Adverse effects of isolation in hospitalised patients: a systematic review.
Adverse effects of isolation in hospitalised patients: a systematic review.
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DOI：
10.1016/j.jhin.2010.04.027
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发表时间：
2010-10
期刊：
影响因子：
--
通讯作者：
Safdar N
中科院分区：
文献类型：
--
作者：
Abad C;Fearday A;Safdar N
建议医疗机构对已知定植或感染多重耐药微生物的患者采取传播预防措施，如接触隔离。尽管接触隔离对于感染控制至关重要，但最近发现接触隔离与患者的不良反应有关。我们进行了一项系统的回顾，以确定接触隔离是否会导致患者的心理或身体问题。如果（1）住院患者因潜在医学适应症接受隔离预防措施，以及（2）评价了与隔离相关的任何不良事件，则纳入研究。我们发现有16项研究报告了隔离对患者心理健康、患者满意度、患者安全或医护人员直接护理患者所花时间的影响。大多数对患者的心理健康和行为产生了负面影响，包括孤立患者的抑郁，焦虑和愤怒得分较高。一些研究还发现，医护人员与病人隔离的时间更少。如果病人不了解他们的医疗保健，隔离会对病人的满意度产生不利影响。患者安全也受到负面影响，导致与支持性护理失败相关的不良事件增加了8倍。我们发现，接触隔离可能会对患者护理的几个方面产生负面影响。需要经过充分验证的工具来进一步研究这些结果。需要进行大型研究，检查一些安全指标，以评估隔离的不利影响。患者教育可能是减轻隔离不良心理影响的重要步骤，并建议进行。
The use of transmission precautions such as contact isolation in patients known to be colonised or infected with multidrug-resistant organisms is recommended in healthcare institutions. Although essential for infection control, contact isolation has recently been associated with adverse effects in patients. We undertook a systematic review to determine whether contact isolation leads to psychological or physical problems for patients. Studies were included if (1) hospitalised patients were placed under isolation precautions for an underlying medical indication, and (2) any adverse events related to the isolation were evaluated. We found 16 studies that reported data regarding the impact of isolation on patient mental well-being, patient satisfaction, patient safety or time spent by healthcare workers in direct patient care. The majority showed a negative impact on patient mental well-being and behaviour, including higher scores for depression, anxiety and anger among isolated patients. A few studies also found that healthcare workers spent less time with patients in isolation. Patient satisfaction was adversely affected by isolation if patients were kept uninformed of their healthcare. Patient safety was also negatively affected, leading to an eight-fold increase in adverse events related to supportive care failures. We found that contact isolation may negatively impact several dimensions of patient care. Well-validated tools are necessary to investigate these results further. Large studies examining a number of safety indicators to assess the adverse effects of isolation are needed. Patient education may be an important step to mitigate the adverse psychological effects of isolation and is recommended.
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