Friday, January 24, 2014

The baggage of contact precautions

Contact precautions (CPs) have long been employed for breaking the chain of infection in hospitals. The basic idea is that by removing surfaces (e.g., gloves and gowns) contaminated in the course of patient-HCW interactions, mechanical transfer of infection between patients via care providers can be prevented. The theory makes sense, though a study by Morgan and Kirkland on how some physicians view the efficacy and impact of the approach is illuminating.

In fact, the recent literature has several studies illustrating issues surrounding contact precautions. Zahar et al suggest that, under certain circumstances, contact isolation of ICU patients is associated with increased rates of medical errors and adverse events and Karki et al show that patients under CPs have an increased risk of injuries and medication errors. Mehrotra et al demonstrate that patients under CPs are more likely to perceive problems with their care than those not under precautions.

Regardless of what you think about CPs, it's clear that they carry some baggage. One of my favorite blogs, Controversies in Hospital Infection Prevention, discussed the Morgan and Kirkland paper a year or so ago within the context of the plague doctor's outfit: the bizarre hats, waxed cloaks, and bird-beak masks stuffed with herbs and flowers worn by medieval doctors caring for plague victims. I've often thought about how terrifying the doctor's garb must have been to patients in the delirium of plague in the middle ages.

But has that changed for modern patients? Though familiar to HCWs, contact precautions surely can be terrifying to patients who are already upset from their condition. Consider the febrile patient in the fragile months following bone marrow transplantation. The incidence of infection in this patient population is often high, and these infections can be fatal. Having been rushed to the hospital late at night, say, such a patient -- a person, after all -- is typically surrounded by unrecognizable people in masks, gloves, and yellow gowns (hopefully properly worn and tied!) while being poked with needles for blood draws. Our clinical and research degrees aside, maybe the patient experience hasn't changed as much as we might have hoped from the days of plague masks and leeches. Food for thought.

(image source: Wikipedia)

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