Are Contact Precautions ethically justifiable in contemporary hospital care?

Abstract

The aim of this article is to discuss and explore whether practices used in hospitals to reduce the transmission of endemic antibiotic-resistant organisms are ethically justified in today's healthcare environment in the developed world. In order to do this, the history of the development of these practices is summarised, and the evidence base for their effectiveness is reviewed. Key bioethics principles are then discussed and contextualised from the perspective of hospital infection prevention and control, and an ethically superior model for the prevention and control of healthcare associated infection is proposed.

27. The ethics of contact precautions in hospital care: An interpretive description

“…Management recommendations were founded on the precautionary principle, where a deductive approach was taken for strong control measures on a background of incomplete knowledge and understanding about the risks imposed by MROs or about the effectiveness of the proposed measures (Bryan et al, 2007;Harris et al, 2019).…”

“…This includes a review of the literature relating to the contemporary understanding of some of the impacts that are felt by these patients. The chapter incorporates a paper co-authored by my supervising team, that was published in Nursing Ethics following a double-blind peer-review process (Harris et al, 2019).…”

Patient autonomy and disclosure of material information about hospital-acquired infections

“…In the case of HAIs, there are three essential principles that potentially require a different modus operandi: autonomy, 21 veracity, 21 and the precautionary principle. 11 In recent years, various international organizations have started to argue for a more active role of patients and their families in various tasks aimed to improve the quality of the medical act. By taking an active role, patients tend to have better adherence to treatment, have an improved safety after surgery, and have a more open communication with health care workers.…”

“…Contact Precautions includes a series of tasks aimed mainly to decrease the risk of transmitting diseases from the affected patient, rather than to protect the patient him/herself, such as patient isolation, the use of personal protective equipment by health care workers in contact with him/her, and alerts about this status in medical records. 11 However, in infectious diseases, this principle has much broader applications. For example, one facet of this principle states that a lack of scientific proof should not be used as an excuse for not taking reasonable measures to minimize a significant threat.…”

“…The principle of double effect considers that it is sometimes justified to harm certain individuals for the greater good. 7 , 10 , 11 , 33 In order to be applicable, it must fulfill four conditions simultaneously: 1) the action should be good or at least morally indifferent; 2) the bad should be a possibility, not a certainty; 3) the benefit should not be generated by the harmful effect; and 4) there has to be a proportionality between the good and the bad effect. 10 , 34 Disclosure about HAI in cases in which the patients seem not to wish to know about the disease (or preventive measures) could be considered a typical example of this principle: 1) the action to tell the truth (veracity) is morally right; 2) the bad (adverse consequences for the patient) is a possibility, not a certainty, 3) the benefit is generated by truth-telling, not by its negative, potential consequences; and 4) veracity generates certain good effects (social justice, respect for autonomy) and possible adverse effects (increased anxiety, depression, decreased therapeutic compliance).…”