American Journal of Infection Control 42 (2014) 198-9
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American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Knowledge and attitudes of visitors to patients in contact isolation Nasira Roidad MD, Rashida Khakoo MD, MACP * Section of Infectious Diseases, Department of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV
Key Words: Isolation Visitor perception
In this study, conducted at a tertiary care center, we surveyed visitors to patients in contact isolation to assess their knowledge and attitudes about contact isolation. Although response rates were low, we found that visitors had an overall positive perception and understanding of contact isolation. We think this is likely attributable to the communication and education provided by health care providers to the visitors. Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
The practice of contact isolation has become more commonplace with the development of multidrug-resistant bacterial organisms (MDROs). Centers for Disease Control and Prevention recommend the use of contact isolation for patients infected with and/or colonized with MDROs to prevent transmission.1 The impact of contact isolation on patients and health care workers (HCW) has been reviewed in several studies with varying results. However, there is limited published literature on the impact of contact isolation on the visitors. We sought to explore the knowledge and attitudes of visitors toward patients in contact isolation at our tertiary care hospital. METHODS The study was carried out at a tertiary care institution that requires contact isolation for patients either colonized or infected with methicillin-resistant Staphylococcus aureus (MRSA), vancomycinresistant enterococcus, multidrug-resistant strains of certain organisms, and Clostridium difﬁcile infection. Visitors are educated about contact isolation; however, this is not required for visitation. Education includes verbal discussion with nursing staff or physician; however, there is no standardized method of education such as information sheets or pamphlets. The study was approved by the Institutional Review Board. Surveys were administered in English only and reviewed by a health literacy expert at our institution. They * Address correspondence to Rashida Khakoo, MD, MACP, Section of Infectious Diseases, Department of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9163, Morgantown, WV 26506-9163. E-mail address: [email protected]
(R. Khakoo). The data from this paper were presented as a poster presentation at the Infectious Diseases Society of America (IDSA) Meeting (IDWeek) in San Diego, CA, October 18, 2012. Conﬂicts of interest: None to report.
were distributed and collected between March 1, 2012, and June 30, 2012. A randomized list of the hospital units was generated once at the initiation of the study, and a list of patients in contact isolation was generated each day. All units were surveyed except for the labor and delivery unit. This included adult and pediatric ﬂoors and intensive care units. The coinvestigator went to the patient’s room and provided a scripted description of the purpose of the study. If a visitor was present, the survey was given directly to the visitor. If there was no visitor present, the survey was left with the patient to be given to the next visitor. Survey boxes were provided at the front desks of each unit for anonymous drop off by the visitor. Demographic data were collected including age, sex, level of education, and whether the visitor was family member or not. The data were analyzed using frequency tables. RESULTS A total of 137 surveys was distributed. We received 36 (26%) completed surveys. Most participants were female (67%) and had at least some high school education (39%). The remaining participants had some college education. A total of 74% of respondents thought that contact isolation is used to prevent spread of infection from patients to visitors. Ninety-two percent of visitors knew why the patient they were visiting was in contact isolation. Seventy-ﬁve percent of the subjects reported that someone had explained to them the reason for contact isolation, either a doctor or a nurse. Ninety-two percent thought that patients in contact isolation are treated the same as those not in contact isolation. Seventy-one percent thought that patients who are in contact isolation are as safe as patients who are not, and 23% thought they were more safe.
0196-6553/$36.00 - Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2013.09.004
N. Roidad, R. Khakoo / American Journal of Infection Control 42 (2014) 198-9
Fig 1. Contact isolation improves patient care. Fig 2. Visitors should be required to wear gowns and gloves when visiting a patient in contact isolation.
None of the respondents reported being scared to visit someone who was in contact isolation. Two respondents reported that they would spend more time visiting a patient in contact isolation. The rest of the respondents said the same amount of time. Forty-four percent of respondents wanted to know more about contact isolation. A total of 68% either agreed or strongly agreed that contact isolation improves patient care (Fig 1). Half of the participants agreed or strongly agreed that visitors should be required to wear gowns and gloves when visiting a patient in contact isolation (Fig 2). DISCUSSION Based on our study results, visitors seem to understand the purpose of contact isolation in the inpatient setting. Most visitors thought that isolated patients are safe and treated the same. All participants said they would spend the same amount of time or more with patients in contact isolation. This is different than many of the studies regarding HCWs and their time spent with patients in contact isolation. Several studies have shown that there are fewer patient encounters and less time spent during each encounter with isolated patients compared with nonisolated patients.2,3 A study done at our tertiary care center in 2006 among HCWs showed that physicians were less likely to examine patients in isolation with the perception that it consumed “too much time.”2 Other studies show that contact isolation is associated with delays in care and more noninfectious adverse events.4-6 In regard to patient perceptions, there have been mixed results. Abad et al4 reported a negative impact on patient well being; however, Gasink et al7 showed no difference in patient satisfaction. In fact, isolated patients felt isolation improved their care. Although this discrepancy may be seen among the HCWs, visitors in our study thought that patients in isolation were treated the same as those not in isolation. Perhaps visitors are not cognizant of any difference in care because they are often only present for short periods of time during the day. Sengupta et al8 surveyed caregivers of hospitalized children with MRSA to assess their knowledge, awareness, and attitudes regarding MRSA speciﬁcally. They found that caregivers were frequently unaware that their child had MRSA. Caregivers wanted to know more about MRSA.8 In a follow-up study 6 months later, many caregivers still wanted more information about MRSA.9 This corresponds to results in our study, with many participants wanting to know more about contact isolation. Education of the patient and visitors is prudent when patients are placed in contact isolation. Markwell and Godkin10 reviewed visitor restrictions during the severe acute respiratory sydrome crisis and found that family members and friends unable to visit
loved ones had fear and anxiety about patients’ safety and wellbeing. A breakdown in communication between health authorities and facilities led to conﬂicting and unpredictable policies that caused the overall fear and uncertainty felt by patients and their visitors.10 By preparing patients and their family members about contact precautions, HCWs may ease the potential psychologic impact of isolation on patients. Our study has several limitations. The sample size was small. The study was carried out in our institution, and ﬁndings may not be generalizable. There was also potential selection bias because a more educated population may have been more likely to complete the survey. We found that visitors were knowledgeable about contact isolation. They had positive responses and did not think that patient care or safety was compromised. They were often educated by nurses or physicians, which likely had the greatest impact. This study emphasizes the importance of communication with patients and visitors on the use of contact isolation and its role in protecting our patients, HCWs, and public.
References 1. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007. Guideline of isolation precautions: preventing transmission of infectious agents in healthcare settings. Available from: http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf. Accessed April 1, 2013. 2. Khan F, Khakoo R, Hobbs G. Impact of contact isolation on health care workers at a tertiary care center. Am J Infect Control 2006;34:408-13. 3. Evans H, Shaffer M, Hughes M, Smith R, Chong T, Raymond DP, et al. Contact isolation in surgical patients: a barrier to care? Surgery 2003;134:180-8. 4. Abad C, Ferday A, Safdar N. Adverse effects of isolation in hospitalised patients: a systematic review. J Hosp Infect 2010;76:97-102. 5. Morgan D, Diekem D, Sepkowitz K, Perencevich E. Adverse outcomes associated with contact precautions: a review of the literature. Am J Infect Control 2009;37:85-93. 6. Stelfox H, Bates D, Redelmeier D. Safety of patients isolated for infection control. JAMA 2003;290:1899-905. 7. Gasink L, et al. Contact isolation for infection control in hospitalized patients: is patient satisfaction affected? Infect Control Hosp Epidemiol 2008; 29:275-8. 8. Sengupta A, Rand C, Perl T, Milstone A. Knowledge, awareness, and attitudes regarding methicillin-resistant Staphylococcus aureus among caregivers of hospitalized children. J Pediatr 2011;158:416-21. 9. Briggs J, Milstone A. Changes over time in caregivers’ knowledge, attitudes and behaviors regarding MRSA. J Pediatr 2011;158:1039. 10. Markwell H, Godkin D. Visitor restrictions during a public health emergency: ethical issues and guidelines for policy development. 2004. Available from: http://www.health.gov.on.ca/en/common/ministry/publications/reports/walker04/ ethics_visitor04.pdf. Accessed May 1, 2012.