection (HO-CDI) rates.

OBJECTIVE

To estimate the association between VCPs and HO-CDI rates using simulation modeling.

DESIGN, SETTING, AND PARTICIPANTS

This simulation study, conducted between July 27, 2020, and August 11, 2020, used an established agent-based simulation model of C difficile transmission in a 200-bed acute care adult hospital to estimate the association between VCPs and HO-CDI while varying assumptions about factors such as patient susceptibility, behavior, and C difficile transmission. The model simulated hospital activity for 1 year among a homogeneous, simulated adult population.

INTERVENTIONS

No VCP use vs ideal use of VCPs under different hospital configurations.

MAIN OUTCOMES AND MEASURES

The rate of HO-CDI per 10 000 patient-days according to the Centers for Disease Control and Prevention's definition of HO-CDI.

RESULTS

With use of the simulation model, the baseline rate of HO-CDI was 7.94 10 000 patient-days (95% CI, 7.91-7.98 per 10 000 patient-days) with no VCP use compared with 7.97 per 10 000 patient-days (95% CI, 7.93-8.01 per 10 000 patient-days) with ideal VCP use. Visitor contact precautions were not associated with a reduction of more than 1% in HO-CDI rates in any of the tested scenarios and hospital settings. Independently increasing the hand-hygiene compliance of the average health care worker and environmental cleaning compliance by no more than 2% each was associated with greater HO-CDI reduction compared with all other scenarios, including VCPs.

CONCLUSIONS AND RELEVANCE

In this simulation study, the association between VCPs and HO-CDI was minimal, but improvements in health care worker hand hygiene and environmental cleaning were associated with greater reductions in estimated HO-CDI. Hospitals may achieve a higher rate of reduction for HO-CDI by focusing on making small improvements in compliance with interventions other than VCP.

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

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.

Mental health effects of infection containment strategies: quarantine and isolation-a systematic review and meta-analysis

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.

SARS-CoV-2 infection and COVID-19: The lived experience and perceptions of patients in isolation and care in an Australian healthcare setting

Background

Isolation and quarantine are key measures in outbreak management and disease control. They are, however, associated with negative patient experiences and outcomes, including an adverse impact on mental health and lower quality of care due to limited interaction with healthcare workers. In this study, we explore the lived experience and perceptions of patients in isolation with COVID-19 in an Australian healthcare setting.

Methods

Using a phenomenological approach from a Heideggerian hermeneutical perspective, we conducted individual semistructured interviews with the first 11 COVID-19 patients admitted to a designated COVID-19 facility in Australia. Interviews were audiorecorded, transcribed verbatim, and imported into NVivo 12 for coding and analysis.

Results

Participants’ lived experience and perceptions of COVID-19 were represented by 5 themes: “Knowing about COVID-19,” “Planning for, and responding to, COVID-19,” “Being infected,” “Life in isolation and the room,” and “Post-discharge life.” Within these, participants conveyed both positive and negative lived experiences of infection, isolation, and illness. The contextual aspects of their social and physical environment together with their individual resources contributed to the framing of their planning for, and response to, the outbreak, and were important mediators in their experience.

Conclusions

Findings from this study provide a valuable insight into the lived experiences of patients with COVID-19, which reflect those of patients with other infectious diseases who require isolation.

Multidrug-Resistant Organisms in Palliative Care: A Systematic Review

Background: Multidrug-resistant organisms (MDROs) are an important health care issue. Patients in Western societies often present an increased morbidity of chronic conditions accompanied by poor immune status and the use of devices. In particular, patients in palliative care (PC) are at greater risk of MDRO colonization, due to accompanying special devices and being hospitalized. Objective: To gain an overview of the literature regarding MDROs in PC. Design: Systematic review Data sources: On the 19th of October 2019 the databases " PubMed" and " CINAHL" were used to identify studies reporting on MDROs in PC; the search was updated on 16th of May 2020. Results: Seventeen out of 486 articles were included. Six represent qualitative data, 10 quantitative data, and one a mixed methods approach. Prevalence data range from 4.0% to 18%. MDRO colonization has a negative impact on patients and families. It leads to uncertainties and higher workload by staff members. Strategies for the management of MDROs in the field of PC are predominantly available for methicillin-resistant Staphylococcus aureus. Not even half of institutions utilize existing protocols. Recommendations for dealing with MDROs indicate required staff and time resources as well as information, communication, and specific knowledge. Conclusion: There is a great need for studies examining the prevalence of all MDROs in the PC setting. Additionally, not only patients but also a public enlightenment on MDROs should be provided to decrease knowledge gaps and therefore reduce transmission on MDROs.

COVID-19 and hand hygiene: the vital importance of hand drying

The significance of hand hygiene for preventing the transmission of microorganisms and reducing the spread of infection has been brought into sharp focus following the global coronavirus (COVID-19) pandemic. In the months since the initial outbreak, international public health campaigns and practitioner education has concentrated on hand washing and hand sanitising, with very little reference to hand drying, if any at all. However, hand drying is integral to effective hand hygiene, and is important in controlling the spread of microorganisms and maintaining healthy skin integrity. This research commentary will focus on two issues of importance with regards to hand drying: microbial transmission and skin irritation, with implications for healthcare practitioners and practice considered. It is argued that a more holistic approach to hand hygiene must be the ambition if health professional and public behaviour is to become embedded and sustained.

Pandemic and mental health of the front-line healthcare workers: a review and implications in the Indian context amidst COVID-19

Pandemic, being unprecedented, leads to several mental health problems, especially among the front-line healthcare workers (HCW). Front-line HCWs often suffer from anxiety, depression, burnout, insomnia and stress-related disorders. This is mediated to a large extent by the biopsychological vulnerabilities of the individuals; socioenvironmental factors such as the risk of exposure to infection, effective risk communication to HCWs, availability of personal protective equipment, job-related stress, perceived stigma and psychological impact of the isolation/quarantine and interpersonal distancing also play the major roles. Despite the huge magnitude of mental health problems among the front-line HCWs, their psychological health is often overlooked. Some of the potential measures to reduce the mental health problems of the front-line HCWs are effective communication, tangible support from the administration/seniors, mental health problem screening—and interventional—facilities, making quarantine/isolation less restrictive and ensuring interpersonal communication through the various digital platforms, proactively curtailing the misinformation/rumour spread by the media and strict legal measures against violence/ill treatment with the HCWs, and so on. India, along with other countries who lately got affected by the COVID-19, must learn from the experiences of the other countries and also from the previous pandemics as to how to address the mental health needs of their front-line HCWs and ensure HCWs’ mental well-being, thereby improving their productivity. Current review attempts to highlight the mental health aspects of the pandemic on the front-line HCWs, discusses some of the contentious issues and provides future directions particularly concerning COVID-19 in the Indian context and other low-resource countries.

Limited multi-drug resistant organism related stigma in carriers exposed to isolation precautions: an exploratory quantitative questionnaire study

BACKGROUND

Isolation precautions are applied to control the risk of transmission of multi-drug resistant organisms (MDROs). These precautions have been associated with adverse effects, such as anxiety and depression. This study aimed to quantify stigma among MDRO carriers and its association with perceived mental health and experienced quality of care.

METHODS

A quantitative questionnaire study was performed in MDRO carriers exposed to ≥3 days of isolation precautions during hospitalization. Items derived from the Consumer Quality Index questionnaire (CQI) were used to assess perception of care. Stigma scores were calculated using the recently modified Berger Stigma Scale for meticillin-resistant Staphylococcus aureus (MRSA). Mental health was measured with the RAND Mental Health Inventory. The Spearman rank correlation test was used to assess the association between stigma score and RAND mental health score.

FINDINGS

Of the 41 included carriers, 31 (75.6%) completed both questionnaires. The experienced quality of care was 'good' according to CQI score. Twenty-four percent reported not to have received proper explanation about MDRO carriership from healthcare workers (HCWs). MDRO-associated stigma was reported in 1/31 (3.2%). Poor mental health was self-reported in 3/31 (9.7%). There was no correlation between stigma score and RAND mental health score (Spearman correlation coefficient: 0.347).

CONCLUSIONS

In this study, MDRO carriers exposed to ≥3 days of isolation precautions did not report stigma. This contrasts with a recent study that investigated MRSA-associated stigma and may be explained by contact plus airborne isolation protocols in MRSA compared with contact isolation alone in most other MDROs. Also, the psychological impact may be of a different magnitude due to as yet unknown reasons.

Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence

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.

Adaptation and validation of the Polish version of the Beliefs about Medicines Questionnaire among cardiovascular patients and medical students

Background

The Beliefs about Medicines Questionnaire (BMQ) is the leading tool intended to assess the cognitive representation of medication, however, the validated Polish version of the questionnaire is lacking.

Aims

To adapt the original BMQ tool to the Polish language (BMQ-PL) and to validate it.

Materials and methods

The BMQ was adapted to Polish according to widely accepted guidelines. A total of 311 cardiovascular in- and outpatients as well as medical students taking chronic medication were surveyed to assess data-to-model fit and internal consistency of the measure. The criterion-related validity was determined with the use of Polish version of the Adherence to Refills and Medications Scale. Confirmatory and exploratory factor analyses were used, as well as general linear modeling.

Results

The BMQ-PL exhibited the same factorial structure as the original questionnaire and all the items loaded on their expected factors. Internal consistency of the questionnaire was satisfactory in the group of cardiovascular patients (Cronbach’s alpha ranging from 0.64 to 0.82 and McDonald’s omega from 0.90 to 0.91). There were significant correlations in the predicted directions between all BMQ-PL subscales and the measure of drug adherence in cardiovascular outpatients, but not in inpatients. Medical students may conceptualize the beliefs about medicines in a different way; as a result, a modified version of the BMQ-PL-General, suitable for medically-educated people, was proposed.

Conclusion

The BMQ-PL exhibits satisfactory proof of validity to be used among cardiovascular patients.

Impact of isolation on hospitalised patients who are infectious: systematic review with meta-analysis

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.

Impact of isolation on hospitalised patients who are infectious: systematic review with meta-analysis

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.

Impact of isolation precautions on quality of life: a meta-analysis

Impact of isolation precautions on psychological wellbeing of patients has yet to be fully quantified. To assess the impact of isolation precautions on patients' health-related quality of life and depression or anxiety scales and estimate per day cost of anxiety and depression. Literature pertaining to impact of isolation precautions was searched on EMBASE and PubMed databases and Google Scholar. A two-step independent screening of the articles was performed. Articles that compared isolated and non-isolated patients using different quality of life and psychological burden scales were included. A meta-analysis was conducted using the Hospital Anxiety and Depression Scales (HADS-A and HADS-D). Psychological burden measures from selected literature were presented in a graph as effect sizes. Per day cost of anxiety and depression was estimated using pooled mean difference from meta-analysis. Out of 106 articles, 94 were excluded due to inclusion criteria, leaving 12 for full text review. After review of full text of the articles, seven articles were shortlisted for empirical analysis and four out of these seven for meta-analysis. The pooled mean difference estimates for HADS-A was -1.4 (P=0.15) and that for HADS-D was -1.85 (P=0.09). In the empirical analysis of psychological burden scales, the effect in all studies except one was negative. Results from meta-analysis and empirical analysis of psychological burden implied that isolated patients are worse off in general. The implied estimated per day cost of anxiety and depression in terms of quality-adjusted life years (QALYs) is approximately US$10.

The effect of isolation precautions on care processes and medical outcomes in patients colonized with MRSA

Background: Isolation precautions used in methicillin-resistant Staph ylo coc cus aureus (MRSA) infection control are effective in inhibiting pathogen transmission, but may cause unintended consequences in medical care. In addition, while costs attributed to MRSA are known to be substantial, little is known about their reimbursement in the German Diagnosis Related Groups (G-DRG) payment system. The aim of our study was to examine the effect of isolation precautions used in MRSA infection control on care processes, patient outcomes and deliver reliable data on MRSA-attributed reimbursement. Methods: A retrospective, matched cohort study of inpatients admitted to a general care teaching hospital in Bad Neuenahr, Germany, between January 1st, 2016, and December 31st, 2017 was performed. Patients isolated for MRSA colonization were matched to non-isolated controls based on age, gender, MRSA-adjusted Patient Clinical Complexity Level (Ma-PCCL) and Major Diagnostic Category (MDC). Main outcome measures on care processes and patient outcomes included adverse events, patient complaints, 30-day readmission rates, length of stay, type of discharge, and performance of instrument-based diagnostics. MRSA-attributed reimbursement was measured by conducting two separate G-DRG groupings, one with inclusion of MRSA-related codes and one without. Results: A total of 26,059 patients were admitted to Maria Hilf Hospital in Bad Neuenahr, Germany, during the study period. We identified 304 patients isolated for MRSA colonization. Compared to non-isolated matched controls, those on isolation precautions for MRSA colonization acquired about 45% more pressure ulcers and experienced significant delays in the performance of radiological diagnostics and echocardiographs. Patients isolated for MRSA colonization received about 49% fewer echocardiographs and had about 38% fewer abdominal ultrasound exams performed compared to non-isolated matched controls. A non-significant tendency towards fewer discharges to rehabilitation clinics and higher mortality rates were observed in patients isolated for MRSA colonization. Reimbursements were negligibly affected when MRSA-related codes were integrated by the grouper. Conclusion: Isolation precautions are associated with adverse consequences for care processes. These consequences need to be mitigated in order to justify placing patients at risk.

Source isolation and patient wellbeing in healthcare settings

Multi-resistant bacteria pose an increasing and significant challenge to public health. Isolation precautions in patients with multi-drug-resistant bacteria and other communicable infectious agents can be associated with adverse effects. Although few would dispute the need for such practices in preventing the spread of transmissible infections, patients' perspectives of isolation suggest that the imposed environment creates barriers to their physical, social and emotional needs. This article reviews the literature to uncover any reliable evidence supporting the assertion that the experience of isolation in healthcare settings impacts adversely on patient wellbeing. Database searches identified 25 relevant papers published between 1990 and 2017. A number of studies claimed to have uncovered an association between negative patient experiences and isolation.

A review of isolation practices and procedures in healthcare settings

The notion of 'isolation' in infectious diseases refers to the possibility of people known or suspected to be infected from the wider population, and has historically been used to control and prevent the spread of infectious diseases. Isolation practices in healthcare settings evolved over the 20th century resulting in a focus on the disruption of known routes of potential transmission. There was renewed attention to infection prevention and control (IPC) in the UK at the turn of the 20th century after high-profile reports acknowledged the importance of IPC as a key indicator of high-quality clinical care, and the impact of healthcare-acquired infections. There has been a shift away from isolation wards towards isolation in single rooms on general wards. For infections that are spread by the airborne, droplet or contact routes, placing the patient in single-room isolation is considered to be an important component of transmission-based precautions (TBPs). However, in practice isolation is complex and a number of challenges are involved in implementing IPC procedures.

The stigmatisation of source isolation: a literature review

Background

Isolation precautions in patients with multi-drug-resistant bacteria and other communicable infectious agents can be associated with adverse effects. Patients' perspectives of isolation suggest that the imposed environment and procedures create barriers to their physical, social and emotional needs.

Aims

The purpose of this paper is to review the literature to uncover any reliable evidence supporting the assertion that stigma is a significant characteristic of the experience of source isolation in healthcare settings.

Methods

The methodological framework of Arksey and O'Malley was applied to this review. A total of 14 papers identified from 189 abstracts screened were included in the review.

Results

The research reviewed suggests a clear association between stigmatisation and isolation in which stigma does have a direct negative effect on patients placed in hospital isolation. None of the studies found evidence to the contrary.

Conclusions

The implications of this literature review for policy-makers and healthcare professionals suggest that when isolation or other forms of constraint are implemented and in use, patients must be provided with strengthened forms of support, including social and emotional support, and given access to healthcare of optimal quality to prevent the associated adverse effects of isolation as much as possible.

Empowering Patients during Hospitalization: Perspectives on Inpatient Portal Use

BACKGROUND

Patients have demonstrated an eagerness to use portals to access their health information and connect with care providers. While outpatient portals have been extensively studied, there is a recognized need for research that examines inpatient portals.

OBJECTIVE

We conducted this study to improve our understanding about the role of a portal in the context of inpatient care. Our study focused on a large sample of the general adult inpatient population and obtained perspectives from both patients and care team members about inpatient portal use.

METHODS

We interviewed patients (n = 120) who used an inpatient portal during their hospitalization at 15 days or 6 months after discharge to learn about their portal use. We also interviewed care team members (n = 331) 4 weeks, 6 months, and 12 months after inpatient portal implementation to collect information about their ongoing perspectives about patients' use of the portal.

RESULTS

The perspectives of patients and care team members generally converged on their views of the inpatient portal. Three features-(1) ordering meals, (2) looking up health information, and (3) viewing the care team-were most commonly used; the secure messaging feature was less commonly used and of some concern to care team members. The inpatient portal benefited patients in four main ways: (1) promoted independence, (2) reduced anxiety, (3) informed families, and (4) increased empowerment.

CONCLUSION

Inpatient portals are recognized as a tool that can enhance the delivery of patient-centered care. In addition to empowering patients by increasing their sense of control, inpatient portals can support family members and caregivers throughout the hospital stay. Given the consistency of perspectives about portal use across patients and care team members, our findings suggest that inpatient portals may facilitate shifts in organizational culture that increase the patient centeredness of care and improve patient experience in the hospital context.

Patient isolation for infection control and patient experience

OBJECTIVE

Hospitalized patients placed in isolation due to a carrier state or infection with resistant or highly communicable organisms report higher rates of anxiety and loneliness and have fewer physician encounters, room entries, and vital sign records. We hypothesized that isolation status might adversely impact patient experience as reported through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, particularly regarding communication.

DESIGN

Retrospective analysis of HCAHPS survey results over 5 years.

SETTING

A 1,165-bed, tertiary-care, academic medical center.

PATIENTS

Patients on any type of isolation for at least 50% of their stay were the exposure group. Those never in isolation served as controls.

METHODS

Multivariable logistic regression, adjusting for age, race, gender, payer, severity of illness, length of stay and clinical service were used to examine associations between isolation status and "top-box" experience scores. Dose response to increasing percentage of days in isolation was also analyzed.

RESULTS

Patients in isolation reported worse experience, primarily with staff responsiveness (help toileting 63% vs 51%; adjusted odds ratio [aOR], 0.77; P = .0009) and overall care (rate hospital 80% vs 73%; aOR, 0.78; P < .0001), but they reported similar experience in other domains. No dose-response effect was observed.

CONCLUSION

Isolated patients do not report adverse experience for most aspects of provider communication regarded to be among the most important elements for safety and quality of care. However, patients in isolation had worse experiences with staff responsiveness for time-sensitive needs. The absence of a dose-response effect suggests that isolation status may be a marker for other factors, such as illness severity. Regardless, hospitals should emphasize timely staff response for this population.

Hospitalization-induced exacerbation of the ill effects of chemotherapy on rest-activity rhythm and quality of life of breast cancer patients: a prospective and comparative cross-sectional follow-up study

Chemotherapy administration may result in the disruption of circadian rhythms and impairment of quality of life (QoL) of cancer patients. Nevertheless, we have little knowledge on the long-term consequences of chemotherapy and the effects of hospitalization. In the present study, we employed the two-factor repeated-measure cross-sectional design to determine the effects of chemotherapy and hospitalization on rest-activity (RA) rhythm and QoL of breast cancer patients. Initially, we randomly selected 39 inpatients and 42 outpatients, scheduled to receive six cycles of chemotherapy, from the Regional Cancer Center (RCC), Raipur, India. Finally, 30 patients in each group were included in the current study. We monitored circadian RA rhythm and QoL using wrist actigraphy and QLQ-C30 and QLQ-BR23, respectively, during the 1st (C1), 3rd (C3) and 6th (C6) chemotherapy cycles. Results revealed that with the progression of chemotherapy cycles (from C1 to C6), all rhythm parameters, namely mesor, amplitude, acrophase, rhythm quotient (RQ), circadian quotient (CQ), peak activity (PA), dichotomy index and autocorrelation coefficient, significantly decreased in both cancer in- and outpatients. In both groups of patients and during C1-C6, all functional and global QoL measures of QLQ-C30 and QLQ-BR23 significantly decreased and the symptoms significantly increased, except constipation, body image, sexual functioning and future perspectives in outpatients. The hospitalization exacerbated the problems associated with the RA rhythm and the QoL of the patients. In conclusion, the current study highlighted the negative consequences of hospitalization among inpatients, irrespective of the stage of cancer. We, therefore, recommend that cancer patients should be administered with chemotherapy as outpatients. The proposed protocol might have a covert bearing on the expression of better physiological state leading to satisfactory treatment outcomes.

Murthy AR, Krasilovsky AM. Behavioral Health Support for Patients, Families, and Healthcare Workers

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.

Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) at a palliative care unit: A prospective single service analysis

BACKGROUND

The emergence of multidrug-resistant bacterial microorganisms is a particular challenge for the health care systems. Little is known about the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Gram-negative bacteria (MDRGNB) in patients of palliative care units (PCU).

AIM

The primary aim of this study was to determine the carriage of MRSA among patients of a PCU at a German University Hospital and to assess whether the positive cases would have been detected by a risk-factor-based screening-approach.

DESIGN

Between February 2014 and January 2015 patients from our PCU were tested for MRSA carriage within 48 hours following admission irrespective of pre-existing risk factors. In addition, risk factors for MRSA colonization were assessed. Samples from the nostrils and, if applicable, from pre-existing wounds were analysed by standardized culture-based laboratory techniques for the presence of MRSA and of other bacteria and fungi. Results from swabs taken prior to admission were also recorded if available.

RESULTS

297 out of 317 patients (93.7%) fulfilled one or more MRSA screening criteria. Swabs from 299 patients were tested. The detection rate was 2.1% for MRSA. All MRSA cases would have been detected by a risk-factor-based screening-approach. Considering the detected cases and the results from swabs taken prior to admission, 4.1% of the patients (n = 13) were diagnosed with MRSA and 4.1% with MDRGNB (n = 13), including two patients with MRSA and MDRGNB (0.6%). The rate of MRSA carriage in PCU patients (4.1%) was elevated compared to the rate seen in the general cohort of patients admitted to our University Hospital (2.7%).

CONCLUSIONS

PCU patients have an increased risk to carry MRSA compared to other hospitalized patients. Although a risk factor-based screening is likely to detect all MRSA carriers amongst PCU patients, we rather recommend a universal screening to avoid the extra effort to identify the few risk factor-negative patients (<7%). As we did not perform a systematic MDRGNB screening, further studies are needed to determine the true prevalence of MDRGNB amongst PCU patients.

The relationship between subjective perception and the psychological effects of patients in spatial isolation

Background: Spatial isolation is a common infection control measure, but negative psychological effects are often neglected. We investigated which factors influence the perception of single room isolated patients.

Methods: In the present correlative cross-sectional study, 32 isolated patients have been interviewed within three departments of the Heidelberg University Hospital, one of Germany’s largest hospitals. The following questionnaires were used: 10-Item Big Five Inventory (BFI-10), Positive and Negative Affect Schedule (PANAS), Hospital Anxiety and Depression Scale (HADS) and a self-developed questionnaire to evaluate the individual experience of isolation. Data were analysed using correlation and regression analysis.

Results: A significant positive correlation was found between the isolation period and anxiety (r=.42, p<.05). Interestingly, a significant positive correlation was demonstrated between the duration of contact to nursing staff and negative daydreaming (r=.89, p<.01). The activity watching television was associated with higher levels of anxiety (r=.38, p<.05). Surfing the internet had a positive relationship with thinking about beautiful things (r=.41, p<.05).

Conclusions: Our study results have implications how to improve the psychological situation of patients during spatial isolation. Contact between nursing staff and patients is crucial, since this contact significantly associated with negative daydreaming, probably due to increased neediness of emotional and physical care in some patients. The duration of the isolation has an influence on the experience of anxiety. Activities to cope with the isolation, however, not always have positive effects on the well-being of the patient.

"Am I also going to die, doctor?" A systematic review of the impact of in-hospital patients witnessing a resuscitation of another patient

BACKGROUND

There is a growing interest in the impact of family-witnessed resuscitation. However, evidence about the effect of hospitalised patients witnessing other patients' resuscitations is limited.

AIM

The aim of this systematic review is to explore the existing evidence related to the impact on patients who witness resuscitation attempts on other patients in hospital settings.

METHODS

The databases BNI, CINAHL, EMBASE, MEDLINE and PsycINFO were searched with the terms 'patient', 'inpatient', 'resuscitation', 'CPR', 'cardiopulmonary resuscitation' and 'witness'. The search strategy excluded the terms 'out-of-hospital', 'family' and 'relative'. The inclusion criteria were: studies related to patients exposed to a resuscitation attempt performed on another patient; quantitative and qualitative design; and physiological or psychological outcome measures. No limitations of date, language or settings were applied.

RESULTS

Five of the 540 identified studies were included: two observational studies with control groups and three qualitative studies with interviews and focus groups. Articles were published between 1968 and 2006 and were mostly rated to have a low quality of evidence. Quantitative results of the observational studies showed an increased heart rate in the study group witnessing a resuscitation ( p = 0.05), increased systolic blood pressure ( p < 0.01) and increased anxiety ( p < 0.01). The qualitative studies highlighted the coping strategies adopted by exposed patients in response to witnessing resuscitation, including denial and dissociation.

CONCLUSIONS

Our findings suggest that patients may find witnessing resuscitation to be a stressful experience. However, the evidence is sparse and mainly of poor quality. Further research is needed in order to better understand the impacts of patients witnessing a resuscitation of another patient and to identify effective support systems.

The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study

BACKGROUND

Isolation precautions have negative effects on patient safety, psychological well-being, and healthcare worker contact. However, it is not known whether isolation precautions affect certain hospital-related outcomes.

OBJECTIVE

To examine the effect of isolation precautions on hospital-related outcomes and cost of care.

DESIGN

Retrospective, propensity-score matched cohort study of inpatients admitted to general internal medicine (GIM) services at three academic hospitals in Toronto, Ontario, Canada between January 2010 and December 2012.

PARTICIPANTS

Adult (≥18 years of age) patients on isolation precautions for respiratory illnesses and methicillin-resistant Staphylococcus aureus (MRSA) were matched to controls based on propensity scores derived from nine covariates: age, sex, Resource Intensity Weight, number of hospital readmissions within 90 days, total length of stay for hospital admissions within 90 days, site of admission, month of isolation, year of isolation, and Case Mix Group.

MAIN MEASURES

Thirty-day readmission rates and emergency department visits, hospital length of stay, expected length of stay, adverse events, in-hospital mortality, patient complaints, and cost of care in Canadian doll ars (CAD).

KEY RESULTS

A total of 17,649 non-isolated patients were admitted to the participating hospitals during the study period. We identified 1506 patients isolated for respiratory illnesses and 745 patients isolated for MRSA. Compared to non-isolated individuals, those on isolation precautions for respiratory illnesses stayed 17 % longer (95 % CI: 9 %, 25 %), stayed 9 % longer than expected (95 % CI: 3 %, 15 %), and had 23 % higher cost of care (95 % CI: 14 %, 32 %). Patients isolated for MRSA had similar outcomes, but they also had a 4.4 % higher (95 % CI: 1.4 %, 7.3 %) rate of readmission to hospital within 30 days.

CONCLUSIONS

Isolation precautions are associated with adverse effects which may result in poorer hospital outcomes. Balancing the benefits for the many with the harms to the few will be a future challenge.

When should contact precautions be discontinued for patients with methicillin-resistant Staphylococcus aureus?

When to discontinue contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA) remains unresolved and policies vary between hospitals. We prospectively performed admission active surveillance cultures on patients known to have been MRSA positive for at least 1 year to determine the proportion who remained positive. The proportion of patients with MRSA who remained positive was 19.9%; however, this significantly decreased over time, particularly after 5 years.

Infection control link professionals' knowledge of Clostridium difficile

lostridium difficile is a common cause of diarrhoea in hospitalised patients. It can result in longer hospital stays and due to the need for strict isolation procedures can add significantly to nursing workload. Additionally, it can be very distressing for the patient and if patients are vulnerable to infection it can have serious health consequences. Cross-transmission can be limited by good infection prevention and control practices, however this relies on a sound knowledge base and support from the infection control team. This small-scale study reports on infection control link professionals' knowledge and assesses how they would utilise this knowledge in practice situations. Findings imply that the knowledge base concerning the microorganism was poor, but knowledge relating to general infection procedures was good.

Patient Experiences Using an Inpatient Personal Health Record

OBJECTIVE

To investigate patients' experience using an inpatient personal health record (PHR) on a tablet computer to increase engagement in their hospital care.

METHODS

We performed observations and conducted semi-structured interviews with 14 post-operative cardiac surgical patients and their family members who received an inpatient PHR. Themes were identified using an inductive coding scheme.

RESULTS

All participants responded favorably to having access to view their clinical information. A majority (85.7%) of participants used the application following an initial training session. Patients reported high satisfaction with being able to view their hospital medications and access educational materials related to their medical conditions. Patients reported a desire to view daily progress reports about their hospital stay and have access to educational information about their post-acute recovery. In addition, patients expressed a common desire to view their diagnoses, laboratory test results, radiology reports, and procedure notes in language that is patient-friendly.

CONCLUSION

Patients have unmet information needs in the hospital setting. Our findings suggest that for some inpatients and their family members, providing personalized health information through a tablet computer may improve satisfaction, decrease anxiety, increase understanding of their health conditions, and improve safety and quality of care.

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

The 2013 Infection Prevention and Control (IP&C) Guideline for Cystic Fibrosis (CF) was commissioned by the CF Foundation as an update of the 2003 Infection Control Guideline for CF. During the past decade, new knowledge and new challenges provided the following rationale to develop updated IP&C strategies for this unique population:

1.The need to integrate relevant recommendations from evidence-based guidelines published since 2003 into IP&C practices for CF. These included guidelines from the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), the World Health Organization (WHO), and key professional societies, including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). During the past decade, new evidence has led to a renewed emphasis on source containment of potential pathogens and the role played by the contaminated healthcare environment in the transmission of infectious agents. Furthermore, an increased understanding of the importance of the application of implementation science, monitoring adherence, and feedback principles has been shown to increase the effectiveness of IP&C guideline recommendations.

2.Experience with emerging pathogens in the non-CF population has expanded our understanding of droplet transmission of respiratory pathogens and can inform IP&C strategies for CF. These pathogens include severe acute respiratory syndrome coronavirus and the 2009 influenza A H1N1. Lessons learned about preventing transmission of methicillin-resistantStaphylococcus aureus(MRSA) and multidrug-resistant gram-negative pathogens in non-CF patient populations also can inform IP&C strategies for CF.

Reconsidering Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus

BACKGROUND

Whether contact precautions (CP) are required to control the endemic transmission of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) in acute care hospitals is controversial in light of improvements in hand hygiene, MRSA decolonization, environmental cleaning and disinfection, fomite elimination, and chlorhexidine bathing.

OBJECTIVE

To provide a framework for decision making around use of CP for endemic MRSA and VRE based on a summary of evidence related to use of CP, including impact on patients and patient care processes, and current practices in use of CP for MRSA and VRE in US hospitals.

DESIGN

A literature review, a survey of Society for Healthcare Epidemiology of America Research Network members on use of CP, and a detailed examination of the experience of a convenience sample of hospitals not using CP for MRSA or VRE.

PARTICIPANTS

Hospital epidemiologists and infection prevention experts.

RESULTS

No high quality data support or reject use of CP for endemic MRSA or VRE. Our survey found more than 90% of responding hospitals currently use CP for MRSA and VRE, but approximately 60% are interested in using CP in a different manner. More than 30 US hospitals do not use CP for control of endemic MRSA or VRE.

CONCLUSIONS

Higher quality research on the benefits and harms of CP in the control of endemic MRSA and VRE is needed. Until more definitive data are available, the use of CP for endemic MRSA or VRE in acute care hospitals should be guided by local needs and resources.

Infect Control Hosp Epidemiol 2015;36(10):1163–1172

Impact of contact isolation on FIM score change, FIM efficiency score, and length of stay in patients in acute inpatient rehabilitation facility

OBJECTIVES

To explore the impact of contact isolation on the change in functional independence measure (FIM) score, FIM efficiency score, and length of stay.

DESIGN

Retrospective matched case control study.

SETTING

Tertiary care hospital (academic medical center).

PARTICIPANTS

Persons admitted to an acute inpatient rehabilitation facility at a tertiary care hospital from July 2009 through December 2010.

METHODS

Retrospective chart review by obtaining patient data regarding contact isolation status, patient demographics, and rehabilitation diagnosis. Two hundred charts were reviewed, which resulted in identification of 20 patients in contact isolation. These patients subsequently were matched to patients not in contact isolation based on age, rehabilitation diagnosis, and type of insurance. Admission and discharge FIM scores were obtained for these 40 study subjects (20 cases and 20 matched controls).

MAIN OUTCOME MEASUREMENTS

The primary study outcome measurements were change in FIM score (discharge FIM score minus admission FIM score), FIM efficiency score (change in FIM score divided by length of stay), and length of stay.

RESULTS

Compared with patients not in contact isolation, patients in contact isolation showed no statistically significant difference in FIM score change, a lower FIM efficiency score (P = .010), and a 39% longer length of stay (P = .017) when adjusting for confounders.

CONCLUSIONS

This study identifies contact isolation as a likely variable that is associated with increased length of stay and decreased FIM efficiency score in patients in an acute inpatient rehabilitation facility. Further study is needed to identify the role or mechanisms by which contact isolation is involved in these adverse effects so that interventions may be developed to counteract them.

Implementing a patient education intervention about Methicillin-resistant Staphylococcus aureus prevention and effect on knowledge and behavior in veterans with spinal cord injuries and disorders: a pilot randomized controlled trial

OBJECTIVES

To assess the feasibility and effect of a nurse-administered patient educational intervention about Methicillin-resistant Staphylococcus aureus (MRSA) prevention on knowledge and behavior of Veterans with spinal cord injuries and disorders (SCI/D).

DESIGN

Blinded, block-randomized controlled pilot trial.

SETTING

Two Department of Veterans Affairs (VA) SCI Centers.

PARTICIPANTS

Veterans were recruited March-September 2010 through referral by a healthcare provider from inpatient, outpatient, and residential care settings.

INTERVENTION

Thirty participants were randomized to the nurse-administered intervention and 31 to the usual care group. The intervention included a brochure and tools to assist nurses in conducting the education.

OUTCOME MEASURES

Pre- and post-intervention measurement of knowledge and behaviors related to MRSA and prevention strategies and feasibility measures related to implementation.

RESULTS

Participants were primarily male (95.1%), white (63.9%), with tetraplegia (63.9%) and mean age and duration of injury of 64.3 and 20.5 years, respectively. The intervention groups mean knowledge score significantly increased between pre- and post-test (mean change score = 1.70, 95% confidence interval, CI 0.25-3.15) while the usual care groups score did not significantly change (mean change score = 1.45, 95% CI -0.08-2.98). However, the mean knowledge change between intervention and usual care groups was not significantly different (P = 0.81). Overall behavior scores did not significantly differ between treatment groups; however, the intervention group was more likely to report intentions to clean hands (90.0% vs. 64.5%, P = 0.03) and asking providers about MRSA status (46.7% vs. 16.1%, P = 0.01). Nurse educators reported that the quality of the intervention was high and could be implemented in clinical care.

CONCLUSIONS

A targeted educational strategy is feasible to implement in SCI/D clinical practices and may improve some participants' knowledge about MRSA and increase intentions to improve hand hygiene and engagement with providers about their MRSA status.

Our recommendations for avoiding exposure to fungi outside the hospital for patients with haematological cancers

Despite several chemotherapeutic and preventative advances, opportunistic fungal infections remain common unintended consequences of cancer treatment. Currently, cancer patients spend most of their time between treatments at home, where they can inadvertently come across potential hazards from environmental and food sources. Therefore, infection prevention measures are of the utmost importance for these patients. Although clinicians closely observe patients throughout their treatment courses in the hospital, the focus of clinical visits is predominantly on cancer care, and clinicians seldom provide recommendations for prevention of such infections. Herein, we provide practical recommendations for busy clinicians to help them educate patients regarding potential sources of fungal infections outside the hospital.