Adverse outcomes associated with contact precautions: A review of the literature
Adverse outcomes associated with contact precautions: A review of the literature
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DOI：
10.1016/j.ajic.2008.04.257
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发表时间：
2009-03-01
影响因子：
4.9
通讯作者：
Perencevich, Eli N.
中科院分区：
文献类型：
--
作者：
Morgan, Daniel J.;Diekema, Daniel J.;Perencevich, Eli N.
背景：接触预防措施 (CP) 是医院环境中预防多种耐药微生物 (MDRO) 患者之间传播的标准方法。随着全世界对包括耐甲氧西林金黄色葡萄球菌 (MRSA) 在内的多重耐药菌 (MDRO) 的持续关注以及主动监测计划的广泛使用，越来越多的患者开始接受 CP 治疗。虽然很少有人会认为 CP 是感染控制的重要工具，但许多报告和小型研究观察到 CP 患者的非感染性结果更差。然而，没有对该文献的综述。方法：我们系统地回顾了描述与 CP 相关的不良后果的文献。我们确定了 1989 年至 2008 年间发表的 15 项与 CF 不良后果相关的研究。根据标准化数据收集和/或纳入对照组，九项的质量较高。 结果：本次评价确定了与 CP 相关的四个主要不良后果。其中包括患者与医护人员的接触减少、护理系统的变化导致延误和更多非传染性不良事件、抑郁和焦虑症状增加以及患者对护理的满意度下降。结论：虽然美国疾病控制和预防中心建议将 CP 作为控制 MDRO 传播的干预措施，但我们对文献的回顾表明，这种方法会产生意想不到的后果，可能对患者有害。迫切需要采取措施改善CP的这些有害后果。版权所有 (C) 2009 感染控制和流行病学专业人员协会，Inc.
Background: Contact Precautions (CP) are a standard method for preventing patient-to-patient transmission of multiple drug-resistant organisms (MDROs) in hospital settings. With the ongoing worldwide concern for MDROs including methicillin-resistant Staphyloroccus aureus (MRSA) and broadened use of active surveillance programs, an increasing number of patients are being placed on CP Whereas few would argue that CP are an important tool in infection control, many reports and small studies have observed worse noninfectious outcomes in patients on CP. However, no review of this literature exists.Methods: We systematically reviewed the literature describing adverse outcomes associated with CP. We identified 15 studies published between 1989 and 2008 relating to adverse Outcomes from CF. Nine were higher quality based on standardized collection of data and/or inclusion of control groups.Results: Four main adverse outcomes related to CP were identified in this review. These included less patient-health care worker contact, changes in systems of care that produce delays and more noninfectious adverse events, increased symptoms of depression and anxiety, and decreased patient satisfaction with care.Conclusion: Although CP are recommended by the Centers for Disease Control and Prevention as an intervention to control spread of MDROs, our review of the literature demonstrates that this approach has unintended consequences that are potentially deleterious to the patient. Measures to ameliorate these deleterious consequences of CP are urgently needed. Copyright (C) 2009 Association for Professionals in Infection Control and Epidemiology, Inc.