American Journal of Infection Control 43 (2015) 397-9
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Brief report
Effects of isolation on patients and staff Carmen Lupión-Mendoza RN a, b, María J. Antúnez-Domínguez RN a, Carmen González-Fernández RN a, Concepción Romero-Brioso RN a, b, Jesús Rodriguez-Bano MD, PhD a, c, * a Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitario Virgen Macarena y Virgen del Rocío, Seville, Spain b Facultad de Medicina, Universidad de Sevilla, Seville, Spain c Departamento de Medicina, Universidad de Sevilla, Seville, Spain
Key Words: Adverse effect Infection control Anxiety Depression Patient care
A matched case-control study and a qualitative investigation were used to identify adverse events in diverse dimensions associated with isolation. Overall satisfaction with care was similar among patients in isolation, but staff was found to be less responsive. Isolation was also associated with depression, but not with increased anxiety. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
The isolation of patients who are colonized or infected by specific pathogens is recommended as part of precautions for preventing transmission. Isolation may affect the mental well-being of patients, their satisfaction with care, and increase the risk of adverse events.1 Our infection control program2,3 includes specific activities with the aim of preventing some of these problems. In this context, we investigated different aspects of the potentially adverse effects of isolation to identify further areas of intervention.
METHODS The study was performed during 2011 and 2012 in a 900-bed tertiary hospital with an active infection control program.2,3 Routine procedures include an infection control nurse informs patients and relatives of the reasons for isolation and the measures; specific messages are given with the aim of reducing anxiety or guilt feelings and the information is reinforced during admission according to perceived needs. Health care workers (HCWs) receive reinforcement training about the specific measures and the importance of adherence. Two studies were performed. For the matched case-control study, the cases were adult patients admitted in isolation
for 5 days. For each case, a control was chosen from among those admitted to the same ward and week with a similar length of previous hospital stay ( 2 days) and a similar Charlson score ( 1).4 Patients with neurocognitive impairment were excluded. A validated questionnaire5 was used to measure satisfaction with the health care received using a Likert scale. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression.6 Conditional logistic regression was used to calculate crude and adjusted P values and odds ratios (OR) with a 95% confidence interval (CI). P values .05 in multivariate analyses were considered significant. Second, a qualitative approach using semistructured individual interviews to cases and HCWs about aspects extracted after a literature review was performed. Qualitative information was analyzed for content as previously recommended.7 The interviews were conducted by using a guide with open questions on 4 major areas: knowledge, meaning, satisfaction, and feelings. The interviews were recorded and transcribed. The information was classified on themes that were refined after several rounds. The final themes included comfort, information, care received, and visits/relatives for patients; and education, risks, and quality of care for HCWs. We provide some quotations as examples. The study was approved by the local ethical review board. RESULTS
* Address correspondence to Jesús Rodriguez-Bano, MD, PhD, Hospital Universitario Virgen Macarena, Sevilla 41009, Spain. E-mail addresses: [email protected], [email protected] (J. RodriguezBano). Conflicts of interest: None to report.
Seventy-two pairs of cases and controls were included. Among the cases, the reasons for isolation were contact precautions in 58 patients (80.6%), and airborne precautions in 14 patients
0196-6553/$36.00 - Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2015.01.009
398
C. Lupión-Mendoza et al. / American Journal of Infection Control 43 (2015) 397-9
Table 1 Univariate comparison of 72 cases with 72 matched controls* Cases (n ¼ 72) Baseline features Median age in years (range) Females Nonfatal chronic underlying disease Accompanied by direct relatives or professional caregivers Residence in urban area Secondary education or higher Patient satisfaction with care received Overall satisfaction with the professional treatment received from health care workers (high/very high)z Nurses treated the patients in polite and respectful manner (totally/partially agree)x Physicians treated the patients in polite and respectful manner (totally/partially agree)x Nurses provided clear information about the health problem (totally/partially agree)x Physicians provided clear information about the health problem (totally/partially agree)x Clear explanations were provided before all procedures (totally/partially agree)x The importance of hand hygiene was explained by staff (totally/partially agree)x Health care workers entered the room whenever the patient called them (totally/partially agree)x Blood pressure and temperature recorded at least once a day (totally/partially agree)x The physician visited daily (totally/partially agree)x The room was comfortable (totally/partially agree)x The food tray was removed promptly after eating (totally/partially agree)x Room cleaning was satisfactory (totally/partially agree)x The room atmosphere was sufficiently quiet (totally/partially agree)x I frequently felt lonely during admission (totally/partially agree)x Medical chart/records review Medical notes were recorded every day Nurse’s notes were recorded every day Blood pressure was recorded at least once daily, every day Daily temperature was recorded at least once a day, every day Daily glycemic levels were recorded as indicated, everyday (only diabetic patients) Adverse events Any falls during present admission Any new pressure ulcers during present admission Any falls or pressure ulcers during present admission Hospital Anxiety and Depression Scale questionnaire Mean total score for anxiety (mean, 95% confidence interval) Patients with significant anxiety (8 points) Mean total score for depression (average, 95% confidence interval) Patients with significant depression (8 points)
Controls (n ¼ 72)
P valuey
62 20 23 71 42 44
(21-93) (27.8) (31.9) (98.6) (58.3) (61.1)
69 32 19 65 41 40
(23-89) (31.9) (26.4) (90.3) (56.9) (55.6)
67 70 71 64 66 62 48 66 65 69 62 34 66 70 17
(93.0) (97.2) (98.6) (88.8) (91.6) (86.1) (66.6) (91.6) (90.2) (95.8) (87.3) (47.2) (91.7) (97.2) (23.6)
69 71 72 68 62 66 18 71 70 71 67 63 70 54 17
(95.8) (98.6) (100) (94.4) (86.1) (91.6) (25.0) (98.6) (97.2) (98.6) (93.1) (87.5) (97.2) (75.0) (23.6)
.47 .56 .99 .23 .29 .29
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Brief report
Effects of isolation on patients and staff Carmen Lupión-Mendoza RN a, b, María J. Antúnez-Domínguez RN a, Carmen González-Fernández RN a, Concepción Romero-Brioso RN a, b, Jesús Rodriguez-Bano MD, PhD a, c, * a Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitario Virgen Macarena y Virgen del Rocío, Seville, Spain b Facultad de Medicina, Universidad de Sevilla, Seville, Spain c Departamento de Medicina, Universidad de Sevilla, Seville, Spain
Key Words: Adverse effect Infection control Anxiety Depression Patient care
A matched case-control study and a qualitative investigation were used to identify adverse events in diverse dimensions associated with isolation. Overall satisfaction with care was similar among patients in isolation, but staff was found to be less responsive. Isolation was also associated with depression, but not with increased anxiety. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
The isolation of patients who are colonized or infected by specific pathogens is recommended as part of precautions for preventing transmission. Isolation may affect the mental well-being of patients, their satisfaction with care, and increase the risk of adverse events.1 Our infection control program2,3 includes specific activities with the aim of preventing some of these problems. In this context, we investigated different aspects of the potentially adverse effects of isolation to identify further areas of intervention.
METHODS The study was performed during 2011 and 2012 in a 900-bed tertiary hospital with an active infection control program.2,3 Routine procedures include an infection control nurse informs patients and relatives of the reasons for isolation and the measures; specific messages are given with the aim of reducing anxiety or guilt feelings and the information is reinforced during admission according to perceived needs. Health care workers (HCWs) receive reinforcement training about the specific measures and the importance of adherence. Two studies were performed. For the matched case-control study, the cases were adult patients admitted in isolation
for 5 days. For each case, a control was chosen from among those admitted to the same ward and week with a similar length of previous hospital stay ( 2 days) and a similar Charlson score ( 1).4 Patients with neurocognitive impairment were excluded. A validated questionnaire5 was used to measure satisfaction with the health care received using a Likert scale. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression.6 Conditional logistic regression was used to calculate crude and adjusted P values and odds ratios (OR) with a 95% confidence interval (CI). P values .05 in multivariate analyses were considered significant. Second, a qualitative approach using semistructured individual interviews to cases and HCWs about aspects extracted after a literature review was performed. Qualitative information was analyzed for content as previously recommended.7 The interviews were conducted by using a guide with open questions on 4 major areas: knowledge, meaning, satisfaction, and feelings. The interviews were recorded and transcribed. The information was classified on themes that were refined after several rounds. The final themes included comfort, information, care received, and visits/relatives for patients; and education, risks, and quality of care for HCWs. We provide some quotations as examples. The study was approved by the local ethical review board. RESULTS
* Address correspondence to Jesús Rodriguez-Bano, MD, PhD, Hospital Universitario Virgen Macarena, Sevilla 41009, Spain. E-mail addresses: [email protected], [email protected] (J. RodriguezBano). Conflicts of interest: None to report.
Seventy-two pairs of cases and controls were included. Among the cases, the reasons for isolation were contact precautions in 58 patients (80.6%), and airborne precautions in 14 patients
0196-6553/$36.00 - Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2015.01.009
398
C. Lupión-Mendoza et al. / American Journal of Infection Control 43 (2015) 397-9
Table 1 Univariate comparison of 72 cases with 72 matched controls* Cases (n ¼ 72) Baseline features Median age in years (range) Females Nonfatal chronic underlying disease Accompanied by direct relatives or professional caregivers Residence in urban area Secondary education or higher Patient satisfaction with care received Overall satisfaction with the professional treatment received from health care workers (high/very high)z Nurses treated the patients in polite and respectful manner (totally/partially agree)x Physicians treated the patients in polite and respectful manner (totally/partially agree)x Nurses provided clear information about the health problem (totally/partially agree)x Physicians provided clear information about the health problem (totally/partially agree)x Clear explanations were provided before all procedures (totally/partially agree)x The importance of hand hygiene was explained by staff (totally/partially agree)x Health care workers entered the room whenever the patient called them (totally/partially agree)x Blood pressure and temperature recorded at least once a day (totally/partially agree)x The physician visited daily (totally/partially agree)x The room was comfortable (totally/partially agree)x The food tray was removed promptly after eating (totally/partially agree)x Room cleaning was satisfactory (totally/partially agree)x The room atmosphere was sufficiently quiet (totally/partially agree)x I frequently felt lonely during admission (totally/partially agree)x Medical chart/records review Medical notes were recorded every day Nurse’s notes were recorded every day Blood pressure was recorded at least once daily, every day Daily temperature was recorded at least once a day, every day Daily glycemic levels were recorded as indicated, everyday (only diabetic patients) Adverse events Any falls during present admission Any new pressure ulcers during present admission Any falls or pressure ulcers during present admission Hospital Anxiety and Depression Scale questionnaire Mean total score for anxiety (mean, 95% confidence interval) Patients with significant anxiety (8 points) Mean total score for depression (average, 95% confidence interval) Patients with significant depression (8 points)
Controls (n ¼ 72)
P valuey
62 20 23 71 42 44
(21-93) (27.8) (31.9) (98.6) (58.3) (61.1)
69 32 19 65 41 40
(23-89) (31.9) (26.4) (90.3) (56.9) (55.6)
67 70 71 64 66 62 48 66 65 69 62 34 66 70 17
(93.0) (97.2) (98.6) (88.8) (91.6) (86.1) (66.6) (91.6) (90.2) (95.8) (87.3) (47.2) (91.7) (97.2) (23.6)
69 71 72 68 62 66 18 71 70 71 67 63 70 54 17
(95.8) (98.6) (100) (94.4) (86.1) (91.6) (25.0) (98.6) (97.2) (98.6) (93.1) (87.5) (97.2) (75.0) (23.6)
.47 .56 .99 .23 .29 .29
