Quality of Care/Patient Safety

Hospital isolation policies to prevent spread of infection may inadvertently reduce care quality for isolated patients

Hospitals often isolate patients with infectious diseases to prevent transmission of the infection to other patients and hospital staff. The recommended infection control precautions depend on the infectious agent, but typically they involve placing the patient in a private room, requiring visitors to wear protective apparel (for example, gloves, gowns, and masks), and restricting the movement of the patient outside of the room. Unfortunately, these isolation policies may inadvertently lead to poorer quality of care and adverse events (injuries caused by medical management that prolong the hospital stay or produce disability) for isolated patients, concludes a study supported by the Agency for Healthcare Research and Quality (HS11169 and HS11534).

David W. Bates, M.D., M.Sc., of Harvard Medical School, and his colleagues found that hospitalized patients who were isolated for methicillin-resistant Staphylococcus aureus infection at two large teaching hospitals (78 admitted with a variety of diagnoses, and 72 admitted for congestive heart failure) were twice as likely as similarly diagnosed patients who did not have to be isolated for infection (matched controls) to experience adverse events (mostly preventable ones) during their hospitalizations (31 vs. 15 adverse events per 1,000 days).

Isolated patients were eight times more likely than control patients to experience supportive care failures such as falls, pressure ulcers, and fluid or electrolyte disorders. They also were more likely to make a formal complaint to the hospital about their care than control patients (8 vs.1 percent), to have their vital signs not recorded as ordered (51 vs. 31 percent), and to have days with no physician progress note (26 vs. 13 percent). Isolated patients with heart failure were less likely to achieve standards of care for heart failure management than similar patients not in isolation. These findings were based on analysis of medical records to compare processes of care, outcomes, and satisfaction for both groups.

The results of this study demonstrate a strong association between patient isolation and shortfalls of processes, outcomes, and satisfaction, notes Dr. Bates. The results also illustrate the importance of balancing the risks and benefits of an intervention while highlighting that mandatory policies may not always be appropriate. Because the complexities of health care are likely to increase in the future, the detection of unintended adverse consequences may be even more difficult, according to Dr. Bates. He calls for well-designed, carefully evaluated, and appropriately implemented interventions to ensure the safety of all patients.

See "Safety of patients isolated for infection control," by Henry Thomas Stelfox, M.D., Dr. Bates,, and Donald A. Redelmeier, M.D., M.Sc., in the October 8, 2003, Journal of the American Medical Association 290(14), pp. 1899-1905.

Editor's Note: Another AHRQ-supported study (HS11540) on infection control compares the infection risk of multilumen and single lumen central venous catheters. For details see: Dezfulian, C., Lavelle, J., Nallamothu, B.K., and others. (2003). "Rates of infection for single-lumen versus multilumen central venous catheters: A meta-analysis." Critical Care Medicine 31(9), pp. 2385-2390.

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