Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-30T20:21:28.515Z Has data issue: false hasContentIssue false
  • English
  • Français

Patient isolation for infection control and patient experience

Published online by Cambridge University Press:  18 December 2018

Zishan K. Siddiqui ,
Sarah Johnson Conway ,
Mohammed Abusamaan ,
Amanda Bertram ,
Stephen A. Berry ,
Lisa Allen ,
Ariella Apfel ,
Holley Farley ,
Junya Zhu  and
Albert W. Wu
...Show all authors
Zishan K. Siddiqui
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Sarah Johnson Conway*
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Mohammed Abusamaan
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Amanda Bertram
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Stephen A. Berry
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Lisa Allen
Affiliation:
Johns Hopkins Health System Service Excellence, Johns Hopkins Medicine, Baltimore, Maryland
Ariella Apfel
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Holley Farley
Affiliation:
Hospitalist Unit, Johns Hopkins Hospital, Baltimore, Maryland
Junya Zhu
Affiliation:
Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, Maryland
Albert W. Wu
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Daniel J. Brotman
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Author for correspondence: Sarah Johnson Conway MD, 600 N Wolfe Street, Meyer 8-145, Baltimore, MD 21287. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 2 , February 2019 , pp. 194 - 199
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: These findings were previously presented as a poster at the Society of Hospital Medicine 2018 Annual Conference on April 9, 2018, in Orlando, Florida.

Cite this article: Siddiqui ZK, et al. (2019). Patient isolation for infection control and patient experience. Infection Control & Hospital Epidemiology 2019, 40, 194–199. doi: 10.1017/ice.2018.324

References

1. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Centers for Disease Control and Prevention website. https://www.cdc.gov/niosh/docket/archive/pdfs/NIOSH-219/0219-010107-siegel.pdf. Accessed January 17, 2017.Google Scholar
2. Evans, HL, Shaffer, MM, Hughes, MG, et al. Contact isolation in surgical patients: a barrier to care? Surgery 2003;134:180–188. doi:10.1067/msy.2003.222.Google Scholar
3. Kirkland, KB, Weinstein, JM. Adverse effects of contact isolation. Lancet 1999;354:1177–1178. doi:10.1016/S0140-6736(99)04196-3.Google Scholar
4. Saint, S, Higgins, LA, Nallamothu, BK, Chenoweth, C. Do physicians examine patients in contact isolation less frequently? A brief report Sanjay Saint. Am J Infect Control 2003;31:354–356.Google Scholar
5. Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA. 2003;290:1899.Google Scholar
6. Lupión-Mendoza, C, Antúnez-Domínguez, MJ, González-Fernández, C, Romero-Brioso, C, Rodriguez-Bano, J. Effects of isolation on patients and staff. Am J Infect Control 2015;43:397–399.Google Scholar
7. Maunder, R, Hunter, J, Vincent, L, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ 2003;168:1245–1251.Google Scholar
8. Catalano, G, Houston, SH, Catalano, MC, et al. Anxiety and depression in hospitalized patients in resistant organism isolation. South Med J 2003;96:141–145.Google Scholar
9. Gammon, J. Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs. Int J Nurs Pract 1998;4:84–96.Google Scholar
10. MacKellaig, JM. A study of the psychological effects of intensive care with particular emphasis on patients in isolation. Intensive Care Nurs 1987;2:176–185.Google Scholar
11. Gasink, LB, Singer, K, Fishman, NO, et al. Contact isolation for infection control in hospitalized patients: Is patient satisfaction affected? Infect Control Hosp Epidemiol 2008;29:275–278.Google Scholar
12. Mehrotra, P, Croft, L, Day, HR, et al. Effects of contact precautions on patient perception of care and satisfaction: a prospective cohort study. Infect Control Hosp Epidemiol 2013;34:1087–1093.Google Scholar
13. Livorsi, DJ, Kundu, MG, Batteiger, B, Kressel, AB. Effect of contact precautions for MRSA on patient satisfaction scores. J Hosp Infect 2015;90:263–266.Google Scholar
14. Vinski, J, Bertin, M, Sun, Z, et al. Impact of isolation on hospital consumer assessment of healthcare providers and systems scores: Is isolation isolating? Infect Control Hosp Epidemiol 2012;33:513–516.Google Scholar
15. Centers for Medicare and Medicaid Services. CAHPS Hospital Survey (HCAHPS): Quality Assurance Guidelines. Consumer Assessment of Healthcare Providers and Systems website. http://www.hcahpsonline.org/globalassets/hcahps/quality-assurance/2018_qag_v13.0.pdf. Accessed June 3, 2018.Google Scholar
16. Hospital Compare datasets. Centers for Medicare and Medicaid Services website. https://data.medicare.gov/data/hospital-compare. Accessed October 30, 2018.Google Scholar
17. Siddiqui, ZK, Zuccarelli, R, Durkin, N, Wu, AW, Brotman, DJ. Changes in patient satisfaction related to hospital renovation: experience with a new clinical building. J Hosp Med. 2015;10:165–171.Google Scholar
18. Sofaer, S, Crofton, C, Goldstein, E, Hoy, E, Crabb, J. What do consumers want to know about the quality of care in hospitals? Health Serv Res 2005;40:2018–2036.Google Scholar
19. Elliott, MN, Kanouse, DE, Edwards, CA, Hilborne, LH. Components of care vary in importance for overall patient-reported experience by type of hospitalization. Med Care 2009;47:842–849.Google Scholar
20. Ahmadi Kashkoli, S, Zarei, E, Daneshkohan, A, Khodakarim, S. Hospital responsiveness and its effect on overall patient satisfaction. Int J Health Care Qual Assur 2017;30:728–736.Google Scholar
21. Meade, CM, Bursell, AL, Ketelsen, L. Effects of nursing rounds: on patients’ call light use, satisfaction, and safety. Am J Nurs 2006;106:58–70.Google Scholar
22. Go, S, Thomasson-Waters, J, Law, E. Improving patient satisfaction by changing patients’ percpetions of staff responsiveness on a cardiac telemetry unit. Cone Health website. https://www.conehealth.com/app/files/public/7258/34-improving-patient-satisfactionby-changing-patients-perception-of-staff-responsiveness.pdf. Accessed March 20, 2018.Google Scholar
23. Williams, DB. Improving Staff Responsiveness to Patient-Initiated Call Lights. San Francisco, CA; 2014.Google Scholar
24. Elliott, MN, Zaslavsky, AM, Goldstein, E, et al. Effects of Survey Mode, Patient Mix, and Nonresponse on CAHPS Hospital Survey Scores. Health Serv Res 2009;44:501–518.Google Scholar