Infection Control & Hospital Epidemiology (2019), 40, 194–199 doi:10.1017/ice.2018.324
Original Article
Patient isolation for infection control and patient experience Zishan K. Siddiqui MD1, Sarah Johnson Conway MD1, Mohammed Abusamaan MBBS1, Amanda Bertram MS1, Stephen A. Berry MD PhD2, Lisa Allen PhD3, Ariella Apfel MPH1, Holley Farley RN4, Junya Zhu PhD5,
Albert W. Wu MD1 and Daniel J. Brotman MD1 1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, 2Division of Infectious Diseases, Department of Medicine, Johns
Hopkins University School of Medicine, Baltimore, Maryland, 3Johns Hopkins Health System Service Excellence, Johns Hopkins Medicine, Baltimore, Maryland, 4Hospitalist Unit, Johns Hopkins Hospital, Baltimore, Maryland and 5Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, Maryland
Abstract
Objective: Hospitalized patients placed in isolation due to a carrier state or infection with resistant or highly communicable organisms report higher rates of anxiety and loneliness and have fewer physician encounters, room entries, and vital sign records. We hypothesized that isolation status might adversely impact patient experience as reported through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, particularly regarding communication. Design: Retrospective analysis of HCAHPS survey results over 5 years. Setting: A 1,165-bed, tertiary-care, academic medical center. Patients: Patients on any type of isolation for at least 50% of their stay were the exposure group. Those never in isolation served as controls. Methods: Multivariable logistic regression, adjusting for age, race, gender, payer, severity of illness, length of stay and clinical service were used to examine associations between isolation status and “top-box” experience scores. Dose response to increasing percentage of days in isolation was also analyzed. Results: Patients in isolation reported worse experience, primarily with staff responsiveness (help toileting 63% vs 51%; adjusted odds ratio [aOR], 0.77; P=.0009) and overall care (rate hospital 80% vs 73%; aOR, 0.78; P<.0001), but they reported similar experience in other domains. No dose-response effect was observed. Conclusion: Isolated patients do not report adverse experience for most aspects of provider communication regarded to be among the most important elements for safety and quality of care. However, patients in isolation had worse experiences with staff responsiveness for time- sensitive needs. The absence of a dose-response effect suggests that isolation status may be a marker for other factors, such as illness severity. Regardless, hospitals should emphasize timely staff response for this population.
(Received 10 July 2018; accepted 16 November 2018)
The Centers forDisease Control and Prevention (CDC) recommends that hospitals consider developing infection transmission control practices that include isolation measures for patients who are colonized or infected with organisms with a high propensity for transmission within healthcare systems, who demonstrate anti- microbial resistance, who are difficult to treat, or whose conditions associated with high morbidity and mortality.1 Although isolation practices are considered a standard of care, they may have some unintended consequences. Patients may have fewer healthcare team visits to the room, resulting in sparser vital sign records, fewer physician encounters and chart notes, and less extensive nursing narratives in the chart.2–6 Additionally, isolated patients
Author for correspondence: Sarah Johnson Conway MD, 600 NWolfe Street, Meyer
8-145, Baltimore, MD 21287. E-mail:
sjohn207@jhmi.edu PREVIOUS PRESENTATION: These findings were previously presented as a poster
at the Society of Hospital Medicine 2018 Annual Conference on April 9, 2018, in Orlando, Florida.
Cite this article: Siddiqui ZK, et al. (2019). Patient isolation for infection control and
patient experience. Infection Control & Hospital Epidemiology 2019, 40, 194–199. doi: 10.1017/ice.2018.324
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
may report higher levels of anxiety and loneliness,6–9 possibly because they believe they are being treated differently.10 Results from studies of the unintended impact of infection
control practices on patient experience are mixed. Some studies have shown that patients in isolation have lower satisfaction with physician communication and staff responsiveness while others show no difference in experience scores.5,11–13 The results of these studies may not be generalizable. Vinski et al14 described results for a hospital that had limited isolation practice, did not isolate for methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE), and had only 203 patients in the isolation arm of the study. Also, these studies did not adjust for confounders like age, gender, race, length of stay, and severity of illness.14 We used patient-level data to compare Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience scores for patients in isolation for a significant portion of their hospital stay with those who were not in isolation, adjusting for potentially confounding variables. We hypothesized that patients in isolation would report worse experiences with
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