title: Adverse outcomes associated with Contact Precautions: a review of the literature.
abstract: BACKGROUND
  Contact Precautions (CP) are a standard method for preventing patient-to-patient transmission of multiple drug-resistant organisms (MDROs) in hospital settings. With the ongoing worldwide concern for MDROs including methicillin-resistant Staphylococcus aureus (MRSA) and broadened use of active surveillance programs, an increasing number of patients are being placed on CP. Whereas few would argue that CP are an important tool in infection control, many reports and small studies have observed worse noninfectious outcomes in patients on CP. However, no review of this literature exists.
  
  
  METHODS
  We systematically reviewed the literature describing adverse outcomes associated with CP. We identified 15 studies published between 1989 and 2008 relating to adverse outcomes from CP. Nine were higher quality based on standardized collection of data and/or inclusion of control groups.
  
  
  RESULTS
  Four main adverse outcomes related to CP were identified in this review. These included less patient-health care worker contact, changes in systems of care that produce delays and more noninfectious adverse events, increased symptoms of depression and anxiety, and decreased patient satisfaction with care.
  
  
  CONCLUSIONS
  Although CP are recommended by the Centers for Disease Control and Prevention as an intervention to control spread of MDROs, our review of the literature demonstrates that this approach has unintended consequences that are potentially deleterious to the patient. Measures to ameliorate these deleterious consequences of CP are urgently needed.
authors.affiliation: Veterans Affairs Maryland Health Care System, and the Department of Epidemiology and Preventative Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA. dmorgan@epi.umaryland.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Morgan
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Diekema
authors.forename: Kent
authors.initials: K
authors.lastname: Sepkowitz
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
mesh_terms: D001424:Bacterial Infections / Q000635:transmission*; D003428:Cross Infection / Q000635:transmission*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017063:Outcome Assessment, Health Care