To the Editor: Dr Stelfox and colleagues1 found that patients with methicillin-resistant Staphylococcus aureus (MRSA) who were isolated for infection control experienced more preventable adverse events, expressed greater dissatisfaction with their treatment, and had less documented care. I have several concerns about the validity of this retrospective case-control study.
First, MRSA colonization or infection had been diagnosed among the isolated cases but not in the control group. Receiving this diagnosis during the hospital stay could also have negatively affected patients' or families' satisfaction independently of the isolation procedure.
Second, examination of baseline characteristics revealed that cases and controls were not "remarkably similar," as the authors stated. For example, more hospitalized patients were found among the cases, as compared with the controls. By increasing the need for assistance, this baseline difference may increase the risk of fall,2 independently of the isolation procedure. The same could be said with diabetes (more prevalent in isolated patients), a well-known risk factor for ulcers. It seems unlikely that these 2 baseline differences among cases and controls were due to chance.3 - 4 Such biases would have favored the control group regarding supportive care, although admittedly the authors' multivariate analysis may have limited this to some degree.
Third, I am not surprised that isolated patients had significantly longer periods of hospitalization. In my experience, many patients remain hospitalized in a teaching hospital with their acute medical problem completely resolved because of the difficulties in arranging discharge planning, especially those with recently discovered colonization with MRSA. In these cases, common process-of-care measures (eg, nursing narrative or physician progess notes) may not always be justified and thus not considered as medical errors. It raises the concern that systematic misclassification might favor the control group regarding the common process-of-care measure.
On the other hand, these data clearly support the need to better inform patients and their family about isolation protocol, ideally before it occurs. Nevertheless, even if the health care team had carefully done that, it may not avoid these negative psychological effects. Qualitative research is also needed to better understand patient's perception.
In my opinion, the authors' conclusion calls for interventions that improve compliance with infection control, including correctly performed isolation protocols when they are justified. This will help limit the spread of MRSA among hospitalized patients and finally limit the use of isolation protocols themselves.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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