Patient isolation tied to dissatisfaction with care

Contact Precautions used to prevent spread of infections create negative perception of care

2013-09-18

(Press-News.org) CHICAGO (September 18, 2013) – Patient satisfaction has an increasing impact on hospitals' bottom lines, factoring into Medicare reimbursement of hospital care. A new study finds patients placed in Contact Precautions (Contact Isolation) were twice as likely to report perceived problems with care compared to patients without Contact Precautions, placing the common infection control practice at odds with hospital interests. The study was published in the October issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

Contact Precautions are routinely used in hospitals to prevent the spread of drug-resistant bacteria between healthcare workers and patients. Healthcare workers are required to use disposable gowns and gloves for all patient contact when a patient is in Contact Precautions.

"As public reporting of patient satisfaction and patient outcomes becomes a national priority linked to hospital reimbursement, this study provides insight into how healthcare workers must balance evidence-based practice with a focus on patient satisfaction," said Preeti Mehrotra, MD, lead author on the study. "By creating a physical barrier, Contact Precautions may modify how healthcare workers interact with patients, affecting the patient experience and the perception of how care is delivered."

Researchers used a retrospective cohort study of 528 medical and surgical patients, comparing those patients who were placed in Contact Precautions with those who were not in Contact Precautions at the University of Maryland, Medical Center. Each participant underwent a standardized interview at enrollment in the study and on hospital days 3, 7, and 14, or until discharged. After discharge, the standardized interview and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey were administered by telephone for all patients who could be successfully contacted (88 patients).

Based on the standardized interview results, patients for whom Contact Precautions were used were more likely to perceive issues with their care, especially as it related to poor coordination of care and a lack of respect for patient preferences.

The authors suggest interventions should be developed to ensure that all patients, whether placed in Contact Precautions or not, receive the same quality of care. This includes staff education to ensure more patient visits and patient education to help patients understand the reasons for Contact Precautions. Additionally, the researchers recommend starting a dialogue among healthcare management and workers regarding the positive and negative effects of patient isolation procedures.

### Preeti Mehrotra, Lindsay Croft, Hannah R. Day, Eli N. Perencevich, Lisa Pineles, Anthony D. Harris, Saul N. Weingart, Daniel J. Morgan. "Effects of Contact Precautions on Patient Perception of Care and Satisfaction: A Prospective Cohort Study." Infection Control and Hospital Epidemiology 34:10 (October 2013).

Published through a partnership between the Society for Healthcare Epidemiology of America and The University of Chicago Press, Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 13 out of 158 journals in its discipline in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.

SHEA is a professional society representing more than 2,000 physicians and other healthcare professionals around the world with expertise in healthcare epidemiology and infection prevention and control. SHEA's mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. The society leads this field by promoting science and research and providing high-quality education and training in epidemiologic methods and prevention strategies. SHEA upholds the value and critical contributions of healthcare epidemiology to improving patient care and healthcare worker safety in all healthcare settings. Visit SHEA online at http://www.shea-online.org, http://www.facebook.com/SHEApreventingHAIs and @SHEA_Epi.

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Patient isolation tied to dissatisfaction with care

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