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Patients under Contact Precautions Have an Increased Risk of Injuries and Medication Errors A Retrospective Cohort Study

  • Surendra Karki (a1), Karin Leder (a1) and Allen C. Cheng (a1) (a2)
Abstract

Contact precautions (CPs) may lead to adverse psychological effects, delays in access to services, and compromises in the quality of care and patient safety. These need to be balanced with the benefits in preventing transmission of resistant microorganisms. In this study, we aimed to quantify the effect of CPs on reported patient safety incidents.

The Alfred hospital is a tertiary referral hospital in Melbourne, Australia. Previous studies have shown that colonization with vancomycin-resistant enterococcus (VRE) is endemic in our hospital. Patients found to be colonized with VRE are placed in CPs immediately and during each subsequent admission. At our facility, modified CPs practiced during the study period include isolation in single rooms with a dedicated toilet, use of gloves when entering the room, and gloves and gown if contact with body fluids is anticipated. The hospital has a computerized risk management system where relevant patient safety incidents are reported to facilitate institutional review and response. We conducted a retrospective cohort study using these routinely collected data, comparing the incidence rate of documented adverse events in patients prior and subsequent to initiation of CPs among patients colonized or infected with VRE. Patients with incident VRE detection between January 2009 and October 2010 were included.

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Corresponding author
Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia (allen.cheng@monash.edu)
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1. DJ Morgan , DJ Diekema , K Sepkowitz , EN Perencevich . Adverse outcomes associated with contact precautions: a review of the literature. Am J Infect Control 2009;37(2):8593.

2. HT Stelfox , DW Bates , DA Redelmeier . Safety of patients isolated for infection control. JAMA 2003;290(14):18991905.

3. KB Kirkland , JM Weinstein . Adverse effects of contact isolation. Lancet 1999;354(9185):11771178.

4. S Karki , L Houston , G Land , et al.Prevalence and risk factors for VRE colonisation in a tertiary hospital in Melbourne, Australia: a cross sectional study. Antimicrob Resist Infect Control 2012;1(1):31.

5. JD Siegel , E Rhinehart , M Jackson , L Chiarello , Health Care Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control 2007;35(suppl 2):S65S164.

7. ES Shenoy , RP Walensky , H Lee , B Orcutt , DC Hooper . Resource burden associated with contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus: the patient access managers' perspective. Infect Control Hosp Epidemiol 2012;33(8):849852.

8. WC Huskins , CM Huckabee , NP O'Grady , et al.Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364(15):14071418.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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