1
|
Chadli S, Nechba Bennis R, Madani N, El Fahime E, Abouqal R, Belayachi J. Psychological Distress Associated with Enforced Hospital Isolation Due to COVID-19 during the "Flatten the Curve" Phase in Morocco: A Single-Center Cross-Sectional Study. Healthcare (Basel) 2024; 12:548. [PMID: 38470659 PMCID: PMC10930375 DOI: 10.3390/healthcare12050548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 03/14/2024] Open
Abstract
(1) Background: although much research has highlighted the mental health challenges faced by patients in hospital isolation during the COVID-19 pandemic, data from low-middle-income countries, including Morocco, are lacking. The main objective of this study was to assess the psychological distress of patients undergoing enforced hospital isolation during the initial phase of the COVID-19 pandemic in Morocco. (2) Methods: we conducted a cross-sectional study between 1 April and 1 May 2020, among patients hospitalized in isolation for suspected or confirmed COVID-19 at the Ibn Sina University Hospital of Rabat, Morocco. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Binary logistic regression was performed to identify variables associated with anxiety and depression, with a cutoff of ≥8 used for both scales to create dichotomous variables. (3) Results: among 200 patients, 42.5% and 43% scored above the cut-off points for anxiety and depression, respectively. Multiple logistic regression identified female gender, a higher education level, a longer duration of isolation, and a poor understanding of the reasons for isolation as significant factors associated with anxiety. Conversely, female gender, chronic disease, a longer duration of isolation, and a poor understanding of the reasons for isolation were factors significantly associated with depression. (4) Conclusions: our study underscores high rates of anxiety and depression among patients forced into hospital isolation during the initial phase of COVID-19 in Morocco. We identified several factors associated with patients experiencing psychological distress that may inform future discussions on mental health and psychiatric crisis management.
Collapse
Affiliation(s)
- Sarra Chadli
- Acute Medical Unit, Ibn Sina University Hospital, Rabat 10056, Morocco; (S.C.); (R.A.)
| | - Rhita Nechba Bennis
- Acute Medical Unit, Ibn Sina University Hospital, Rabat 10056, Morocco; (S.C.); (R.A.)
- Laboratory of Biostatistics, Clinical, and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat 10100, Morocco
| | - Naoufel Madani
- Acute Medical Unit, Ibn Sina University Hospital, Rabat 10056, Morocco; (S.C.); (R.A.)
- Laboratory of Biostatistics, Clinical, and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat 10100, Morocco
| | - ElMostafa El Fahime
- Molecular Biology and Functional Genomics Platform, National Center for Scientific and Technical Research (CNRST), Rabat 10000, Morocco
- Neuroscience and Neurogenetics Research Team, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat 10100, Morocco
| | - Redouane Abouqal
- Acute Medical Unit, Ibn Sina University Hospital, Rabat 10056, Morocco; (S.C.); (R.A.)
- Laboratory of Biostatistics, Clinical, and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat 10100, Morocco
| | - Jihane Belayachi
- Acute Medical Unit, Ibn Sina University Hospital, Rabat 10056, Morocco; (S.C.); (R.A.)
- Laboratory of Biostatistics, Clinical, and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat 10100, Morocco
| |
Collapse
|
2
|
Gaube S, Däumling S, Biebl I, Rath A, Caplunik-Pratsch A, Schneider-Brachert W. Patients with multi-drug-resistant organisms feel inadequately informed about their status: adverse effects of contact isolation. J Hosp Infect 2023; 133:89-94. [PMID: 36481686 DOI: 10.1016/j.jhin.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Contact isolation of patients with multi-drug-resistant organisms (MDROs) is an essential element of infection prevention strategies in hospitals worldwide. However, this practice may be associated with adverse side effects on patients' health and well-being. AIM This study was the first to assess mental health and well-being variables among isolated patients compared with non-isolated control patients in a German cohort. METHODS We conducted a matched case-control study among N = 267 patients admitted to a tertiary care teaching hospital in Germany. Their levels of anxiety, depression, loneliness, and dissatisfaction with their hospital experience were assessed using a questionnaire. Additionally, among isolated patients, it was evaluated how well they felt informed about their MDRO status. FINDINGS In our cohort, patients under contact isolation were significantly more dissatisfied than non-isolated control patients but did not show higher levels of anxiety, depression, and loneliness. A large proportion of patients felt insufficiently informed about their MDRO status. This lack of information was the strongest predictor of dissatisfaction among isolated patients. CONCLUSION These findings underline the importance of adequate patient communication. It is essential for patients' well-being to receive timely, relevant, and understandable information about the background and consequences of their infection or colonisation with MDROs.
Collapse
Affiliation(s)
- S Gaube
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; LMU Center for Leadership and People Management, LMU Munich, Munich, Germany.
| | - S Däumling
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - I Biebl
- LMU Center for Leadership and People Management, LMU Munich, Munich, Germany; Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - A Rath
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - A Caplunik-Pratsch
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - W Schneider-Brachert
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
3
|
de Abreu JM, de Souza RA, Viana-Meireles LG, Landeira-Fernandez J, Filgueiras A. Effects of physical activity and exercise on well-being in the context of the Covid-19 pandemic. PLoS One 2022; 17:e0260465. [PMID: 35081122 PMCID: PMC8791524 DOI: 10.1371/journal.pone.0260465] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/10/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) was discovered in China and characterized by the World Health Organization as a pandemic in March 2020. Many countries worldwide implemented stringent social isolation as a strategy to contain virus transmission. However, the same physical distancing that protects against the spread of COVID-19 may negatively impact mental health and well-being of the population. The present study sought to shed light on this phenomenon by assessing the relationship between physical activity and subjective well-being (SWB) among individuals who were subjected to social isolation during the COVID-19 pandemic. Data were collected in Brazil between March 31 and April 2, 2020. All of the volunteers agreed to participate by digitally checking the option of agreement after reading consent terms. The inclusion criteria were participants who had been in social isolation for at least 1 week and agreed to the consent terms. Three instruments were applied. A questionnaire was constructed for this study that assessed the participants’ exercise routines. The Psychosocial Aspects, Well-being, and Exercise in Confinement (PAWEC) scale was created by researchers of this study that assessed the relationship between well-being and physical activity during social isolation. The Brazilian Portuguese-adapted version of the Positive and Negative Affect Schedule (PANAS) was also used. A total of 592 participants (371 female, 220 male, 1 transgender), 14–74 years old (M = 32.39 years, SD = 10.5 years), reported being in social isolation for an average of 14.4 days (SD = 3.3 days). Well-being that was related to the practice of physical activity during quarantine was linked to an established routine of physical activity before the social isolation period. Participants who already practiced physical exercises previously and reported continuing the practice during the quarantine period had higher positive affect scores. Participants who engaged in physical activity without direct guidance only during the quarantine period had higher negative affect scores. Participants who already practiced physical activity felt more motivated to continue practicing physical activity during the social isolation period, resulting in positive affect, unlike participants who began exercising only during quarantine. Our results suggest that negative affect can occur among individuals who only just begin exercising during social isolation, indicating that physical activity should be habitual and not only occur during periods of social isolation. Engaging in exercise only during social isolation may contribute to an increase in malaise.
Collapse
Affiliation(s)
| | | | | | - J. Landeira-Fernandez
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alberto Filgueiras
- Departamento de Cognição e Desenvolvimento, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| |
Collapse
|
4
|
Boumans J, Scheffelaar A, van Druten VP, Hendriksen THG, Nahar-van Venrooij LMW, Rozema AD. Coping Strategies Used by Older Adults to Deal with Contact Isolation in the Hospital during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147317. [PMID: 34299774 PMCID: PMC8304333 DOI: 10.3390/ijerph18147317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022]
Abstract
Due to the COVID-19 pandemic, many older adults have experienced contact isolation in a hospital setting which leads to separation from relatives, loss of freedom, and uncertainty regarding disease status. The objective of this study was to explore how older adults (55+) cope with contact isolation in a hospital setting during the COVID-19 pandemic in order to improve their physical and psychological wellbeing. The realist evaluation approach was used to formulate initial program theories on coping strategies used by (older) adults in an isolation setting. Twenty-one semi-structured interviews with older patients (n = 21) were analysed. This study revealed that both emotion-focused coping strategies as well as problem-focused coping strategies were used by older adults during contact isolation. The study also uncovered some new specific coping strategies. The results have useful implications for hospital staff seeking to improve the wellbeing of older adults in contact isolation in hospitals. Problem-focused coping strategies could be stimulated through staff performing care in a person-centred way. Trust in staff, as part of emotion-focused coping strategies, could be stimulated by improving the relationship between patients and staff.
Collapse
Affiliation(s)
- Jogé Boumans
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.S.); (V.P.v.D.); (A.D.R.)
- Correspondence:
| | - Aukelien Scheffelaar
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.S.); (V.P.v.D.); (A.D.R.)
| | - Vera P. van Druten
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.S.); (V.P.v.D.); (A.D.R.)
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands; (T.H.G.H.); (L.M.W.N.-v.V.)
| | - Tessel H. G. Hendriksen
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands; (T.H.G.H.); (L.M.W.N.-v.V.)
| | - Lenny M. W. Nahar-van Venrooij
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands; (T.H.G.H.); (L.M.W.N.-v.V.)
| | - Andrea D. Rozema
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.S.); (V.P.v.D.); (A.D.R.)
| |
Collapse
|
5
|
Rotărescu VS, Matei DB, Mircea IA, Mirescu AM, Nedelescu BG, Nedelea DG, Raluca Neagu AN, Necşulescu AG, Oteşanu GA, Tudor LC. How anxious did you feel during lockdown? The roles resilience, living environment, and gender play on the level of anxiety state during pandemic isolation. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:496. [PMID: 33585301 PMCID: PMC7875071 DOI: 10.4081/ripppo.2020.496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/26/2020] [Indexed: 12/21/2022]
Abstract
In the unique context of the coronavirus disease 2019 (COVID-19) pandemic, researchers and clinicians alike drew attention to the risks involved by physical and social isolation for mental health. Factors like resilience, gender, urban/rural environment, or preexisting anxiety can impact anxious states produced by home forced isolation. Based on these, we assumed that: i) there are significant differences in the level of anxiety (state) during the pandemic, depending on the living area of the subjects; ii) gender plays a moderating role in the relationship between resilience and anxiety; and iii) anxiety (trait), experiential avoidance, resilience, and family connectedness, determine the level of anxiety (state). The MemoryLab team conducted the present study on 495 subjects (n=411 women, age between 18 and 65). Of these, 350 live in large and medium urban areas, 63 in small urban areas, and 82 in rural areas. As instruments, we used The State-Trait Anxiety Inventory (STAI 2.0), The Acceptance and Action Questionnaire 2 (AAQ-2), The Aggression Questionnaire (AQ), The Family Connectedness Questionnaire, and Connor-Davidson Resilience Scale 10 (CD-RISC-10), as well as the standard division of living areas according to community size. Data collection took place online during the spring peak of the pandemic. According to ANOVA analysis, people living in small urban areas have a higher level of anxiety. The difference is significant compared to those living in large and medium cities and villages. Gender has no moderating role in the relationship between resilience and the anxiety state. Also, experiential avoidance, anxiety (trait), and resilience play a significant role on the level of anxiety (state), measured during social isolation. The results could be an important indicator for understanding psychological mechanisms guiding interventions to support the communities effectively.
Collapse
|
6
|
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.
Collapse
|
7
|
Abstract
Multi-resistant bacteria pose an increasing and significant challenge to public health. Isolation precautions in patients with multi-drug-resistant bacteria and other communicable infectious agents can be associated with adverse effects. Although few would dispute the need for such practices in preventing the spread of transmissible infections, patients' perspectives of isolation suggest that the imposed environment creates barriers to their physical, social and emotional needs. This article reviews the literature to uncover any reliable evidence supporting the assertion that the experience of isolation in healthcare settings impacts adversely on patient wellbeing. Database searches identified 25 relevant papers published between 1990 and 2017. A number of studies claimed to have uncovered an association between negative patient experiences and isolation.
Collapse
Affiliation(s)
- John Gammon
- Deputy Head, College of Human and Health Sciences, Swansea University, Swansea
| | - Julian Hunt
- Research Officer, College of Human and Health Sciences, Swansea University, Swansea
| |
Collapse
|
8
|
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.
Collapse
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
| | | |
Collapse
|
9
|
Hewlett A, K. Murthy AR, Krasilovsky AM. Behavioral Health Support for Patients, Families, and Healthcare Workers. BIOEMERGENCY PLANNING 2018. [PMCID: PMC7123438 DOI: 10.1007/978-3-319-77032-1_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
During the 2014–2016 Ebola outbreak in West Africa, over 850 healthcare workers contracted Ebola, and over 500 died. These tragic numbers underscore the need for strict adherence to infection control precautions when caring for patients with Ebola and other diseases that are both highly infectious and potentially fatal. In addition to the use of personal protection equipment (PPE), such measures include source isolation of infected patients. In the process of confining infectious pathogens, however, it is essential that health systems do not overlook the psychological needs of patients nor that of the medical staff who care for them. This chapter is divided into two sections. The first explores the experiences of patients cared for in source isolation, highlighting the possible iatrogenic psychological consequences of treatment in a biocontainment unit. Strategies for mitigating the potentially harmful psychological effects of isolation are reviewed, including considerations for children. The second section considers the experiences of healthcare workers. The discussion outlines the psychological impact of treating patients with infectious diseases, risk factors for emotional distress, and strategies to promote psychological well-being and resilience.
Collapse
Affiliation(s)
- Angela Hewlett
- grid.266813.80000 0001 0666 4105Division of Infectious Diseases, Nebraska Biocontainment Unit, University of Nebraska Medical Center, Omaha, NE USA
| | - A. Rekha K. Murthy
- grid.50956.3f0000 0001 2152 9905Division of Infectious Diseases, Department of Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | | |
Collapse
|
10
|
Patient Involvement in Healthcare-Associated Infection Research: A Lexical Review. Infect Control Hosp Epidemiol 2018; 39:710-717. [PMID: 29606155 DOI: 10.1017/ice.2018.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVEThis review examines patient involvement in healthcare-associated infection (HAI) research. Healthcare-associated infections represent an intractable issue with considerable implications for patients and staff. Participatory methodologies that involve patients in healthcare research are associated with myriad benefits.DESIGNLexical review.METHODSPubMed was searched to identify all publications on patient involvement in HAI research since 2000; publications were also identified from the cited references. A lexical analysis was conducted of the methods sections of 148 publications.RESULTSThe findings reveal that HAI research that actively involves patients and members of the public is limited.CONCLUSIONSPatient involvement is largely limited to recruitment to HAI studies rather than extended to patient involvement in research design, implementation, analysis, and/or dissemination. As such, there is considerable opportunity to further this important research area via alternative methodologies that award primacy to patient expertise and agency.Infect Control Hosp Epidemiol 2018;39:710-717.
Collapse
|
11
|
Becoming patient-centred: sobering insight into CPE-positive patients' experiences of clinical care. J Hosp Infect 2017; 96:129-130. [PMID: 28434628 DOI: 10.1016/j.jhin.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 11/22/2022]
|
12
|
Pires E, Frange P, Henry B, Lortholary O, Reichert C. [Psychological impacts of being a carrier of multi-drug resistant bacteria]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2015; 60:33-36. [PMID: 26154359 DOI: 10.1016/j.soin.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Learning that they are a carrier of multi-drug resistant bacteria and being placed in isolation to prevent transmission has significant psychological repercussions for the patient and their families. Through therapeutic education, caregivers adapt their support to the patient's experience, raising their awareness of prevention.
Collapse
Affiliation(s)
- Elisabete Pires
- Centre d'infectiologie Necker-Pasteur, service des maladies infectieuses et tropicales, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Pierre Frange
- Unité d'immunologie, hématologie et rhumatologie pédiatriques, service de microbiologie, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Sorbonne Paris-Cité, Université Paris-Descartes, 12, rue de l'École de médecine, 75006 Paris, France
| | - Benoît Henry
- Centre d'infectiologie Necker-Pasteur, service des maladies infectieuses et tropicales, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Sorbonne Paris-Cité, Université Paris-Descartes, 12, rue de l'École de médecine, 75006 Paris, France
| | - Olivier Lortholary
- Centre d'infectiologie Necker-Pasteur, service des maladies infectieuses et tropicales, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Sorbonne Paris-Cité, Université Paris-Descartes, 12, rue de l'École de médecine, 75006 Paris, France
| | - Catherine Reichert
- Centre d'infectiologie Necker-Pasteur, service des maladies infectieuses et tropicales, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
| |
Collapse
|
13
|
Wise ME, Weber SG, Schneider A, Stojcevski M, France AM, Schaefer MK, Lin MY, Kallen AJ, Cochran RL. Hospital Staff Perceptions of a Legislative Mandate for Methicillin-Resistant Staphylococcus aureus Screening. Infect Control Hosp Epidemiol 2015; 32:573-8. [DOI: 10.1086/660016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.In August 2007, Illinois passed legislation mandating methicillin-resistant Staphylococcus aureus (MRSA) admission screening for intensive care unit patients. We assessed hospital staff perceptions of the implementation of this law.Design.Mixed-methods evaluation using structured focus groups and questionnaires.Setting.Eight Chicago-area hospitals.Participants.Three strata of staff (leadership, midlevel, and frontline) at each hospital.Methods.All participants completed a questionnaire and participated in a focus group. Focus group transcripts were thematically coded and analyzed. The proportion of staff agreeing with statements about MRSA and the legislation was compared across staff types.Results.Overall, 126 hospital staff participated in 23 focus groups. Fifty-six percent of participants agreed that the legislation had a positive effect at their facility; frontline staff were more likely to agree than midlevel and leadership staff (P < .01). Perceived benefits of the legislation included increased awareness of MRSA among staff and better knowledge of the epidemiology of MRSA colonization. Perceived negative consequences included the psychosocial effect of screening and contact precautions on patients and increased use of resources. Most participants (59%) would choose to continue the activities associated with the legislation but advised facilities in states considering similar legislation to educate staff and patients about MRSA screening and to draft clear implementation plans.Conclusion.Staff from Chicago-area hospitals perceived that mandatory MRSA screening legislation resulted in some benefits but highlighted implementation challenges. States considering similar initiatives might minimize these challenges by optimizing messaging to patients and healthcare staff, drafting implementation plans, and developing program evaluation strategies.
Collapse
|
14
|
Naranje S, Lendway L, Mehle S, Gioe TJ. Does operative time affect infection rate in primary total knee arthroplasty? Clin Orthop Relat Res 2015; 473:64-9. [PMID: 24740318 PMCID: PMC4390911 DOI: 10.1007/s11999-014-3628-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prolonged operative time may increase the risk of infection after total knee arthroplasty (TKA). Both surgeon-related and patient-related factors can contribute to increased operative times. QUESTIONS/PURPOSES The purpose of this study was to determine (1) whether increased operative time is an independent risk factor for revision resulting from infection after TKA; (2) whether increasing body mass index (BMI) increased operative time; and (3) whether increasing experience substantially decreased operative time. METHODS We retrospectively evaluated primary TKAs from our joint registry between March 2000 and August 2012. Cox proportional hazard models were used to assess the relationship between operative time and revision resulting from infection after accounting for age, sex, BMI, and Agency for Healthcare Research and Quality comorbidity score. Of 9973 instances of primary TKA, 73 underwent revision surgery for infection (0.73%). RESULTS After accounting for the confounders of age and sex, operative time was not found to have a significant effect; a 15-minute increase in operative time increased the hazard of revision resulting from infection by only 15.6% (p=0.053; 95% confidence interval, 0.0%-34.0%). In addition, a five-unit increase in BMI was found to increase mean operative time by 1.9 minutes, on average, regardless of sex (p<0.0001). Operative time decreases with increasing experience but appears to plateau at approximately 300 surgeries. CONCLUSIONS Operative time is only one of many factors that may increase infection risk and may be influenced by numerous confounders. Increasing BMI increased operative time but the effect was modest. The effect of increasing experience on operative duration of this common procedure was surprisingly limited among our surgeons. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Sameer Naranje
- />Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN USA
| | - Lisa Lendway
- />HealthEast Department of Research, St Paul, MN USA
| | - Susan Mehle
- />HealthEast Department of Research, St Paul, MN USA
| | - Terence J. Gioe
- />Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN USA
- />Minneapolis Veterans Administration Health Care System, Section 112E, 1 Veterans Drive, Minneapolis, MN 55417 USA
| |
Collapse
|
15
|
Abstract
TOPIC Concept analysis of isolation. PURPOSE This article uses Walker and Avant's methodological approach in distinguishing the concept of isolation between the normal, ordinary language usage and the scientific usage of the concept. BACKGROUND The importance of social contact has long been recognized as a fundamental need for humans. The concept of isolation is used throughout the lay and scientific literature and has a primarily negative connotation for humans. The experience is sometimes severe enough to result in serious reductions in adaptation and performance. DATA SOURCES The Medline, CINAHL, and Google Scholar databases were searched using the key terms of concept analysis, human, and isolation with no restriction on the year of publication. English language reports were used exclusively. CONCLUSION Three attributes were identified: sensory deprivation, social isolation, and confinement. Antecedents included individual perception and situational dimensions. Consequences included anxiety, depression, mood disturbances, anger, loneliness, and adverse health events. Through this concept analysis, isolation has been theoretically defined as a state in which an individual experiences a reduction in the level of normal sensory and social input with possible involuntary limitations on physical space or movement. Systematic studies of isolation using this concept can ultimately enhance nurses' knowledge base and contribute to the quality of life for isolated persons.
Collapse
|
16
|
Webber KL, Macpherson S, Meagher A, Hutchinson S, Lewis B. The Impact of Strict Isolation on MRSA Positive Patients: An Action-Based Study Undertaken in a Rehabilitation Center. Rehabil Nurs 2012; 37:43-50. [DOI: 10.1002/rnj.00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
17
|
Mutsonziwa GA, Green J. Colonised and isolated: a qualitative metasynthesis of patients’ experiences of being infected with multiple drug resistant organisms and subsequent isolation. ACTA ACUST UNITED AC 2011. [DOI: 10.1071/hi11020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
18
|
Lee YM, Lang D, Tho PC. The experience of being a neutropenic cancer patient in an acute care isolation room: a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2011; 9:400-416. [PMID: 27820579 DOI: 10.11124/01938924-201109120-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Protective isolation is one of the precautionary measures put in place for neutropenic cancer patients, where patients will be placed in an isolation room during their medical treatment in the hospital. The purpose of this practice is to minimise neutropenic patients from contracting nosocomial infection and the length of stay in the isolation room varies depending on their medical condition. It has been reported in some literature that this group of patients experience social isolation, a wide range of emotions and psychological burdens such as depression and anxiety as a result of staying in the isolation room. Therefore, a systematic review on neutropenic cancer patients' experience in isolation room will add knowledge to the nursing science of providing high quality care for this particular group of patients. OBJECTIVES The objectives of this review are to understand neutropenic cancer patients' experiences in the isolation room and their coping mechanisms. INCLUSION CRITERIA The participants of interest were adults neutropenic cancer patients aged 18 years old and above.The phenomenon of interest i was the experience of neutropenic cancer patients who were nursed in an isolation room due to chemotherapy induced neutropenia or during the period of haematopoietic stem cell transplant.The studies of interests were are qualitative studies which focus on adult neutropenic cancer patients' experiences in an isolation room.The outcome of interest wai s patients' self reported experiences. SEARCH STRATEGY An initial search to identify keywords was undertaken in MEDLINE and CINAHL. A second search using all identified keywords and index terms across the databases was performed subsequently. The final search included reference lists from included papers for additional studies. METHODOLOGICAL QUALITY Six qualitative papers were included in this review. The papers were qualitative descriptive, phenomenological, qualitative exploratory and grounded theory. All the papers used interview as primary method to collect data except one study which had an additional art making directive method. DATA COLLECTION Data were extracted using standardised data extraction tools from JBI-QARI. DATA SYNTHESIS Categories were formed based on aggregation from the similar findings with like meaning. The categories were then read and reread to develop two synthesised findings that were presented as declamatory and generalisable statements to guide and inform clinical practice. RESULTS Two syntheses were generated based on the meta-aggregation. The first synthesis was that health care workers need to be aware physical isolation could result in social isolation in patients that made them feel powerless. The second synthesis was that health care workers should encourage patients to use cognitive mechanisms to cope with isolation experiences. Family, friends and nurses should step in to provide help in any form whenever patients need it. CONCLUSIONS Isolation room has a negative impact on the neutropenic cancer patients while they are hospitalised. However, they are coping effectively using cognitive mechanisms and receive adequate support externally.Offering patients more options especially having flexibility in their daily routine such as meal times could be a useful intervention to allow them to take some control. Notifying the patient in advance of their time of treatment and involving patients in their treatment care will promote their autonomy. Tracking the patients' coping mechanisms and offering support when necessary will ease the patients' isolation experience.The psychological effects of being cared for in isolation room may undermine the clinical benefits of infection control. Therefore, future research is needed to evaluate the effectiveness of isolation room in preventing neutropenic cancer patients from infection.
Collapse
Affiliation(s)
- Yee Mei Lee
- 1. Singapore National University Hospital Centre for Evidence Based Nursing: Joanna Briggs Collaboration
| | | | | |
Collapse
|
19
|
Lee YM, Lang D, Tho PC. The experience of being a neutropenic cancer patient in an acute care isolation room: a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2011. [DOI: 10.11124/jbisrir-2011-118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
20
|
Abad C, Fearday A, Safdar N. Adverse effects of isolation in hospitalised patients: a systematic review. J Hosp Infect 2010; 76:97-102. [PMID: 20619929 PMCID: PMC7114657 DOI: 10.1016/j.jhin.2010.04.027] [Citation(s) in RCA: 338] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 04/23/2010] [Indexed: 12/14/2022]
Abstract
The use of transmission precautions such as contact isolation in patients known to be colonised or infected with multidrug-resistant organisms is recommended in healthcare institutions. Although essential for infection control, contact isolation has recently been associated with adverse effects in patients. We undertook a systematic review to determine whether contact isolation leads to psychological or physical problems for patients. Studies were included if (1) hospitalised patients were placed under isolation precautions for an underlying medical indication, and (2) any adverse events related to the isolation were evaluated. We found 16 studies that reported data regarding the impact of isolation on patient mental well-being, patient satisfaction, patient safety or time spent by healthcare workers in direct patient care. The majority showed a negative impact on patient mental well-being and behaviour, including higher scores for depression, anxiety and anger among isolated patients. A few studies also found that healthcare workers spent less time with patients in isolation. Patient satisfaction was adversely affected by isolation if patients were kept uninformed of their healthcare. Patient safety was also negatively affected, leading to an eight-fold increase in adverse events related to supportive care failures. We found that contact isolation may negatively impact several dimensions of patient care. Well-validated tools are necessary to investigate these results further. Large studies examining a number of safety indicators to assess the adverse effects of isolation are needed. Patient education may be an important step to mitigate the adverse psychological effects of isolation and is recommended.
Collapse
Affiliation(s)
- C Abad
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison, Wisconsin, USA
| | | | | |
Collapse
|
21
|
Morgan DJ, Diekema DJ, Sepkowitz K, Perencevich EN. Adverse outcomes associated with Contact Precautions: a review of the literature. Am J Infect Control 2009; 37:85-93. [PMID: 19249637 DOI: 10.1016/j.ajic.2008.04.257] [Citation(s) in RCA: 240] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 04/23/2008] [Accepted: 04/24/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Contact Precautions (CP) are a standard method for preventing patient-to-patient transmission of multiple drug-resistant organisms (MDROs) in hospital settings. With the ongoing worldwide concern for MDROs including methicillin-resistant Staphylococcus aureus (MRSA) and broadened use of active surveillance programs, an increasing number of patients are being placed on CP. Whereas few would argue that CP are an important tool in infection control, many reports and small studies have observed worse noninfectious outcomes in patients on CP. However, no review of this literature exists. METHODS We systematically reviewed the literature describing adverse outcomes associated with CP. We identified 15 studies published between 1989 and 2008 relating to adverse outcomes from CP. Nine were higher quality based on standardized collection of data and/or inclusion of control groups. RESULTS Four main adverse outcomes related to CP were identified in this review. These included less patient-health care worker contact, changes in systems of care that produce delays and more noninfectious adverse events, increased symptoms of depression and anxiety, and decreased patient satisfaction with care. CONCLUSION Although CP are recommended by the Centers for Disease Control and Prevention as an intervention to control spread of MDROs, our review of the literature demonstrates that this approach has unintended consequences that are potentially deleterious to the patient. Measures to ameliorate these deleterious consequences of CP are urgently needed.
Collapse
|
22
|
Cassidy I. Student nurses' experiences of caring for infectious patients in source isolation. A hermeneutic phenomenological study. J Clin Nurs 2006; 15:1247-56. [PMID: 16968429 DOI: 10.1111/j.1365-2702.2006.01404.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To illuminate issues central to general student nurses' experiences of caring for isolated patients within the hospital environment, which may assist facilitators of learning to prepare students for caring roles. BACKGROUND Because of the development of hospital-resistant micro-organisms, caring for patients in source isolation is a frequent occurrence for supernumerary students on the general nursing programme. Despite this, students' perceptions of caring for this client group remain under researched. DESIGN AND METHODS Through methods grounded in hermeneutic phenomenology, eight students in the second year of the three-year undergraduate programme in general nursing were interviewed using an un-structured, open-ended and face-to-face interview approach. Data analysis was approached through thematic analysis. RESULTS Four themes emerged: The organization: caring in context, Barriers and breaking the barriers, Theory and practice, Only a student. The imposed physical, psychological, social and emotional barriers of isolation dramatically alter the caring experience. Balancing the care of isolated patients to meet their individual needs while preventing the spread of infection has significance for students. Applying infection control theory to the care of patients in source isolation is vital for students' personal and professional development. Perceptions of supernumerary status influence students' experiences of caring for these patients. RELEVANCE TO CLINICAL PRACTICE Designating equipment for the sole use of isolated patients assists students in maintaining infection control standards. Balancing the art and science of caring for patients in source isolation is important to reduce barriers to the student-patient relationship and to promote delivery of holistic care. Staff nurses should consider using available opportunities to impart recommended isolation practices to students thereby linking the theory of infection control to patient care. Providing structured, continuing education for all grades of staff would acknowledge the interdependence of all healthcare workers in controlling hospital-acquired infection.
Collapse
Affiliation(s)
- Irene Cassidy
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
| |
Collapse
|
23
|
Saiman L, Siegel J. Infection control recommendations for patients with cystic fibrosis: microbiology, important pathogens, and infection control practices to prevent patient-to-patient transmission. Infect Control Hosp Epidemiol 2003; 24:S6-52. [PMID: 12789902 DOI: 10.1086/503485] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Infection Control Recommendations for Patients With Cystic Fibrosis: Microbiology, Important Pathogens, and Infection Control Practices to Prevent Patient-to-Patient Transmissionupdates, expands, and replaces the consensus statement,Microbiology and Infectious Disease in Cystic Fibrosispublished in 1994. This consensus document presents background data and evidence-based recommendations for practices that are intended to decrease the risk of transmission of respiratory pathogens among CF patients from contaminated respiratory therapy equipment or the contaminated environment and thereby reduce the burden of respiratory illness. Included are recommendations applicable in the acute care hospital, ambulatory, home care, and selected non-healthcare settings. The target audience includes all healthcare workers who provide care to CF patients. Antimicrobial management is beyond the scope of this document.
Collapse
Affiliation(s)
- Lisa Saiman
- Department of Pediatrics, Columbia University, New York, New York, USA
| | | |
Collapse
|