Skip to main content
×
×
Home

The Effect of Contact Precautions on Frequency of Hospital Adverse Events

  • Lindsay D. Croft (a1), Michael Liquori (a2) (a3), James Ladd (a1), Hannah Day (a1), Lisa Pineles (a1), Elizabeth Lamos (a2), Ryan Arnold (a2), Preeti Mehrotra (a4), Jeffrey C. Fink (a1) (a5) (a3), Patricia Langenberg (a1), Linda Simoni-Wastila (a6), Eli Perencevich (a7) (a8), Anthony D. Harris (a1) (a3) and Daniel J. Morgan (a1) (a3)...
Abstract
OBJECTIVE

To determine whether use of contact precautions on hospital ward patients is associated with patient adverse events

DESIGN

Individually matched prospective cohort study

SETTING

The University of Maryland Medical Center, a tertiary care hospital in Baltimore, Maryland

METHODS

A total of 296 medical or surgical inpatients admitted to non–intensive care unit hospital wards were enrolled at admission from January to November 2010. Patients on contact precautions were individually matched by hospital unit after an initial 3-day length of stay to patients not on contact precautions. Adverse events were detected by physician chart review and categorized as noninfectious, preventable and severe noninfectious, and infectious adverse events during the patient’s stay using the standardized Institute for Healthcare Improvement’s Global Trigger Tool.

RESULTS

The cohort of 148 patients on contact precautions at admission was matched with a cohort of 148 patients not on contact precautions. Of the total 296 subjects, 104 (35.1%) experienced at least 1 adverse event during their hospital stay. Contact precautions were associated with fewer noninfectious adverse events (rate ratio [RtR], 0.70; 95% confidence interval [CI], 0.51–0.95; P=.02) and although not statistically significant, with fewer severe adverse events (RtR, 0.69; 95% CI, 0.46–1.03; P=.07). Preventable adverse events did not significantly differ between patients on contact precautions and patients not on contact precautions (RtR, 0.85; 95% CI, 0.59–1.24; P=.41).

CONCLUSIONS

Hospital ward patients on contact precautions were less likely to experience noninfectious adverse events during their hospital stay than patients not on contact precautions.

Infect. Control Hosp. Epidemiol. 2015;36(11):1268–1274

Copyright
Corresponding author
Address correspondence to Daniel J. Morgan, MD, MS, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W. Baltimore St. MSTF 334, Baltimore, Maryland 21201 (dmorgan@epi.umaryland.edu).
References
Hide All
1. Siegel, J, Rhinehart, E, Jackson, M, Chiarello, L, Health Care Infection Control Practices Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65S164.
2. Griffin, F, Resar, R. Institute for Healthcare Improvement. IHI global trigger tool for measuring adverse events. Institute for Healthcare Improvement Innovation Series White Paper. http://www.ihi.org/knowledge/pages/IHIWhitePapers/IHIGlobalTriggerToolWhitePaper.aspx. Published 2009. Accessed March 2014.
3. Landrigan, C, Parry, G, Bones, C, Hackbarth, A, Goldmann, D, Sharek, P. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med 2010;363:21242134.
4. Goodman, J, Villarreal, P, Jones, B. The social cost of adverse medical events, and what we can do about it. Health Aff 2011;30:590595.
5. Kohn, LT, Corrigan, JM, Donaldson, MS, eds.; Committee on Quality of Health Care in America, Institute of Medicine. To err is human: building a safer health system. Washington, DC: The National Academy Press. www.iom.edu/Reports/1999/to-err-is-human-building-a-safer-health-system.aspx. Published 2000. Accessed March 2014.
6. Kirkland, KB, Weinstein, JM. Adverse effects of contact isolation. Lancet 1999;354:11771178.
7. Morgan, DJ, Pineles, L, Shardell, M, et al. The effect of contact precautions on healthcare worker activity in acute care hospitals. Infect Control Hosp Epidemiol 2013;34:6973.
8. Morgan, DJ, Diekema, DJ, Sepkowitz, K, Perencevich, EN. Adverse outcomes associated with contact precautions: a review of the literature. Am J Infect Control 2009;37:8593.
9. Stelfox, H, Bates, D, Redelmeier, D. Safety of patients isolated for infection control. JAMA 2003;290:18991905.
10. Karki, S, Leder, K, Cheng, AC. Patients under contact precautions have an increased risk of injuries and medication errors: a retrospective cohort study. Infect Control Hosp Epidemiol 2013;34:11181120.
11. Zahar, JR, Garrouste-Orgeas, M, Vesin, A, et al. Impact of contact isolation for multidrug-resistant organisms on the occurrence of medical errors and adverse events. Intensive Care Med 2013;39:21532160.
12. Day, H, Perencevich, E, Harris, A, et al. Depression, anxiety, and moods of hospitalized patients under contact precautions. Infect Control Hosp Epidemiol 2013;34:251258.
13. Mehrotra, P, Croft, L, Day, HR, Perencevich, EN, Pineles, L, Harris, AD, Weingart, SN, Morgan, DJ. Effects of contact precautions on patient perception of care and satisfaction: a prospective cohort study. Infect Control Hosp Epidemiol 2013;34:10871093.
14. Naessens, JM, O’Byrne, TJ, Johnson, MG, Vansuch, MB, McGlone, CM, Huddleston, JM. Measuring hospital adverse events: Assessing inter-rater reliability and trigger performance of the global trigger tool. Int J Qual Health Care 2010;22:266274.
15. Classen, DC, Resar, R, Griffin, F, Federico, F, et al. ‘Global trigger tool’ shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff 2011;30:581589.
16. Harris, AD, Pineles, L, Belton, B, et al. Benefits of Universal Glove and Gown (BUGG) Investigators. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:15711580.
17. National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index for Categorizing Medication Errors. http://www.nccmerp.org/medErrorCatIndex.html. Published 2001. Accessed March 2014.
18. Rothschild, JM, Landrigan, CP, Cronin, JW, et al. The Critical Care Safety Study: the incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med 2005;33:16941700.
19. Sharek, PJ, Parry, G, Goldmann, D, et al. Performance characteristics of a methodology to quantify adverse events over time in hospitalized patients. Health Serv Res 2011;46:654678.
20. Masse, V, Louis, Valiquette, Boukhoudmi, S, et al. Impact of methicillin-resistant Staphylococcus aureus contact isolation units on medical care. PLoS One 2013;8:e57057.
21. Naessens, J, Campbell, C, Huddleston, J, et al. A comparison of hospital adverse events identified by three widely used detection methods. Int J Qual Health Care 2009;21:301307.
22. Ho, PL, Hong Kong Intensive Care Unit Antimicrobial Resistance Study (HK-ICARE) Group. Carriage of methicillin-resistant Staphylococcus aureus, ceftazidime-resistant Gram-negative bacilli, and vancomycin-resistant Enterococci before and after intensive care unit admission. Crit Care Med 2003;31:11751182.
23. Dequito, AB, Mol, PG, van Doormaal, JE, et al. Preventable and non-preventable adverse drug events in hospitalized patients: a prospective chart review in the Netherlands. Drug Saf 2011;34:10891100.
24. Baines, RJ, Langelaan, M, de Bruijne, MC, et al. Changes in adverse event rates in hospitals over time: a longitudinal retrospective patient record review study. BMJ Qual Saf 2013;22:290298.
25. Kolata, G. Doctors strive to do less harm. The New York Times website. http://www.nytimes.com/2015/02/18/health/doctors-strive-to-do-less-harm-by-inattentive-care.html. Published February 17, 2015. Accessed February 18, 2015.
26. Classen, DC, Lloyd, RC, Provost, L, Griffin, FA, Resar, R. Development and evaluation of the Institute for Healthcare Improvement global trigger tool. J Patient Saf 2008;4:169177.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 13
Total number of PDF views: 167 *
Loading metrics...

Abstract views

Total abstract views: 1037 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd August 2018. This data will be updated every 24 hours.