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Digby R, Kramer S, Yuan V, Ozavci G, Bucknall TK. Patients in isolation, their physical, environmental and mental health: An exploratory study. J Clin Nurs 2024; 33:3526-3538. [PMID: 38887821 DOI: 10.1111/jocn.17295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/08/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Strict patient isolation in hospital is associated with adverse health outcomes. However, there is a lack of high-quality evidence for effective interventions to improve safety and quality of care for these patients. AIMS To identify patient reported areas for improvement in the care of patients in hospital isolation and to determine the feasibility of collecting patient reported outcomes using validated tools. METHODS Design An exploratory mixed methods study. Setting A major metropolitan teaching hospital in Melbourne, Australia. Participants Patients in hospital isolation for transmissible infections. Data collection Data were collected by (1) phone interviews with patients in isolation and (2) seven validated measurement tools to assess cognition, loneliness, nutritional status, quality of life, anxiety and depression and physical activity. Data were collected between September and December 2021. Data analysis Interviews were transcribed and analysed using thematic analysis. Quantitative data were analysed descriptively including participant characteristics and outcome data. RESULTS Participants identified areas for improvement including activities to decrease boredom, more contact with staff to mitigate loneliness and increase comfort care, and formalised communication about clinical treatment and discharge plan. Patients with gastrointestinal symptoms were happier to be alone. There were operational challenges within the health service including delays and miscommunication. Only 70% of the participants completed all questionnaires. CONCLUSION This study identified areas for improvement in care of patients in isolation and demonstrated that collecting patient reported outcomes using validated tools was feasible. The results of this research will inform development of an intervention to manage adverse effects. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Patients in hospital isolation require additional consideration to ensure that their needs are met to avoid adverse outcomes. The patient experience and comfort can be negatively affected when fundamental care is lacking. REPORTING METHOD (EQUATOR) EQUATOR guidelines for Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS). PATIENT OR PUBLIC CONTRIBUTION Thirteen patients in hospital isolation agreed to participate in this study, sharing their experiences through interviews and assessment.
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Affiliation(s)
- Robin Digby
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Sharon Kramer
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Vicky Yuan
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Guncag Ozavci
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Tracey K Bucknall
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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van Veen A, de Goeij I, Damen M, Huijskens EGW, Paltansing S, van Rijn M, Bentvelsen RG, Veenemans J, van der Linden M, Vos MC, Severin JA. Regional variation in the interpretation of contact precautions for multi-drug-resistant Gram-negative bacteria: a cross-sectional survey. J Hosp Infect 2024; 152:1-12. [PMID: 39069006 DOI: 10.1016/j.jhin.2024.06.020] [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: 03/22/2024] [Revised: 06/12/2024] [Accepted: 06/15/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Contact precautions are recommended when caring for patients with carbapenemase-producing Enterobacterales (CPE), carbapenemase-producing Pseudomonas aeruginosa (CPPA), and extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E). AIM Our aim was to determine the interpretation of contact precautions and associated infection prevention and control (IPC) measures in the non-ICU hospital setting for patients with CPE, CPPA or ESBL-E in 11 hospitals in the Southwest of the Netherlands. METHODS A cross-sectional survey was developed to collect information on all implemented IPC measures, including use of personal protective equipment, IPC measures for visitors, cleaning and disinfection, precautions during outpatient care and follow-up strategies. All 11 hospitals were invited to participate between November 2020 and April 2021. FINDINGS The survey was filled together with each hospital. All hospitals installed isolation precautions for patients with CPE and CPPA during inpatient care and day admissions, whereas 10 hospitals (90.9%) applied isolation precautions for patients with ESBL-E. Gloves and gowns were always used during physical contact with the patient in isolation. Large variations were identified in IPC measures for visitors, cleaning and disinfection products used, and precautions during outpatient care. Four hospitals (36.4%) actively followed up on CPE or CPPA patients with the aim of declaring them CPE- or CPPA-negative as timely as possible, and two hospitals (20.0%) actively followed up on ESBL-E patients. CONCLUSION Contact precautions are interpreted differently between hospitals, leading to regional differences in IPC measures applied in clinical settings. Harmonizing infection-control policies between the hospitals could facilitate patient transfers and benefit collective efforts of preventing transmission of multi-drug-resistant Gram-negative bacteria.
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Affiliation(s)
- A van Veen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - I de Goeij
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - M Damen
- Department of Medical Microbiology, Maasstad General Hospital, Rotterdam, The Netherlands
| | - E G W Huijskens
- Department of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - S Paltansing
- Department of Medical Microbiology and Infection Prevention, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - M van Rijn
- Department of Medical Microbiology and Infectious Diseases, Ikazia Hospital, Rotterdam, The Netherlands
| | - R G Bentvelsen
- Department of Infection Prevention, ZorgSaam Hospital, Terneuzen, The Netherlands; Microvida Laboratory for Microbiology, Amphia Hospital, Breda, The Netherlands
| | - J Veenemans
- Department of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands; Department of Infection Prevention, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - M van der Linden
- Department of Infection Prevention, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - M C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - J A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
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Diekema DJ, Nori P, Stevens MP, Smith MW, Coffey KC, Morgan DJ. Are Contact Precautions "Essential" for the Prevention of Healthcare-associated Methicillin-Resistant Staphylococcus aureus? Clin Infect Dis 2024; 78:1289-1294. [PMID: 37738565 DOI: 10.1093/cid/ciad571] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
The recently updated Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, and the Association of Professionals in Infection Control practice recommendations for methicillin-resistant Staphylococcus aureus (MRSA) prevention in acute care facilities list contact precautions (CPs) for patients known to be infected or colonized with MRSA as an "essential practice," meaning that it should be adopted in all acute care facilities. We argue that existing evidence on benefits and harms associated with CP do not justify this recommendation. There are no controlled trials that support broad use of CP for MRSA prevention. Data from hospitals that have discontinued CP for MRSA have found no impact on MRSA acquisition or infection. The burden and harms of CP remain concerning, including the environmental impact of increased gown and glove use. We suggest that CP be included among other "additional approaches" to MRSA prevention that can be implemented under specific circumstances (eg outbreaks, evidence of ongoing transmission despite application of essential practices).
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Affiliation(s)
- Daniel J Diekema
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Priya Nori
- Department of Medicine, Division of Infectious Diseases, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NewYork, USA
| | - Michael P Stevens
- Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Matthew W Smith
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - K C Coffey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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4
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Zheng X, Qian M, Ye X, Zhang M, Zhan C, Li H, Luo T. Implications for long COVID: A systematic review and meta-aggregation of experience of patients diagnosed with COVID-19. J Clin Nurs 2024; 33:40-57. [PMID: 36253950 PMCID: PMC9874539 DOI: 10.1111/jocn.16537] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/19/2022] [Accepted: 09/06/2022] [Indexed: 01/27/2023]
Abstract
AIMS AND OBJECTIVES This review aims to synthesize the available evidence of what patients experience when infected with COVID-19, both in hospital and post-discharge settings. DESIGN This review was conducted using the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews and evidence synthesis. Reporting of results was presented according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist. BACKGROUND Coronavirus disease 2019 (COVID-19) continues to be a public health crisis worldwide. Many patients diagnosed with COVID-19 have varied levels of persisting mental disorders. Previous studies have reported the degree, prevalence and outcome of psychological problems. Minimal research explored the experience of patients with long COVID. The real-life experience of patients with COVID-19 from diagnosis to post-discharge can deepen the understanding of nurses, physicians and policymakers. METHODS All studies describing the experience of patients were included. Two authors independently appraised the methodological quality of the included studies using the JBI Critical Appraisal Checklist for Qualitative Research 2020. RESULTS This systematic review aggregated patients' experience of being diagnosed with COVID-19 in both hospitalized and post-discharge settings. Finally, 17 studies met inclusion criteria and quality appraisal guidelines. The selected studies in the meta-synthesis resulted in 12 categories, and further were concluded as five synthesized findings: physical symptoms caused by the virus, positive and negative emotional responses to the virus, positive coping strategies as facilitators of epidemic prevention and control, negative coping strategies as obstacles of epidemic prevention and control, and unmet needs for medical resource. CONCLUSIONS The psychological burden of patients diagnosed with COVID-19 is heavy and persistent. Social support is essential in the control and prevention of the epidemic. Nurses and other staff should pay more attention to the mental health of the infected patients both in and after hospitalization. RELEVANCE TO CLINICAL PRACTICE Nurses should care about the persistent mental trauma of COVID-19 survivors and provide appropriate psychological interventions to mitigate the negative psychological consequences of them. Besides, nurses, as healthcare professionals who may have the most touch with patients, should evaluate the level of social support and deploy it for them. It is also needed for nurses to listen to patient's needs and treat them with carefulness and adequate patience in order to decrease the unmet needs of patients.
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Affiliation(s)
- Xutong Zheng
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Min Qian
- Department of NursingBeijing Ji Shui Tan Hospital and the 4th Medical College of Peking UniversityBeijingChina
| | - Xinxin Ye
- Department of Sports and Exercise ScienceZhejiang UniversityHangzhouChina
- School of Public HealthZhejiang University School of MedicineHangzhouChina
| | - Man Zhang
- School of MedicineYan'an UniversityYan'anChina
| | - Chenju Zhan
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Hui Li
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Tiantian Luo
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
- Department of Scientific ResearchXiamen Xianyue HospitalXiamenChina
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5
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Gill CM, Rajkotia P, Roberts AL, Tenover FC, Nicolau DP. Directed carbapenemase testing is no longer just for Enterobacterales: cost, labor, and workflow assessment of expanding carbapenemase testing to carbapenem-resistant P. aeruginosa. Emerg Microbes Infect 2023; 12:2179344. [PMID: 36786132 PMCID: PMC9980414 DOI: 10.1080/22221751.2023.2179344] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Molecular carbapenem-resistance testing, such as for the presence of carbapenemases genes, is commonly implemented for the detection of carbapenemase-producing Enterobacterales. Carbapenemase-producing P. aeruginosa is also associated with significant morbidity and mortality, although; prevalence may be underappreciated in the United States due to a lack of carbapenemase testing. The present study sought to compare hands-on time, cost and workflow implementation of carbapenemase gene testing in Enterobacterales and P. aeruginosa isolates versus sending out isolates to a public health laboratory (PHL) for testing to assess if in-house can provide actionable results. The time to carbapenemase gene results were compared. Differences in cost for infection prevention measures were extrapolated from the time of positive carbapenemase gene detection in-house versus PHL. The median time to perform carbapenemase gene testing was 7.5 min (range 5-14) versus 10 min (range 8-22) for preparation to send isolates to the PHL. In-house testing produced same day results compared with a median of 6 days (range 3-14) to receive results from PHL. Cost of in-house testing and send outs were similar ($46.92 versus $40.53, respectively). If contact precautions for patients are implemented until carbapenemase genes are ruled out, in-house testing can save an estimated $76,836.60 annually. Extension of in-house carbapenemase testing to include P. aeruginosa provides actionable results 3-14 days earlier than PHL Standard Pathway testing, facilitating guided therapeutic decisions and infection prevention measures. Supplemental phenotypic algorithms can be implemented to curb the cost of P. aeruginosa carbapenemases testing by identifying isolates most likely to harbour carbapenemases.
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Affiliation(s)
- Christian M. Gill
- Center for Anti-Infective Research & Development Hartford Hospital, Hartford, CT, USA, Christian M. Gill Center for Anti-Infective Research & Development Hartford Hospital, Hartford, CT, USA
| | - Poonam Rajkotia
- Microbiology Laboratory Services, Hartford Healthcare Ancillary Microbiology Laboratory, Newington, CT, USA
| | - Amity L. Roberts
- Microbiology Laboratory Services, Hartford Healthcare Ancillary Microbiology Laboratory, Newington, CT, USA
| | | | - David P. Nicolau
- Center for Anti-Infective Research & Development Hartford Hospital, Hartford, CT, USA,Department of Infectious Diseases, Hartford Hospital, Hartford, CT, USA
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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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7
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Weber A, Neffe L, Diaz LAP, Thoma N, Aghdassi SJS, Denkel LA, Maechler F, Behnke M, Häussler S, Gastmeier P, Kola A. Analysis of transmission-related third-generation cephalosporin-resistant Enterobacterales by electronic data mining and core genome multi-locus sequence typing. J Hosp Infect 2023; 140:96-101. [PMID: 37562589 DOI: 10.1016/j.jhin.2023.07.020] [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: 05/16/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND To contain intra-hospital transmission of third-generation cephalosporin-resistant Enterobacterales (3GCR-E), contact isolation precautions are recommended. AIM To quantify transmissions of 3GCR Escherichia coli and 3GCR Klebsiella pneumoniae within a hospital. METHODS An automated outbreak detection system (AODS) was used to identify clusters (N≥2) of 3GCR Enterobacterales for the years 2016, 2018 and 2020. Clusters were defined by phenotypic agreement of microbiological results and spatial and temporal relationship. Core genome multi-locus sequence typing (cgMLST) was used to confirm whether the cluster isolates were transmitted between patients. FINDINGS A total of 4343 3GCR E. coli and 1377 K. pneumoniae isolates were analysed. Among the 3GCR E. coli isolates, the AODS identified 304 isolates as cluster isolates, the median cluster size was two (range: 2-5). The cgMLST analysis revealed that a total of 23 (7.5%) 3GCR E. coli cluster isolates were transmission-associated, of which 20 isolates (87%) were detected in intensive care patients. Among the 3GCR K. pneumoniae isolates, the AODS identified 73 isolates as cluster isolates, the median cluster size was two (range: 2-4). CgMLST revealed that 35 (48%) 3GCR K. pneumoniae cluster isolates were transmission associated, of which 27 isolates (77%) were detected in intensive care patients. CONCLUSION For 3GCR K. pneumoniae, cgMLST confirmed the AODS results more frequently than for 3GCR E. coli. Therefore, contact isolation precautions for 3GCR K. pneumoniae may be appropriate on intensive care units, but only in certain circumstances, such as outbreaks, for Enterobacterales with lower transmissibility, such as E. coli.
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Affiliation(s)
- A Weber
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - L Neffe
- Helmholtz Centre for Infection Research, Department of Molecular Bacteriology, Braunschweig, Germany
| | - L A P Diaz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - N Thoma
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - S J S Aghdassi
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Programme, Berlin, Germany
| | - L A Denkel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - F Maechler
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - M Behnke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - S Häussler
- Helmholtz Centre for Infection Research, Department of Molecular Bacteriology, Braunschweig, Germany; TWINCORE, Centre for Experimental and Clinical Infection Research, A Joint Venture of the HZI and the Hannover Medical School, Hannover, Germany
| | - P Gastmeier
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - A Kola
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany.
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Cui J, Cho S, Kamruzzaman M, Bielskas M, Vullikanti A, Prakash BA. Using spectral characterization to identify healthcare-associated infection (HAI) patients for clinical contact precaution. Sci Rep 2023; 13:16197. [PMID: 37758756 PMCID: PMC10533902 DOI: 10.1038/s41598-023-41852-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Healthcare-associated infections (HAIs) are a major problem in hospital infection control. Although HAIs can be suppressed using contact precautions, such precautions are expensive, and we can only apply them to a small fraction of patients (i.e., a limited budget). In this work, we focus on two clinical problems arising from the limited budget: (a) choosing the best patients to be placed under precaution given a limited budget to minimize the spread (the isolation problem), and (b) choosing the best patients to release when limited budget requires some of the patients to be cleared from precaution (the clearance problem). A critical challenge in addressing them is that HAIs have multiple transmission pathways such that locations can also accumulate 'load' and spread the disease. One of the most common practices when placing patients under contact precautions is the regular clearance of pathogen loads. However, standard propagation models like independent cascade (IC)/susceptible-infectious-susceptible (SIS) cannot capture such mechanisms directly. Hence to account for this challenge, using non-linear system theory, we develop a novel spectral characterization of a recently proposed pathogen load based model, 2-MODE-SIS model, on people/location networks to capture spread dynamics of HAIs. We formulate the two clinical problems using this spectral characterization and develop effective and efficient algorithms for them. Our experiments show that our methods outperform several natural structural and clinical approaches on real-world hospital testbeds and pick meaningful solutions.
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Affiliation(s)
- Jiaming Cui
- College of Computing, Georgia Institute of Technology, Atlanta, GA, 30332, USA.
| | - Sungjun Cho
- College of Computing, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Methun Kamruzzaman
- Biocomplexity Institute, University of Virginia, Charlottesville, VA, 22904, USA
| | - Matthew Bielskas
- Biocomplexity Institute, University of Virginia, Charlottesville, VA, 22904, USA
- Department of Computer Science, University of Virginia, Charlottesville, VA, 22904, USA
| | - Anil Vullikanti
- Biocomplexity Institute, University of Virginia, Charlottesville, VA, 22904, USA
- Department of Computer Science, University of Virginia, Charlottesville, VA, 22904, USA
| | - B Aditya Prakash
- College of Computing, Georgia Institute of Technology, Atlanta, GA, 30332, USA.
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Hagiya H, Otsuka F. Increased evidence for no benefit of contact precautions in preventing extended-spectrum β-lactamases-producing Enterobacteriaceae: Systematic scoping review. Am J Infect Control 2023; 51:1056-1062. [PMID: 36736903 DOI: 10.1016/j.ajic.2023.01.018] [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: 11/21/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL-E) is a critical antimicrobial resistance pathogen, to which we need to pay the greatest attention. This study was aimed at uncovering the present evidence for the preventive effectiveness of contact precautions for patients colonized or infected with ESBL-E. METHODS According to the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews, we searched MEDLINE for articles with relevant keywords from the beginning of 2010 to October 18, 2022. RESULTS Of the 355 articles found, 9, including 8 observational studies and 1 randomized controlled trial, were selected. Safety of discontinuing contact precautions was evaluated mainly in acute-care and long-term care hospitals. Consistently, all authors concluded that contact precautions can be safely discontinued in patients colonized or infected with ESBL-E. CONCLUSION The clinical impact of discontinuing contact precautions for patients with ESBL-E is minimal and can be safely withdrawn at acute, noncritical, adult care wards. Relevant data from pediatric and geriatric wards, as well as intensive care units, were insufficient and should be investigated in future research.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 7008558, Japan.
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 7008558, Japan
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Gilboa M, Baharav N, Melzer E, Regev-Yochay G, Yahav D. Screening for Asymptomatic Clostridioides difficile Carriage Among Hospitalized Patients: A Narrative Review. Infect Dis Ther 2023; 12:2223-2240. [PMID: 37704801 PMCID: PMC10581986 DOI: 10.1007/s40121-023-00856-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/04/2023] [Indexed: 09/15/2023] Open
Abstract
Clostridioides difficile infection (CDI) has become the most common healthcare-associated infection in the United States, with considerable morbidity, mortality, and healthcare costs. Assessing new preventive strategies is vital. We present a literature review of studies evaluating a strategy of screening and isolation of asymptomatic carriers in hospital settings. Asymptomatic detection of C. difficile is reported in ~ 10-20% of admitted patients. Risk factors for carriage include recent hospitalization, previous antibiotics, older age, lower functional capacity, immunosuppression, and others. Asymptomatic C. difficile carriers of toxigenic strains are at higher risk for progression to CDI. They are also shedders of C. difficile spores and may contribute to the persistence and transmission of this bacterium. Screening for asymptomatic carriers at hospital admission can theoretically reduce CDI by isolating carriers to reduce transmission, and implementing antibiotic stewardship measures targeting carriers to prevent progression to clinical illness. Several observational studies, summarized in this review, have reported implementing screening and isolation strategies, and found a reduction in CDI rates. Nevertheless, the data are still limited to a few observational studies, and this strategy is not commonly practiced. Studies supporting screening were performed in North America, coinciding with the period of dominance of the 027/BI/NAP1 strain. Additional studies evaluating screening, followed by infection control and antibiotic stewardship measures, are needed.
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Affiliation(s)
- Mayan Gilboa
- Infection Prevention Unit, Sheba Medical Center, Ramat-Gan, Israel.
- Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel-Aviv, Israel.
| | - Nadav Baharav
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Eyal Melzer
- Infection Prevention Unit, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel-Aviv, Israel
| | - Gili Regev-Yochay
- Infection Prevention Unit, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel-Aviv, Israel
| | - Dafna Yahav
- Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel-Aviv, Israel
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
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Martin EM, Colaianne B, Bridge C, Bilderback A, Tanner C, Wagester S, Yassin M, Pontzer R, Snyder GM. Discontinuing MRSA and VRE contact precautions: Defining hospital characteristics and infection prevention practices predicting safe de-escalation. Infect Control Hosp Epidemiol 2022; 43:1595-1602. [PMID: 34847970 DOI: 10.1017/ice.2021.457] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To define conditions in which contact precautions can be safely discontinued for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). DESIGN Interrupted time series. SETTING 15 acute-care hospitals. PARTICIPANTS Inpatients. INTERVENTION Contact precautions for endemic MRSA and VRE were discontinued in 12 intervention hospitals and continued at 3 nonintervention hospitals. Rates of MRSA and VRE healthcare-associated infections (HAIs) were collected for 12 months before and after. Trends in HAI rates were analyzed using Poisson regression. To predict conditions when contact precautions may be safely discontinued, selected baseline hospital characteristics and infection prevention practices were correlated with HAI rate changes, stratified by hospital. RESULTS Aggregated HAI rates from intervention hospitals before and after discontinuation of contact precautions were 0.14 and 0.15 MRSA HAI per 1,000 patient days (P = .74), 0.05 and 0.05 VRE HAI per 1,000 patient days (P = .96), and 0.04 and 0.04 MRSA laboratory-identified (LabID) events per 100 admissions (P = .57). No statistically significant rate changes occurred between intervention and non-intervention hospitals. All successful hospitals had low baseline MRSA and VRE HAI rates and high hand hygiene adherence. We observed no correlations between rate changes after discontinuation and the assessed hospital characteristics and infection prevention factors, but the rate improved with higher proportion of semiprivate rooms (P = .04). CONCLUSIONS Discontinuing contact precautions for MRSA/VRE did not result in increased HAI rates, suggesting that contact precautions can be safely removed from diverse hospitals, including community hospitals and those with lower proportions of private rooms. Good hand hygiene and low baseline HAI rates may be conditions permissive of safe removal of contact precautions.
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Affiliation(s)
- Elise M Martin
- Department of Infection Prevention and Control, UPMC Presbyterian, Pittsburgh, Pennsylvania
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | | | - Colleen Tanner
- Department of Quality, UPMC Passavant, Pittsburgh, Pennsylvania
| | | | - Mohamed Yassin
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Infection Prevention and Control, UPMC Mercy, Pittsburgh, Pennsylvania
| | - Raymond Pontzer
- Department of Infection Prevention and Control, UPMC St. Margaret, Pittsburgh, Pennsylvania
| | - Graham M Snyder
- Department of Infection Prevention and Control, UPMC Presbyterian, Pittsburgh, Pennsylvania
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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12
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Vuichard-Gysin D, Nueesch R, Fuerer RL, Dangel M, Widmer A. Measuring perception of mental well-being in patients under isolation precautions: a prospective comparative study. BMJ Open 2022; 12:e044639. [PMID: 35314467 PMCID: PMC8938694 DOI: 10.1136/bmjopen-2020-044639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Danielle Vuichard-Gysin
- Internal Medicine, Spital Thurgau AG, Muensterlingen, Switzerland
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Reto Nueesch
- Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
- Internal Medicine, Schwyz Hospital, Schwyz, Switzerland
| | | | - Marc Dangel
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Andreas Widmer
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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13
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Kang J, Ji E, Kim J, Bae H, Cho E, Kim ES, Shin MJ, Kim HB. Evaluation of Patients' Adverse Events During Contact Isolation for Vancomycin-Resistant Enterococci Using a Matched Cohort Study With Propensity Score. JAMA Netw Open 2022; 5:e221865. [PMID: 35267031 PMCID: PMC8914578 DOI: 10.1001/jamanetworkopen.2022.1865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although contact isolation has been widely recommended for multidrug-resistant organisms, contact isolation has raised some concerns that it may bring unintended patient harms. OBJECTIVE To compare adverse events between a contact isolation group with vancomycin-resistant Enterococcus (VRE) and a matched comparison group using a relatively large data set from full electronic medical records (EMR) and propensity score-matching methods. DESIGN, SETTING, AND PARTICIPANTS This retrospective, matched cohort study was conducted at Seoul National University Bundang Hospital (SNUBH) in Korea, a tertiary, university-affiliated hospital that has 1337 inpatient beds. Participants included a total of 98 529 hospitalized adult patients (aged ≥18 years) during 2015 to 2017. EXPOSURES Contact isolation in a single or shared double room. MAIN OUTCOMES AND MEASURES As adverse contact isolation-related outcomes, falls and pressure ulcers were included. All relevant EMR data were extracted from the SNUBH clinical data warehouse. Risk factors for adverse events were included in the propensity score model based on literature reviews, such as Braden scale score and Hendrich II fall risk score. A fine stratification and weighting (FSW) and a 1:10 nearest neighbor (NN) propensity score matching as a sensitivity analysis were adopted to compare adverse events between the 2 groups for the observation period from the study entry date and the exit date. Time-to-event analyses with a Cox proportional hazard model were conducted in December 2021. RESULTS For comparison of outcomes in wards, 177 patients (mean [SD] age, 67.38 [14.12] years; 98 [55.4%] female) with VRE and 93 022 patients (mean [SD] age, 56.44 [16.88] years; 49 462 [53.2%] female) without VRE were included and no difference was found in basic characteristics from the FSW (VRE contact isolation [n = 172] vs comparison [n = 69 434]) as well as from the 1:10 NN (VRE contact isolation [n = 168] vs comparison [n = 1650]). Among 177 patients with VRE contact isolation, 8 pressure ulcers and 3 falls occurred during their hospital stays; incidence rates of adverse events were 2.5 and 0.9 per 1000 patient-days, respectively (pressure ulcer incidence rate from the FSW: 2.53 per 1000 patient-days [95% CI, 1.09-4.99 per 1000 patient-days]; pressure ulcer incidence rate from the 1:10 NN: 2.54 per 1000 patient-days [95% CI, 1.10-5.01 per 1000 patient-days]; fall incidence rate from the FSW: 0.87 per 1000 patient-days [95% CI, 0.18-2.54 per 1000 patient-days]; fall incidence rate from the 1:10 NN: 0.87 per 1000 patient-days [95% CI, 0.18-2.55 per 1000 patient-days]). The hazard ratios for adverse events showed no statistically significant differences for both groups: 1.42 (95% CI, 0.67-2.99) for pressure ulcer and 0.66 (95% CI, 0.20-2.13) for fall from the FSW. CONCLUSIONS AND RELEVANCE In this cohort study, no association was found between the likelihood of adverse events and contact isolation using propensity score-matching methods and closely related covariates for adverse events.
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Affiliation(s)
- JaHyun Kang
- College of Nursing, Seoul National University, Seoul, Korea
- Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Eunjeong Ji
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Junghee Kim
- Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Hyunok Bae
- Office of Digital Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Eunyoung Cho
- Office of Digital Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Eu Suk Kim
- Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Center for Infection Control, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Myoung Jin Shin
- Center for Infection Control, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Hong Bin Kim
- Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
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14
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Mackey RM, Yeow ME, Christensen AR, Ingram C, Carey EC, Lapid MI. Reconnecting: Strategies for Supporting Isolated Older Adults during COVID-19 through Tele-palliative Care. Clin Gerontol 2022; 45:204-211. [PMID: 33074777 DOI: 10.1080/07317115.2020.1830905] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Regina M Mackey
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Medicine, Center for Palliative Medicine
| | - Mei E Yeow
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Medicine, Center for Palliative Medicine
| | - April R Christensen
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Medicine, Center for Palliative Medicine
| | - Cory Ingram
- Department of Medicine, Center for Palliative Medicine
| | - Elise C Carey
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Medicine, Center for Palliative Medicine
| | - Maria I Lapid
- Department of Medicine, Center for Palliative Medicine.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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15
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Affiliation(s)
- Shannon Chun
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Ontario, Canada
| | - Justin N Hall
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Ontario, Canada
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Ontario, Canada
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16
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Lapp V, Fowler SB, Miller HD. The voice of adolescents: Perceptions of isolation during hospitalization. Nursing 2021; 51:51-56. [PMID: 34807864 DOI: 10.1097/01.nurse.0000800128.35559.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is a lack of understanding of the pediatric patient experience in isolation. This qualitative, descriptive study interviewed adolescent patients during their hospital stay about their perception of isolation. This article analyzes the themes gleaned from the interviews as well as nursing practice implications and strategies in caring for young patients in isolation.
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Affiliation(s)
- Valerie Lapp
- Valerie Lapp is a nurse scientist at Orlando Health|Arnold Palmer Hospital for Children and Orlando Health | Winnie Palmer Hospital for Women & Babies. Susan B. Fowler is a nurse scientist at Orlando Health's Center for Nursing Research. Harriet D. Miller is a program manager for Nursing and Special Projects at Orlando Health | Winnie Palmer Hospital for Women & Babies and Orlando Health | Arnold Palmer Hospital for Children
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17
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Adverse Events Associated with Patient Isolation: A Systematic Literature Revue and Meta-analysis. J Hosp Infect 2021; 119:54-63. [PMID: 34666116 DOI: 10.1016/j.jhin.2021.09.023] [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: 07/16/2021] [Revised: 09/26/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patient isolation is widely recommended and used in healthcare institutions to prevent transmission of MDRO. However, its risk-benefit ratio is debated. AIM We undertook a systematic literature review and meta-analysis since 2009 to assess, based on the newly published studies, whether or not there are physical and psychological adverse events associated with patient isolation. METHODS Systematic literature review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies were systematically searched from PubMed, from the 1st of may 2009 till the 31st of January 2020. The concepts of the research questions were defined as: "Adverse events", "patient isolation or cohorting", and "multi-drug resistant organisms colonized or infection patients". Three reviewers independently screened studies and extracted data. All statistical analysis was performed with Stata Software and R. FINDINGS After screening titles of 15921 articles, abstracts of 196 and reviewing full texts of 50 studies, we included 19 studies. Studies were divided into 3 groups: 4 qualitative studies, 7 observational studies suitable for meta-analysis and 8 other observational studies. Meta-analysis shows no adverse events related to clinical care or patient's experience associated with patient isolation. CONCLUSIONS More studies with correct methodology, including a control group and standardized inclusion criteria, must be conducted to confirm our results.
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18
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Shaban RZ, Nahidi S, Sotomayor-Castillo C, Li C, Gilroy N, O'Sullivan MV, Sorrell TC, White E, Hackett K, Bag S. SARS-CoV-2 infection and COVID-19: The lived experience and perceptions of patients in isolation and care in an Australian healthcare setting. Am J Infect Control 2020; 48:1445-1450. [PMID: 32890549 PMCID: PMC7466942 DOI: 10.1016/j.ajic.2020.08.032] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022]
Abstract
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.
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19
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Wijnakker R, Lambregts MMC, Rump B, Veldkamp KE, Reis R, Visser LG, de Boer MGJ. Limited multi-drug resistant organism related stigma in carriers exposed to isolation precautions: an exploratory quantitative questionnaire study. J Hosp Infect 2020; 106:126-133. [PMID: 32628981 DOI: 10.1016/j.jhin.2020.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- R Wijnakker
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.
| | - M M C Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - B Rump
- National Institute of Public Health and the Environment - National Coordination Centre for Communicable Disease Control (RIVM-LCI), Bilthoven, the Netherlands
| | - K E Veldkamp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - R Reis
- Department of Medical Anthropology, Leiden University Medical Center, Leiden, the Netherlands
| | - L G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - M G J de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
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20
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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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21
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Arbefeville S, Ferrieri P. Role of Multiplex Molecular Diagnosis for Acute Gastroenteritis. Curr Infect Dis Rep 2020. [DOI: 10.1007/s11908-020-0718-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Contact isolation versus standard precautions to decrease acquisition of extended-spectrum β-lactamase-producing Enterobacterales in non-critical care wards: a cluster-randomised crossover trial. THE LANCET. INFECTIOUS DISEASES 2020; 20:575-584. [PMID: 32087113 DOI: 10.1016/s1473-3099(19)30626-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/02/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The effectiveness of contact isolation for decreasing the spread of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) has been questioned. The aim of this study was to establish the benefits of contact isolation over standard precautions for reducing the incidence density of ESBL-E colonisation and infection in adult medical and surgical wards with an active surveillance culture programme. METHODS We did a cluster-randomised crossover trial in adult wards in four European university hospitals. Medical, surgical, or combined medical-surgical wards without critical care were randomised to continue standard precautions alone or implement contact isolation alongside standard precautions for 12 months, followed by a 1 month washout period and 12 months of the alternate strategy. Randomisation was done via a computer-generated sequence, with a block size of two consecutive wards. Only laboratory technicians and data analysts were masked to allocation. Patients were screened for ESBL-E carriage within 3 days of admission, once a week thereafter, and on discharge. The primary outcome was the incidence density of ESBL-E, defined as the acquisition rate per 1000 patient-days at risk at the ward level and assessed in the per-protocol population, which included all patients screened at least twice with a length of stay of more than 1 week for each intervention period. No specific safety measures were assessed given the minimal risk of adverse events. The trial is registered, ISRCTN57648070. FINDINGS We enrolled 20 wards from four hospitals in Germany (eight wards), the Netherlands (four wards), Spain (four wards), and Switzerland (four wards). Between Jan 6, 2014, and Aug 31, 2016, 38 357 patients were admitted to these wards. Among 15 184 patients with a length of stay of more than 1 week, 11 368 patients (75%) were screened at least twice. The incidence density of ward-acquired ESBL-E was 6·0 events per 1000 patient-days at risk (95% CI 5·4-6·7) during periods of contact isolation and 6·1 (5·5-6·7) during periods of standard precautions (p=0·9710). Multivariable analysis adjusted for length of stay, percentage of patients screened, and prevalence in first screening cultures yielded an incidence rate ratio of 0·99 (95% CI 0·80-1·22; p=0·9177) for care under contact isolation compared with standard precautions. INTERPRETATION Contact isolation showed no benefit when added to standard precautions for controlling the spread of ESBL-E on non-critical care wards with extensive surveillance screening. FUNDING European Commission.
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23
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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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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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25
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Sharma A, Pillai DR, Lu M, Doolan C, Leal J, Kim J, Hollis A. Impact of isolation precautions on quality of life: a meta-analysis. J Hosp Infect 2020; 105:35-42. [PMID: 32059996 DOI: 10.1016/j.jhin.2020.02.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/07/2020] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- A Sharma
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
| | - D R Pillai
- Departments of Pathology & Laboratory Medicine, Medicine, and Microbiology & Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - M Lu
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
| | - C Doolan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - J Leal
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada; Departments of Community Health Sciences and Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - J Kim
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - A Hollis
- Department of Economics, University of Calgary, Calgary, Alberta, Canada.
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Nair R, Perencevich EN, Goto M, Livorsi DJ, Balkenende E, Kiscaden E, Schweizer ML. Patient care experience with utilization of isolation precautions: systematic literature review and meta-analysis. Clin Microbiol Infect 2020; 26:684-695. [PMID: 32006691 DOI: 10.1016/j.cmi.2020.01.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 12/16/2019] [Accepted: 01/18/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Use of isolation precautions (IP) may represent a trade-off between reduced transmission of infectious pathogens and reduced patient satisfaction with their care. OBJECTIVE To perform a systematic literature review and meta-analysis to identify if and how IPs impact patients' care experiences. DATA SOURCES Medline, ClinicalTrials.gov, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PsychInfo, HSRProj and Cochrane Library databases. STUDY ELIGIBILITY CRITERIA Interventional and observational studies published January 1990 to May 2019 were eligible for inclusion. PARTICIPANTS Patients admitted to an acute-care facility. INTERVENTIONS IPs versus no IPs. METHODS Six reviewers screened titles, abstracts and full text. Experience of care reported by patients using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was assessed as the outcome for the meta-analysis. Pooled odds ratios were calculated using the random-effects model. Heterogeneity was assessed using the I2 value. RESULTS After screening 7073 titles and abstracts, 15 independent studies were included in the review. Pooling of unadjusted estimates from the HCAHPS survey demonstrated that IP patients were less likely to give top scores on questions pertaining to respect, communication, receiving assistance and cleanliness compared to the no-IP patients. Patients under IP with longer length of stay appeared to have more negative experiences with the care received during their stay compared to no IP. CONCLUSIONS Patients under IP were more likely to be dissatisfied with several aspects of patient care compared to patients not under IP. It is crucial to educate patients and healthcare workers in order to balance successful implementation of IP and patient care experiences, particularly in healthcare settings where it may be beneficial.
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Affiliation(s)
- R Nair
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, USA
| | - E N Perencevich
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, USA
| | - M Goto
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, USA
| | - D J Livorsi
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, USA
| | - E Balkenende
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, USA
| | - E Kiscaden
- Hardin Library for Health Sciences, University of Iowa, Iowa City, IA, USA
| | - M L Schweizer
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, USA.
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Morioka S, Tajima T, Sugiki Y, Hayakawa K, Ohmagari N. Adherence to personal protective equipment use among nurses in Japanese tertiary care hospitals: what determines variability? J Hosp Infect 2019; 104:344-349. [PMID: 31790746 DOI: 10.1016/j.jhin.2019.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/25/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Though nurses have frequent contact with patients, their personal protective equipment (PPE) compliance rate is low, which poses a significant challenge in infection control. AIM To investigate the relative influence of specific factors on PPE compliance. METHODS A sequential two-stage mixed-methods design was applied. In a qualitative study, semi-structured interviews were conducted from May to July 2018. In a quantitative study, a nationwide, cross-sectional survey was conducted from January to March 2019, in which a questionnaire was mailed to 735 nurses in 28 tertiary care hospitals in Japan. FINDINGS In the quantitative study, 435 (59.2%) analysable responses were obtained. In the linear regression analysis, the lack of the knowledge that 'standard precaution was the fundamental infection countermeasure applied when patients had signs of infections, and these countermeasures could be terminated if there was no infection found' was significantly associated with decreased PPE adherence, whereas an antimicrobial-resistant bacteria outbreak or a ward shutdown due to an outbreak and the belief 'I must never be the cause of spreading infection' were significantly associated with increased PPE adherence. The β of standard coefficients and t-values of the items were -0.344, -7.784, 0.090, 2.089, 0.088, 2.018, respectively. CONCLUSION This survey systematically identified nursing-associated factors that contribute to PPE compliance. As a practical approach to ensure positive outcomes, we suggest educating nurses by providing adequate knowledge on appropriate PPE use and sharing outbreak or ward shutdown experiences.
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Affiliation(s)
- S Morioka
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan.
| | - T Tajima
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Y Sugiki
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - K Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - N Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
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Gammon J, Hunt J, Musselwhite C. The stigmatisation of source isolation: a literature review. J Res Nurs 2019; 24:677-693. [PMID: 34394593 DOI: 10.1177/1744987119845031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- John Gammon
- Deputy Head of College, Innovation, Engagement and Organisational Development, Swansea University, UK
| | - Julian Hunt
- Research Officer, College of Human and Health Sciences, Swansea University, UK
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Schrank GM, Snyder GM, Davis RB, Branch-Elliman W, Wright SB. The discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: Impact upon patient adverse events and hospital operations. BMJ Qual Saf 2019; 29:1-2. [PMID: 31320496 DOI: 10.1136/bmjqs-2018-008926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 06/11/2019] [Accepted: 06/29/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Contact precautions for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) are a resource-intensive intervention to reduce healthcare-associated infections, potentially impeding patient throughput and limiting bed availability to isolate other contagious pathogens. We investigated the impact of the discontinuation of contact precautions (DcCP) for endemic MRSA and VRE on patient outcomes and operations metrics in an acute care setting. METHODS This is a retrospective, quasi-experimental analysis of the 12 months before and after DcCP for MRSA and VRE at an academic medical centre. The frequency for bed closures due to contact isolation was measured, and personal protective equipment (PPE) expenditures and patient satisfaction survey results were compared using the Wilcoxon signed-rank test. Using an interrupted time series design, emergency department (ED) admission wait times and rates of patient falls, pressure ulcers and nosocomial MRSA and VRE clinical isolates were compared using GEEs. RESULTS Prior to DcCP, bed closures for MRSA and/or VRE isolation were associated with estimated lost hospital charges of $9383 per 100 bed days (95% CI: 8447 to 10 318). No change in ED wait times or change in trend was observed following DcCP. There were significant reductions in monthly expenditures on gowns (-61.0%) and gloves (-16.3%). Patient satisfaction survey results remained stable. No significant changes in rates or trends were observed for patient falls or pressure ulcers. Incidence rates of nosocomial MRSA (1.58 (95% CI: 0.82 to 3.04)) and VRE (1.02 (95% CI: 0.82 to 1.27)) did not significantly change. CONCLUSIONS DcCP was associated with an increase in bed availability and revenue recovery, and a reduction in PPE expenditures. Benefits for other hospital operations metrics and patient outcomes were not identified.
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Affiliation(s)
- Gregory M Schrank
- Department of Medicine, Division of Infectious Diseases, University of Maryland Medical Center, Baltimore, Maryland, United States
| | - Graham M Snyder
- Department of Infection Prevention and Control, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Roger B Davis
- Department of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Westyn Branch-Elliman
- Department of Medicine, Section of Infectious Diseases, VA Boston Healthcare System, West Roxbury, Massachusetts, United States.,VA Boston Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, United States.,Harvard Medical School, Boston, Massachusetts, United States
| | - Sharon B Wright
- Harvard Medical School, Boston, Massachusetts, United States.,Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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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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Abstract
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.
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Methicillin-Resistant Staphylococcus aureus: The Effects Are More Than Skin Deep. J Pediatr 2018; 199:158-165. [PMID: 29759849 PMCID: PMC6063792 DOI: 10.1016/j.jpeds.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the psychosocial effects of a methicillin-resistant Staphylococcus aureus (MRSA) diagnosis on the households of children with MRSA skin and soft tissue infection (SSTI). STUDY DESIGN We constructed and administered an interview to the primary caregiver within the home of a child with a history of MRSA SSTI. RESULTS Seventy-six households were enrolled. Survey responses were analyzed and grouped into 4 themes: health behavior changes, disclosure, social interactions, and knowledge/awareness. The most common theme was disclosure; 91% of participants reported sharing their child's MRSA diagnosis with someone outside of the household. Forty-two percent of respondents reported a change in the manner in which household contacts interacted as a result of the index patient's MRSA diagnosis, including isolating the index patient from other children in the household. Many households reported adopting enhanced personal hygiene behaviors and environmental cleaning routines. Thirty-eight percent of participating households reported altering how they interact with people outside of their home, largely to avoid spreading MRSA to vulnerable individuals. In addition, many participants perceived that others regarded them with caution, especially at daycare, whereas other affected households were excluded from family gatherings. CONCLUSION Primary caregivers of children with MRSA SSTI reported changing their health behaviors, altering their interactions with people outside of their home, and feeling isolated by others in response to their child's MRSA diagnosis. The findings of our study highlight a need for community interventions and education to prevent the negative psychosocial repercussions associated with MRSA.
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Noninfectious Hospital Adverse Events Decline After Elimination of Contact Precautions for MRSA and VRE. Infect Control Hosp Epidemiol 2018; 39:788-796. [PMID: 29745356 DOI: 10.1017/ice.2018.93] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVETo evaluate the impact of discontinuing routine contact precautions (CP) for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) on hospital adverse events.DESIGNRetrospective, nonrandomized, observational, quasi-experimental study.SETTINGAcademic medical center with single-occupancy rooms.PARTICIPANTSInpatients.METHODSWe compared hospital reportable adverse events 1 year before and 1 year after discontinuation of routine CP for endemic MRSA and VRE (preintervention and postintervention periods, respectively). Throughout the preintervention period, daily chlorhexidine gluconate bathing was expanded to nearly all inpatients. Chart reviews were performed to identify which patients and events were associated with CP for MRSA/VRE in the preintervention period as well as the patients that would have met prior criteria for MRSA/VRE CP but were not isolated in the postintervention period. Adverse events during the 2 periods were compared using segmented and mixed-effects Poisson regression models.RESULTSThere were 24,732 admissions in the preintervention period and 25,536 in the postintervention period. Noninfectious adverse events (ie, postoperative respiratory failure, hemorrhage/hematoma, thrombosis, wound dehiscence, pressure ulcers, and falls or trauma) decreased by 19% (12.3 to 10.0 per 1,000 admissions, P=.022) from the preintervention to the postintervention period. There was no significant difference in the rate of infectious adverse events after CP discontinuation (20.7 to 19.4 per 1,000 admissions, P=.33). Patients with MRSA/VRE showed the largest reduction in noninfectious adverse events after CP discontinuation, with a 72% reduction (21.4 to 6.08 per 1,000 MRSA/VRE admissions; P<.001).CONCLUSIONAfter discontinuing routine CP for endemic MRSA/VRE, the rate of noninfectious adverse events declined, especially in patients who no longer required isolation. This suggests that elimination of CP may substantially reduce noninfectious adverse events.Infect Control Hosp Epidemiol 2018;788-796.
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Datta R, Juthani-Mehta M. Burden and Management of Multidrug-Resistant Organisms in Palliative Care. Palliat Care 2017; 10:1178224217749233. [PMID: 29317826 PMCID: PMC5753884 DOI: 10.1177/1178224217749233] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/10/2017] [Indexed: 12/26/2022] Open
Abstract
Palliative care includes comprehensive strategies to optimize quality of life for patients and families confronting terminal illness. Infections are a common complication in terminal illness, and infections due to multidrug-resistant organisms (MDROs) are particularly challenging to manage in palliative care. Limited data suggest that palliative care patients often harbor MDRO. When MDROs are present, distinguishing colonization from infection is challenging due to cognitive impairment or metastatic disease limiting symptom assessment and the lack of common signs of infection. Multidrug-resistant organisms also add psychological burden through infection prevention measures including patient isolation and contact precautions which conflict with the goals of palliation. Moreover, if antimicrobial therapy is indicated per goals of care discussions, available treatment options are often limited, invasive, expensive, or associated with adverse effects that burden patients and families. These issues raise important ethical considerations for managing and containing MDROs in the palliative care setting.
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Affiliation(s)
- Rupak Datta
- Rupak Datta, Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA.
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Frickmann H, Schwarz NG, Hahn A, Ludyga A, Warnke P, Podbielski A. Comparing a single-day swabbing regimen with an established 3-day protocol for MRSA decolonization control. Clin Microbiol Infect 2017; 24:522-527. [PMID: 28870730 DOI: 10.1016/j.cmi.2017.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 08/15/2017] [Accepted: 08/24/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Success of methicillin-resistant Staphylococcus aureus (MRSA) decolonization procedures is usually verified by control swabs of the colonized body region. This prospective controlled study compared a single-day regimen with a well-established 3-day scheme for noninferiority and adherence to the testing scheme. METHODS Two sampling schemes for screening MRSA patients of a single study cohort at a German tertiary-care hospital 2 days after decolonization were compared regarding their ability to identify MRSA colonization in throat or nose. In each patient, three nose and three throat swabs were taken at 3- to 4-hour intervals during screening day 1, and in the same patients once daily on days 1, 2 and 3. Swabs were analysed using chromogenic agar and broth enrichment. The study aimed to investigate whether the single-day swabbing scheme is not inferior to the 3-day scheme with a 15% noninferiority margin. RESULTS One hundred sixty patients were included, comprising 105 and 101 patients with results on all three swabs for decolonization screening of the nose and throat, respectively. Noninferiority of the single-day swabbing scheme was confirmed for both pharyngeal and nasal swabs, with 91.8% and 89% agreement, respectively. The absolute difference of positivity rates between the swabbing regimens was 0.025 (-0.082, 0.131) for the nose and 0.006 (-0.102, 0.114) (95% confidence interval) for the pharynx as calculated with McNemar's test for matched or paired data. Compliance with the single-day scheme was better, with 12% lacking second-day swabs and 27% lacking third-day swabs from the nostrils. CONCLUSIONS The better adherence to the single-day screening scheme with noninferiority suggests its implementation as the new gold standard.
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Affiliation(s)
- H Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, Bundeswehr Hospital Hamburg, Germany; Institute for Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany.
| | - N G Schwarz
- Infectious Disease Epidemiology Working Group, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - A Hahn
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
| | | | - P Warnke
- Institute for Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - A Podbielski
- Institute for Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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Harris J, Walsh K, Dodds S. Are Contact Precautions ethically justifiable in contemporary hospital care? Nurs Ethics 2017; 26:611-624. [PMID: 28617193 DOI: 10.1177/0969733017709335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hospital infection control practices known as Contact Precautions are recommended for the management of people with pathogens such as methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococci. Background: The patient is isolated, and staff are required to wear gloves, and a gown or apron when providing care. A notice is displayed to remind staff of these requirements and an 'alert' message is placed in the patient's medical record. Objective: The aim of this article is to discuss and explore whether practices used in hospitals to reduce the transmission of endemic antibiotic-resistant organisms are ethically justified in today's healthcare environment in the developed world. In order to do this, the history of the development of these practices is summarised, and the evidence base for their effectiveness is reviewed. Key bioethics principles are then discussed and contextualised from the perspective of hospital infection prevention and control, and an ethically superior model for the prevention and control of healthcare associated infection is proposed.
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Affiliation(s)
- Joanna Harris
- Illawarra Shoalhaven Local Health District (ISLHD), Australia; University of Tasmania, Australia
| | - Kenneth Walsh
- University of Tasmania, and Tasmanian Health Service, Australia
| | - Susan Dodds
- University of NSW Arts & Social Sciences, Sydney NSW, Australia
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Effect of Cessation of Contact Isolation for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci. Infect Control Hosp Epidemiol 2017; 38:1005-1007. [DOI: 10.1017/ice.2017.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hamill ME, Reed CR, Fogel SL, Bradburn EH, Powers KA, Love KM, Baker CC, Collier BR. Contact Isolation Precautions in Trauma Patients: An Analysis of Infectious Complications. Surg Infect (Larchmt) 2017; 18:273-281. [DOI: 10.1089/sur.2015.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Mark E. Hamill
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Christopher R. Reed
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Sandy L. Fogel
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Eric H. Bradburn
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Kinga A. Powers
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Katie M. Love
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Christopher C. Baker
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Bryan R. Collier
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
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Roderick M, Speroni KG, Stafford A, Seibert DJ. Pilot evaluation of isolation patients' perceptions on ability to identify types of health care workers when wearing isolation gowns. Am J Infect Control 2017; 45:324-326. [PMID: 27856073 DOI: 10.1016/j.ajic.2016.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 11/18/2022]
Abstract
In a survey research study, perceptions of 50 hospitalized patients on contact isolation were evaluated regarding their ability to identify health care worker (HCW) type in isolation gowns with no hospital badge under or on the gown, in isolation gowns with the hospital badge partially visible through the gown, and in isolation gowns with a preprinted large font Registered Nurse and Nursing Technician sticker badge on the outside of the gown. Patients ranked their ability to identify HCWs when entering their hospital room as important (average ranking, 8.0, where 0 was not at all important and 10 was very important); 28 patients (56%) specified all HCWs entering their hospital room should wear a preprinted large font sticker badge on the outside of their isolation gowns. Patients found little difficulty identifying HCW type with the large font preprinted sticker badge (average difficulty ranking, 1.0, where 0 is not at all difficult and 10 is very difficult), a simplistic method to improve HCW type identification.
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Affiliation(s)
- Mickey Roderick
- University of Maryland Shore Medical Center at Chestertown, Chestertown, MD.
| | | | - Amy Stafford
- University of Maryland Shore Regional Health, Easton, MD
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Reyes K, Bardossy AC, Zervos M. Vancomycin-Resistant Enterococci: Epidemiology, Infection Prevention, and Control. Infect Dis Clin North Am 2016; 30:953-965. [PMID: 27660091 DOI: 10.1016/j.idc.2016.07.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Vancomycin-resistant enterococci (VRE) infections have acquired prominence as a leading cause of health care-associated infections. Understanding VRE epidemiology, transmission modes in health care settings, risk factors for colonization, and infection is essential to prevention and control of VRE infections. Infection control strategies are pivotal in management of VRE infections and should be based on patient characteristics, hospital needs, and available resources. Hand hygiene is basic to decrease acquisition of VRE. The effectiveness of surveillance and contact precautions is variable and controversial in endemic settings, but important during VRE outbreak investigations and control. Environmental cleaning, chlorhexidine bathing, and antimicrobial stewardship are vital in VRE prevention and control.
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Affiliation(s)
- Katherine Reyes
- Infection Prevention and Control, Division of Infectious Disease, Henry Ford Hospital, Henry Ford Health System, 2799 West Grand Boulevard, CFP 302, Detroit, MI 48202, USA.
| | - Ana Cecilia Bardossy
- Division of Infectious Disease, Henry Ford Health System, 2799 West Grand Boulevard, CFP 302, Detroit, MI 48202, USA
| | - Marcus Zervos
- Division of Infectious Disease, Henry Ford Health System, 2799 West Grand Boulevard, CFP 302, Detroit, MI 48202, USA; Wayne State University School of Medicine, Detroit, MI, USA
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Elimination of Routine Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: A Retrospective Quasi-Experimental Study. Infect Control Hosp Epidemiol 2016; 37:1323-1330. [PMID: 27457254 DOI: 10.1017/ice.2016.156] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the impact of discontinuation of contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) and expansion of chlorhexidine gluconate (CHG) use on the health system. DESIGN Retrospective, nonrandomized, observational, quasi-experimental study. SETTING Two California hospitals. PARTICIPANTS Inpatients. METHODS We compared hospital-wide laboratory-identified clinical culture rates (as a marker of healthcare-associated infections) 1 year before and after routine CP for endemic MRSA and VRE were discontinued and CHG bathing was expanded to all units. Culture data from patients and cost data on material utilization were collected. Nursing time spent donning personal protective equipment was assessed and quantified using time-driven activity-based costing. RESULTS Average positive culture rates before and after discontinuing CP were 0.40 and 0.32 cultures/100 admissions for MRSA (P=.09), and 0.48 and 0.40 cultures/100 admissions for VRE (P=.14). When combining isolation gown and CHG costs, the health system saved $643,776 in 1 year. Before the change, 28.5% intensive care unit and 19% medicine/surgery beds were on CP for MRSA/VRE. On the basis of average room entries and donning time, estimated nursing time spent donning personal protective equipment for MRSA/VRE before the change was 45,277 hours/year (estimated cost, $4.6 million). CONCLUSION Discontinuing routine CP for endemic MRSA and VRE did not result in increased rates of MRSA or VRE after 1 year. With cost savings on materials, decreased healthcare worker time, and no concomitant increase in possible infections, elimination of routine CP may add substantial value to inpatient care delivery. Infect Control Hosp Epidemiol 2016;1-8.
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Hospital based clearance of patients with skin and soft tissue methicillin resistant Staphylococcus aureus (MRSA): A systematic review of the literature. Infect Dis Health 2016. [DOI: 10.1016/j.idh.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Chittick P, Koppisetty S, Lombardo L, Vadhavana A, Solanki A, Cumming K, Agboto V, Karl C, Band J. Assessing patient and caregiver understanding of and satisfaction with the use of contact isolation. Am J Infect Control 2016; 44:657-60. [PMID: 26897698 DOI: 10.1016/j.ajic.2015.12.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Contact isolation is a method used for limiting the spread of antimicrobial-resistant organisms when caring for patients. This policy has been linked to several adverse outcomes and less patient satisfaction. We assessed patient and caregiver understanding and satisfaction with the use of contact isolation. METHODS A prospective survey of >500 patients in contact isolation at our institution was performed during 2014. Participants responded to a series of statements relating to contact isolation, using a 5-point Likert scale. Responses were assessed for overall positivity or negativity and further compared according to floor type or designation. RESULTS Of the patients, 48.7% responded to the survey; 70 caregivers also responded. Patient and caregiver responses were similar and were positive overall. Most respondents felt safer because of the use of contact isolation and because it prevented infections. A smaller majority of respondents also thought the policy was adequately explained to them and adhered to by staff. CONCLUSIONS In the largest collection of respondents surveyed to date about contact isolation and its impact on them, the policy was viewed positively, both by patients and caregivers. There is still room for improvement in the area of patient education regarding the use of contact isolation.
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Watson PA, Watson LR, Torress-Cook A. Efficacy of a hospital-wide environmental cleaning protocol on hospital-acquired methicillin-resistant Staphylococcus aureus rates. J Infect Prev 2016; 17:171-176. [PMID: 28989476 DOI: 10.1177/1757177416645342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/27/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Environmental contamination has been associated with over half of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in hospitals. We explored if a hospital-wide environmental and patient cleaning protocol would lower hospital acquired MRSA rates and associated costs. OBJECTIVE This study evaluates the impact of implementing a hospital-wide environmental and patient cleaning protocol on the rate of MRSA infection and the potential cost benefit of the intervention. METHODS A retrospective, pre-post interventional study design was used. The intervention comprised a combination of enhanced environmental cleaning of high touch surfaces, daily washing of patients with benzalkonium chloride, and targeted isolation of patients with active infection. The rate of MRSA infection per 1000 patient days (PD) was compared with the rate after the intervention (Steiros Algorithm®) was implemented. A cost-benefit analysis based on the number of MRSA infections avoided was conducted. RESULTS The MRSA rates decreased by 96% from 3.04 per 1000 PD to 0.11 per 1000 PD (P <0.0001). This reduction in MRSA infections, avoided an estimated $1,655,143 in healthcare costs. DISCUSSION Implementation of this hospital-wide protocol appears to be associated with a reduction in the rate of MRSA infection and therefore a reduction in associated healthcare costs.
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Kullar R, Vassallo A, Turkel S, Chopra T, Kaye KS, Dhar S. Degowning the controversies of contact precautions for methicillin-resistant Staphylococcus aureus: A review. Am J Infect Control 2016; 44:97-103. [PMID: 26375351 DOI: 10.1016/j.ajic.2015.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/05/2015] [Accepted: 08/07/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Contact precautions (CPs) are recommended to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission in institutions. Rising doubts about CP effectiveness and recognition of unintended consequences for patients have raised questions about the benefit. The objective of this study was to evaluate the effectiveness and adverse outcomes associated with CPs for prevention of MRSA transmission. METHODS We searched PubMed, Embase, and the Cochrane Library for articles related to effectiveness and adverse outcomes of CPs in patients with MRSA. Criteria for inclusion included the following: articles conducted in the United States, articles performed in an acute care setting, articles that were not a case series or review, and those with standardized collection of data or inclusion of case and control groups. Results were summarized and examined for potential limitations. Recommendations were based on our findings. RESULTS CPs reduced MRSA transmission in epidemic settings and in instances with high compliance, but a decrease in infection rates was not shown. Unintended consequences of CPs include decreased health care provider (HCP) time spent with patients, low HCP compliance, decreased perceptions of comfort from patients, and greater likelihood of patient complaints and negative psychologic implications. CONCLUSION In endemic settings, there are few data to support routine use of CPs to control the spread of MRSA. Education should be performed in hospitals to improve patients' perception of care and understanding of CPs when implemented and HCPs' adherence to good hand hygiene and standard precautions practices.
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Affiliation(s)
- Ravina Kullar
- Department of Medical Affairs, Cubist Pharmaceuticals, Lexington, MA.
| | - Angela Vassallo
- Department of Infection Prevention/Epidemiology, Providence Saint John's Health Center, Santa Monica, CA
| | - Sarah Turkel
- Department of Infection Prevention/Epidemiology, Providence Saint John's Health Center, Santa Monica, CA
| | - Teena Chopra
- Department of Medicine, Wayne State University and Detroit Medical Center, Detroit, MI
| | - Keith S Kaye
- Department of Medicine, Wayne State University and Detroit Medical Center, Detroit, MI
| | - Sorabh Dhar
- Division of Infectious Diseases, Detroit Medical Center, John D Dingell Veterans Affairs Medical Center, Wayne State University, Detroit, MI.
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Croft LD, Liquori M, Ladd J, Day H, Pineles L, Lamos E, Arnold R, Mehrotra P, Fink JC, Langenberg P, Simoni-Wastila L, Perencevich E, Harris AD, Morgan DJ. The Effect of Contact Precautions on Frequency of Hospital Adverse Events. Infect Control Hosp Epidemiol 2015; 36:1268-74. [PMID: 26278419 PMCID: PMC4686266 DOI: 10.1017/ice.2015.192] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine whether use of contact precautions on hospital ward patients is associated with patient adverse events DESIGN Individually matched prospective cohort study SETTING The University of Maryland Medical Center, a tertiary care hospital in Baltimore, Maryland METHODS A total of 296 medical or surgical inpatients admitted to non-intensive care unit hospital wards were enrolled at admission from January to November 2010. Patients on contact precautions were individually matched by hospital unit after an initial 3-day length of stay to patients not on contact precautions. Adverse events were detected by physician chart review and categorized as noninfectious, preventable and severe noninfectious, and infectious adverse events during the patient's stay using the standardized Institute for Healthcare Improvement's Global Trigger Tool. RESULTS The cohort of 148 patients on contact precautions at admission was matched with a cohort of 148 patients not on contact precautions. Of the total 296 subjects, 104 (35.1%) experienced at least 1 adverse event during their hospital stay. Contact precautions were associated with fewer noninfectious adverse events (rate ratio [RtR], 0.70; 95% confidence interval [CI], 0.51-0.95; P=.02) and although not statistically significant, with fewer severe adverse events (RtR, 0.69; 95% CI, 0.46-1.03; P=.07). Preventable adverse events did not significantly differ between patients on contact precautions and patients not on contact precautions (RtR, 0.85; 95% CI, 0.59-1.24; P=.41). CONCLUSIONS Hospital ward patients on contact precautions were less likely to experience noninfectious adverse events during their hospital stay than patients not on contact precautions.
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Affiliation(s)
- Lindsay D. Croft
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael Liquori
- Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland
- VA Maryland Healthcare System, Baltimore, Maryland
| | - James Ladd
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hannah Day
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elizabeth Lamos
- Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Ryan Arnold
- Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Preeti Mehrotra
- Division of Infectious Diseases, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Jeffrey C. Fink
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Medicine, Division of General Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- VA Maryland Healthcare System, Baltimore, Maryland
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Eli Perencevich
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | - Anthony D. Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
- VA Maryland Healthcare System, Baltimore, Maryland
| | - Daniel J. Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
- VA Maryland Healthcare System, Baltimore, Maryland
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Routine Use of Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: Which Way Is the Pendulum Swinging? Infect Control Hosp Epidemiol 2015; 37:36-40. [PMID: 26486272 DOI: 10.1017/ice.2015.246] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies have suggested that contact precautions (CP) for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus may have risks that outweigh the benefits. These risks, coupled with more widespread use of horizontal interventions such as daily bathing with chlorhexidine gluconate, have brought into question the value of routine CP for these organisms. OBJECTIVE To assess the state of utilization of CP as well as adjunctive measures to reduce the risk of transmission in US hospitals. DESIGN Cross-sectional survey. PARTICIPANTS Total of 751 physician members of the Emerging Infections Network. METHODS An 8-question electronic survey distributed by email. RESULTS A total of 426/751 (57%) responded to the survey; 337/364 (93%) of respondents use routine CP for methicillin-resistant S. aureus and 335/364 (92%) use routine CP for vancomycin-resistant enterococcus. The most widely used trigger for initiation of CP for both pathogens was positive clinical culture. Practices for discontinuation of isolation varied widely. We found that 325/354 (92%) perform routine chlorhexidine gluconate bathing and 236/353 (67%) perform S. aureus decolonization with mupirocin for 1 or more subsets of inpatients, and 82/356 (23%) reported using either hydrogen peroxide vapor or ultraviolet-C room disinfection at discharge. Free text responses noted frustration and variation in the application, practice, and process for initiation and discontinuation of CP. CONCLUSIONS Use of CP for methicillin-resistant S. aureus and vancomycin-resistant enterococcus remains commonplace, although horizontal interventions such as chlorhexidine gluconate bathing are increasingly used. The heterogeneity of practices and policies was striking. Evidence-based guidelines regarding CP and horizontal interventions are needed. Infect. Control Hosp. Epidemiol. 2015;37(1):36-40.
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Abstract
Purpose of review Hand hygiene and isolation are basic, but very effective, means of preventing the spread of pathogens in healthcare. Although the principle may be straightforward, this review highlights some of the controversies regarding the implementation and efficacy of these interventions. Recent findings Hand hygiene compliance is an accepted measure of quality and safety in many countries. The evidence for the efficacy of hand hygiene in directly reducing rates of hospital-acquired infections has strengthened in recent years, particularly in terms of reduced rates of staphylococcal sepsis. Defining the key components of effective implementation strategies and the ideal method(s) of assessing hand hygiene compliance are dependent on a range of factors associated with the healthcare system. Although patient isolation continues to be an important strategy, particularly in outbreaks, it also has some limitations and can be associated with negative effects. Recent detailed molecular epidemiology studies of key healthcare-acquired pathogens have questioned the true efficacy of isolation, alone as an effective method for the routine prevention of disease transmission. Summary Hand hygiene and isolation are key components of basic infection control. Recent insights into the benefits, limitations and even adverse effects of these interventions are important for their optimal implementation.
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López‐Alcalde J, Mateos‐Mazón M, Guevara M, Conterno LO, Solà I, Cabir Nunes S, Bonfill Cosp X. Gloves, gowns and masks for reducing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in the hospital setting. Cochrane Database Syst Rev 2015; 2015:CD007087. [PMID: 26184396 PMCID: PMC7026606 DOI: 10.1002/14651858.cd007087.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Meticillin-resistant Staphylococcus aureus (MRSA; also known as methicillin-resistant S aureus) is a common hospital-acquired pathogen that increases morbidity, mortality, and healthcare costs. Its control continues to be an unresolved issue in many hospitals worldwide. The evidence base for the effects of the use of gloves, gowns or masks as control measures for MRSA is unclear. OBJECTIVES To assess the effectiveness of wearing gloves, a gown or a mask when contact is anticipated with a hospitalised patient colonised or infected with MRSA, or with the patient's immediate environment. SEARCH METHODS We searched the Specialised Registers of three Cochrane Groups (Wounds Group on 5 June 2015; Effective Practice and Organisation of Care (EPOC) Group on 9 July 2013; and Infectious Diseases Group on 5 January 2009); CENTRAL (The Cochrane Library 2015, Issue 6); DARE, HTA, NHS EED, and the Methodology Register (The Cochrane Library 2015, Issue 6); MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations (1946 to June week 1 2015); EMBASE (1974 to 4 June 2015); Web of Science (WOS) Core Collection (from inception to 7 June 2015); CINAHL (1982 to 5 June 2015); British Nursing Index (1985 to 6 July 2010); and ProQuest Dissertations & Theses Database (1639 to 11 June 2015). We also searched three trials registers (on 6 June 2015), references list of articles, and conference proceedings. We finally contacted relevant individuals for additional studies. SELECTION CRITERIA Studies assessing the effects on MRSA transmission of the use of gloves, gowns or masks by any person in the hospital setting when contact is anticipated with a hospitalised patient colonised or infected with MRSA, or with the patient's immediate environment. We did not assess adverse effects or economic issues associated with these interventions.We considered any comparator to be eligible. With regard to study design, only randomised controlled trials (clustered or not) and the following non-randomised experimental studies were eligible: quasi-randomised controlled trials (clustered or not), non-randomised controlled trials (clustered or not), controlled before-and-after studies, controlled cohort before-after studies, interrupted time series studies (controlled or not), and repeated measures studies. We did not exclude any study on the basis of language or date of publication. DATA COLLECTION AND ANALYSIS Two review authors independently decided on eligibility of the studies. Had any study having been included, two review authors would have extracted data (at least for outcome data) and assessed the risk of bias independently. We would have followed the standard methodological procedures suggested by Cochrane and the Cochrane EPOC Group for assessing risk of bias and analysing the data. MAIN RESULTS We identified no eligible studies for this review, either completed or ongoing. AUTHORS' CONCLUSIONS We found no studies assessing the effects of wearing gloves, gowns or masks for contact with MRSA hospitalised patients, or with their immediate environment, on the transmission of MRSA to patients, hospital staff, patients' caregivers or visitors. This absence of evidence should not be interpreted as evidence of no effect for these interventions. The effects of gloves, gowns and masks in these circumstances have yet to be determined by rigorous experimental studies, such as cluster-randomised trials involving multiple wards or hospitals, or interrupted time series studies.
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Affiliation(s)
- Jesús López‐Alcalde
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaCatalunyaSpain08041
| | - Marta Mateos‐Mazón
- University Hospital Central de AsturiasDepartment of Preventive MedicineAvenida de Roma s/nOviedoOviedoSpain33006
| | - Marcela Guevara
- Public Health Institute of Navarre, CIBER Epidemiología y Salud Pública (CIBERESP), IdiSNAC/ Leyre 15PamplonaNavarreSpainE‐31003
| | - Lucieni O Conterno
- Marilia Medical SchoolDepartment of General Internal Medicine and Clinical Epidemiology UnitAvenida Monte Carmelo 800FragataMariliaSão PauloBrazil17519‐030
| | - Ivan Solà
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaCatalunyaSpain08041
| | | | - Xavier Bonfill Cosp
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaCatalunyaSpain08041
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