Emerging Infections: The Contact Precautions Controversy

Zastrow, Rachel L.

doi:10.1097/10.1097/01.naj.0000395242.14347.37

Cited by 9 publications

(10 citation statements)

References 34 publications

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“…20 Another issue addressed by several systematic reviews is the impact of contact precautions on patients' well-being: troubling common themes of harm emerge from these reviews and drawbacks associated with CP have sometimes been reported. [21][22][23] For example, Kirkland et al reported that HCWs who treated patients in contact isolation entered their rooms less frequently, and had significantly less direct contact with them, than those caring in SP. 14 Stelfox et al reported that compared with controls, patients isolated for infection control precautions experience more preventable adverse events, express greater dissatisfaction with their treatment, and have less documented care.…”

Section: Methodological Limitationsmentioning

confidence: 99%

Is patient isolation the single most important measure to prevent the spread of multidrug-resistant pathogens?

2013

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Isolation or cohorting of infected patients is an old concept. Its purpose is to prevent the transmission of microorganisms from infected or colonized patients to other patients, hospital visitors, and health care workers, who may subsequently transmit them to other patients or become infected or colonized themselves. Because the process of isolating patients is expensive, time-consuming, often uncomfortable for patients and may impede care, it should be implemented only when necessary. Conversely, failure to isolate a patient with multidrug-resistant microorganisms may lead to adverse outcomes, and may ultimately be expensive when one considers the direct costs of an outbreak investigation and the indirect costs of lost productivity. In this review, we argue that contact precautions are essential to control the spread of epidemic and endemic multidrug-resistant microorganisms, and discuss limitations of some available data.

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Section: Methodological Limitationsmentioning

confidence: 99%

Is patient isolation the single most important measure to prevent the spread of multidrug-resistant pathogens?

2013

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“…2002), ‘host-agent-environment complex’ (Smith 1986), ‘agent-host-environment model’ (Zastrow 2011), ‘epidemiologic triangle’ (Huerta & Leventhal 2002) and the ‘traditional public health triangle’ (Wilde 1997). As detailed in a textbook focused on ‘health promotion and disease prevention’ in medicine and dentistry (Leavell & Clark 1958), the motivation for development of this model was to frame infection prevention strategies (Clark 1954) and assemble facts in a body of knowledge regarding the natural history of disease (Leavell & Clark 1958).…”

Section: Discussionmentioning

confidence: 99%

“…In applications to the study of isolation precautions, this framework emphasizes a means to change the environmental component, breaking the links to both presence of an agent and contact with a susceptible host. The model was also specifically identified as a useful tool to study contact precautions (Zastrow 2011). Indeed, simplicity of the framework and breadth of concepts are strengths that enhance the model’s applicability to diverse disciplines and topics.…”

Section: Discussionmentioning

confidence: 99%

“…As wide variation exists in clinical practice guidelines regarding isolation precautions, even among those from English-speaking countries (Aboelela et al . 2006), variation in the healthcare systems and isolation precautions processes threatens external validity of study results (Zastrow 2011). Therefore, it is difficult to combine and draw conclusions from this international body of literature.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of conceptual frameworks applicable to the study of isolation precautions effectiveness

Cohen

Shang

2015

Journal of Advanced Nursing

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Aims A discussion of conceptual frameworks applicable to the study of isolation precautions effectiveness according to Fawcett and DeSanto-Madeya’s (2013) evaluation technique and their relative merits and drawbacks for this purpose Background Isolation precautions are recommended to control infectious diseases with high morbidity and mortality, but effectiveness is not established due to numerous methodological challenges. These challenges, such as identifying empirical indicators and refining operational definitions, could be alleviated though use of an appropriate conceptual framework. Design Discussion paper Data Sources In mid-April 2014, the primary author searched five electronic, scientific literature databases for conceptual frameworks applicable to study isolation precautions, without limiting searches by publication date. Implications for Nursing By reviewing promising conceptual frameworks to support isolation precautions effectiveness research, this paper exemplifies the process to choose an appropriate conceptual framework for empirical research. Hence, researchers may build on these analyses to improve study design of empirical research in multiple disciplines, which may lead to improved research and practice. Conclusion Three frameworks were reviewed: the epidemiologic triad of disease, Donabedian’s healthcare quality framework and the Quality Health Outcomes model. Each has been used in nursing research to evaluate health outcomes and contains concepts relevant to nursing domains. Which framework can be most useful likely depends on whether the study question necessitates testing multiple interventions, concerns pathogen-specific characteristics and yields cross-sectional or longitudinal data. The Quality Health Outcomes model may be slightly preferred as it assumes reciprocal relationships, multi-level analysis and is sensitive to cultural inputs.

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“…Isolation precautions are the preferred technique to control transmission of pathogens with high morbidity, mortality, or epidemiological significance, but controversy remains regarding the effectiveness of isolation precautions. 3 , 5 , 6 , 7 , 8 , 9 , 10 This debate intensified following transmission of Ebola virus to healthcare workers despite use of isolation precautions. 11 Like Ebola virus, MDROs are spread through direct or indirect contact.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of contact precautions against multidrug-resistant organism transmission in acute care: a systematic review of the literature

Cohen

Shang

2015

Journal of Hospital Infection

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SUMMARY Contact precautions are widely recommended to prevent multidrug-resistant organism (MDRO) transmission. However, conflicting data exist regarding their effectiveness. Prior systematic reviews examined contact precautions as part of a larger bundled approach, limiting ability to understand their effectiveness. The aim of this review was to characterize the effectiveness of contact precautions alone against transmission of any MDRO among adult acute care patients. Directed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, comprehensive searches of four electronic scientific literature databases were conducted for studies published in English from January 2004 to June 2014. Studies were included if interventional, original research, evaluating contact isolation precautions against MDRO transmission among inpatients. Searches returned 284 studies, six of which were included in the review. These studies measured four different MDROs with one study showing a reduction in transmission. Whereas studies were of high quality regarding outcome operationalization and statistical analyses, overall quality was moderate to low due to poor intervention description, population characterization and potential biases. Where compliance was measured (N = 4), it presented a threat to validity because it included select parts of the intervention, ranged from 21% to 87%, and was significantly different across study phases (N = 2). The poor quality of evidence on this topic continues to limit interpretation of these data. Hence, this conflicting body of literature does not constitute evidence for or against contact precautions. We recommend that researchers consider power calculation, compliance monitoring, non-equivalent concurrent controls when designing future studies on this topic.

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Emerging Infections: The Contact Precautions Controversy

Cited by 9 publications

References 34 publications

Is patient isolation the single most important measure to prevent the spread of multidrug-resistant pathogens?

Is patient isolation the single most important measure to prevent the spread of multidrug-resistant pathogens?

Evaluation of conceptual frameworks applicable to the study of isolation precautions effectiveness

Effectiveness of contact precautions against multidrug-resistant organism transmission in acute care: a systematic review of the literature

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