Do physicians examine patients in contact isolation less frequently? A brief report.
BACKGROUND
Patients who are hospitalized and infected with multidrug-resistant bacteria are usually placed in contact isolation, which requires hospital personnel to gown and glove before patient examination. Contact isolation with active culture surveillance appears beneficial in preventing the spread of drug-resistant infections; however, contact isolation may impede the ability to examine patients as a result of the additional effort required to gown and glove. We assessed whether patients who are hospitalized and placed under contact precautions are examined less often by second- and third-year medical residents (ie, senior medical residents), and attending physicians during morning rounds.


METHODS
We conducted a prospective cohort study on the inpatient medical services at 2 university-affiliated medical centers. We directly observed senior medical residents and attending physicians during morning rounds, and recorded the contact precaution status of the patient and whether they were examined by either physician.


RESULTS
Of a total of 139 patients, 31 (22%) were in contact isolation. Senior medical residents examined 26 of 31 patients (84%) in contact isolation versus 94 of 108 patients (87%) not in contact isolation (relative risk, 0.96; 95% confidence interval, 0.81-1.14; P =.58). In comparison, attending physicians examined 11 of 31 patients (35%) in contact isolation versus 79 of 108 patients (73%) not in contact isolation (relative risk, 0.49; 95% confidence interval, 0.30-0.79; P <.001).


CONCLUSIONS
Attending physicians are about half as likely to examine patients in contact isolation compared with patients not in contact isolation.
Saint
Sanjay
S
Ann Arbor Department of Veterans Affairs Medical Center, USA.
Higgins
Leigh Ann
LA
Nallamothu
Brahmajee K
BK
Chenoweth
Carol
C
D000046:Academic Medical Centers; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D010356:Patient Isolation; D010808:Physical Examination / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011336:Probability; D011446:Prospective Studies; D011787:Quality of Health Care