title: Impact of methicillin resistant Staphylococcus aureus contact isolation units on medical care.
abstract: BACKGROUND
  Patient isolation using contact precautions has gained widespread use to halt MRSA transmission, however supportive data is scarce and concerns regarding patient safety and satisfaction have been raised. At our institution, MRSA patients are isolated on a dedicated ward (cohort isolation), rather than in separate rooms. Our objectives were (1) to determine the proportion of bedside medical visits to patients on an isolation ward, (2) to quantify complications in those patients and (3) to determine if those complications are related to isolation and if they can be prevented.
  
  
  METHODS
  This retrospective case-control study was performed on the two sites of a tertiary teaching hospital in Sherbrooke, QC, Canada. We matched MRSA patients with an admission diagnosis of heart failure or chronic obstructive pulmonary disease to similar non-isolated controls. The proportion of bedside visits was ascertained through the number of progress notes with subjective elements or with a physical examination. Complications were sought through an extensive file review, and events were analysed according to Baker's CAES causality and preventability scales.
  
  
  RESULTS
  Overall, 111 patient pairs were analysed (35 with heart failure and 76 with COPD). Isolated patients received less bedside visits (subjective notes/1,000 patient-days: 849.6 vs. 983.3, p = 0,001). Attending physicians (454.5 vs. 451.4, p = 0,02) and residents (347.0 vs. 416.9, p = 0.01) are responsible for this discrepancy, while medical students appear to visit isolated and non-isolated patients equally (116.5 vs. 114.9, p = 0.90). Isolated patients showed a tendency towards longer stay and more preventable complications, although no difference in the total number of complications was observed.
  
  
  CONCLUSIONS
  Isolated patients have less documented care that suggests less bedside visits from the medical staff, which could hamper the therapeutical relationship. Further studies are needed to explain this finding.
authors: Infectious Diseases Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
authors: Vincent
authors: V
authors: Masse
authors: Louis
authors: L
authors: Valiquette
authors: Soraya
authors: S
authors: Boukhoudmi
authors: Francis
authors: F
authors: Bonenfant
authors: Yasmine
authors: Y
authors: Talab
authors: Jean-Christophe
authors: JC
authors: Carvalho
authors: Isabelle
authors: I
authors: Alarie
authors: Nathalie
authors: N
authors: Carrier
authors: Paul
authors: P
authors: Farand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006757:Hospital Units; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010356:Patient Isolation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000628:therapy*