Safety of patients isolated for infection control.
BACKGROUND
Hospital infection control policies that use patient isolation prevent nosocomial transmission of infectious diseases, but may inadvertently lead to patient neglect and errors.


OBJECTIVE
To examine the quality of medical care received by patients isolated for infection control.


METHODS
We identified consecutive adults who were isolated for methicillin-resistant Staphylococcus aureus colonization or infection at 2 large North American teaching hospitals: a general cohort (patients admitted with all diagnoses between January 1, 1999, and January 1, 2000; n = 78); and a disease-specific cohort (patients admitted with a diagnosis of congestive heart failure between January 1, 1999, and July 1, 2002; n = 72). Two matched controls were selected for each isolated patient (n = 156 general cohort controls and n = 144 disease-specific cohort controls).


METHODS
Quality-of-care measures encompassing processes, outcomes, and satisfaction. Adjustments for study cohort and patient demographic, hospital, and clinical characteristics were conducted using multivariable regression.


RESULTS
Isolated and control patients generally had similar baseline characteristics; however, isolated patients were twice as likely as control patients to experience adverse events during their hospitalization (31 vs 15 adverse events per 1000 days; P<.001). This difference in adverse events reflected preventable events (20 vs 3 adverse events per 1000 days; P<.001) as opposed to nonpreventable events (11 vs 12 adverse events per 1000 days; P =.98). Isolated patients were also more likely to formally complain to the hospital about their care than control patients (8% vs 1%; P<.001), to have their vital signs not recorded as ordered (51% vs 31%; P<.001), and more likely to have days with no physician progress note (26% vs 13%; P<.001). No differences in hospital mortality were observed for the 2 groups (17% vs 10%; P =.16).


CONCLUSIONS
Compared with controls, patients isolated for infection control precautions experience more preventable adverse events, express greater dissatisfaction with their treatment, and have less documented care.
Stelfox
Henry Thomas
HT
Department of Medicine, University of Toronto, Toronto, Ontario. stelfox@fas.harvard.edu
Bates
David W
DW
Redelmeier
Donald A
DA
D002170:Canada; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D019300:Medical Errors / Q000706:statistics & numerical data*; D016106:Methicillin Resistance; D010043:Outcome and Process Assessment, Health Care; D010356:Patient Isolation / Q000592:standards*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012044:Regression Analysis; D017751:Safety Management; D013203:Staphylococcal Infections / Q000517:prevention & control; D013211:Staphylococcus aureus; D014481:United States