Context Hospital infection control policies that use patient isolation prevent
nosocomial transmission of infectious diseases, but may inadvertently lead
to patient neglect and errors.
Objective To examine the quality of medical care received by patients isolated
for infection control.
Design, Setting, and Patients We identified consecutive adults who were isolated for methicillin-resistant Staphylococcus aureus colonization or infection at 2 large
North American teaching hospitals: a general cohort (patients admitted with
all diagnoses between January 1, 1999, and January 1, 2000; n = 78); and a
disease-specific cohort (patients admitted with a diagnosis of congestive
heart failure between January 1, 1999, and July 1, 2002; n = 72). Two matched
controls were selected for each isolated patient (n = 156 general cohort controls
and n = 144 disease-specific cohort controls).
Main Outcome Measures Quality-of-care measures encompassing processes, outcomes, and satisfaction.
Adjustments for study cohort and patient demographic, hospital, and clinical
characteristics were conducted using multivariable regression.
Results Isolated and control patients generally had similar baseline characteristics;
however, isolated patients were twice as likely as control patients to experience
adverse events during their hospitalization (31 vs 15 adverse events per 1000
days; P<.001). This difference in adverse events
reflected preventable events (20 vs 3 adverse events per 1000 days; P<.001) as opposed to nonpreventable events (11 vs 12
adverse events per 1000 days; P = .98). Isolated
patients were also more likely to formally complain to the hospital about
their care than control patients (8% vs 1%; P<.001),
to have their vital signs not recorded as ordered (51% vs 31%; P<.001), and more likely to have days with no physician progress
note (26% vs 13%; P<.001). No differences in hospital
mortality were observed for the 2 groups (17% vs 10%; P = .16).
Conclusion Compared with controls, patients isolated for infection control precautions
experience more preventable adverse events, express greater dissatisfaction
with their treatment, and have less documented care.