Contact isolation in surgical patients: A barrier to care?
Contact isolation in surgical patients: A barrier to care?
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DOI：
10.1067/msy.2003.222
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发表时间：
2003-08-01
期刊：
影响因子：
3.8
通讯作者：
Sawyer, RG
中科院分区：
文献类型：
--
作者：
Evans, HL;Shaffer, MM;Sawyer, RG
背景接触隔离通常用于防止耐药微生物的传播。我们假设接触隔离对直接患者护理的数量产生负面影响。在5周的时间内，一名观察员每天记录2小时的供应商/患者接触，在大学医院的外科重症监护室（ICU）和外科病房的相邻隔离和非隔离病房。记录就诊次数、接触时间和隔离依从性，以及通过APACHE II评分评估的疾病严重程度。隔离患者的就诊次数少于非隔离患者（5.3 vs 10.9次/h，P <0.0001），总体接触时间更短（29 +/- 5 vs 37 +/- 3 min/h，P = 0.008），在ICU（41 +/- 10 vs 47 +/- 5 min/h，P = 0.001）。在地板上（17 +/- 3 vs 28 +/- 4 min/h，P = 0.039），尽管孤立组的平均APACHE II评分较高（10.1 +/- 1.0 vs 7.6 +/- 0.8，P = 0.05）。在APACHE II评分大于10的地板患者中，隔离组患者每小时的接触时间比非隔离组患者少近40%（19 +/- 4 vs 34 +/- 7 min/h，P = 0.05）。由于观察到的接触时间明显较短，特别是在病情最严重的地板患者中，我们建议重新检查这种感染控制方法的风险效益比。
Background. Contact isolation is commonly used to prevent transmission of resistant organisms. We hypothesized that contact isolation negatively impacts the amount of direct patient care.Methods. For 2 hours per day over a 5-week period, a single observer recorded provider/patient contact in adjacent isolated and nonisolated patient rooms on both the surgical intensive care unit (ICU) and surgical wards of a university hospital. Number of visits, contact time, and compliance with isolation were recorded, as was illness severity as assessed by APACHE II score.Results. Isolated patients were visited fewer times than nonisolated patients (5.3 vs 10.9 visits/h, P < .0001) and had less contact time overall (29 +/- 5 vs 37 +/- 3 min/h, P = .008), in the ICU (41 +/- 10 vs 47 +/- 5 min/h, P =. 03), and on the floor (17 +/- 3 vs 28 +/- 4 min/h, P = .039), in spite of higher mean APACHE II scores in the isolated (10.1 +/- 1.0 vs 7.6 +/- 0.8, P = .05). Among floor patients with APACHE II scores greater than 10, patients in the isolated group had nearly 40% less contact time per hour than patients in the nonisolated group (19 +/- 4 vs 34 +/- 7 min/h, P = .05).Conclusion. Because of the significantly lower contact time observed, particularly among the most severely ill of floor patients, we propose a reexamination of the risk-benefit ratio of this infection control method.