Contact isolation in surgical patients: a barrier to care?
BACKGROUND
Contact isolation is commonly used to prevent transmission of resistant organisms. We hypothesized that contact isolation negatively impacts the amount of direct patient care.


METHODS
For 2 hours per day over a 5-week period, a single observer recorded provider/patient contact in adjacent isolated and nonisolated patient rooms on both the surgical intensive care unit (ICU) and surgical wards of a university hospital. Number of visits, contact time, and compliance with isolation were recorded, as was illness severity as assessed by APACHE II score.


RESULTS
Isolated patients were visited fewer times than nonisolated patients (5.3 vs 10.9 visits/h, P <.0001) and had less contact time overall (29 +/- 5 vs 37 +/- 3 min/h, P =.008), in the ICU (41 +/- 10 vs 47 +/- 5 min/h, P =.03), and on the floor (17 +/- 3 vs 28 +/- 4 min/h, P =.039), in spite of higher mean APACHE II scores in the isolated (10.1 +/- 1.0 vs 7.6 +/- 0.8, P =.05). Among floor patients with APACHE II scores greater than 10, patients in the isolated group had nearly 40% less contact time per hour than patients in the nonisolated group (19 +/- 4 vs 34 +/- 7 min/h, P =.05).


CONCLUSIONS
Because of the significantly lower contact time observed, particularly among the most severely ill of floor patients, we propose a reexamination of the risk-benefit ratio of this infection control method.
Evans
Heather L
HL
Department of Surgery, UVA Health System, Charlottesville, VA 22908, USA.
Shaffer
Mary M
MM
Hughes
Michael G
MG
Smith
Robert L
RL
Chong
Tae W
TW
Raymond
Daniel P
DP
Pelletier
Shawn J
SJ
Pruett
Timothy L
TL
Sawyer
Robert G
RG
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003152:Community Health Nursing / Q000706:statistics & numerical data*; D003422:Critical Care / Q000592:standards* / Q000706:statistics & numerical data; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects / Q000502:physiology; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D008297:Male; D008875:Middle Aged; D010356:Patient Isolation; D011446:Prospective Studies; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000453:epidemiology / Q000517:prevention & control; D013503:Surgery Department, Hospital
D000900:Anti-Bacterial Agents; D005839:Gentamicins