Searcy RJ, Jankowski CA, Johnson DW, Ferreira JA. Evaluation of sedation-related medication errors in patients on contact isolation in the intensive care unit.
J Hosp Infect 2017;
98:175-180. [PMID:
28666781 DOI:
10.1016/j.jhin.2017.06.025]
[Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/21/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND
Patients in intensive care units (ICUs) may be placed on contact isolation for meticillin-resistant Staphylococcus aureus (MRSA) colonization to prevent transmission. Prior studies suggest that isolated patients may receive substandard care compared with non-isolated patients. An optimal level of sedation is required to facilitate mechanical ventilation (MV) and to minimize adverse outcomes.
AIM
To determine if patients on MV and isolated for MRSA colonization are at increased risk of oversedation compared with non-isolated patients.
METHODS
Retrospective chart review of adult patients on MV who received an MRSA nasal polymerase chain reaction assay and sedation within 24 and 48 h of ICU admission, respectively. Endpoints included rate of inappropriate sedation, length of ICU stay, length of time on MV, and incidence of ventilator-associated complications.
FINDINGS
In total, 226 patients were included (114 MRSA positive, 112 MRSA negative). Baseline demographics were similar between the groups, with the exception of ICU admission diagnosis. Fifty-six (55%) isolated patients experienced inappropriate sedation compared with 49 (50%) non-isolated patients (P=0.482). Isolated patients spent longer in the ICU (10.4 vs 6.8 days, P=0.0006), longer on MV (8.98 vs 4.81 days, P<0.001), and required tracheostomies more frequently [37 (32%) vs 14 (13%), P=0.0003] than non-isolated patients.
CONCLUSIONS
Isolated patients were not at increased risk of oversedation compared with non-isolated patients. There was an association between the use of contact isolation for MRSA nares colonization and prolonged ICU stay and prolonged MV.
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