Isolating infectious patients: organizational, clinical, and ethical issues

Gould, Dinah; Drey, Nicholas; Chudleigh, Jane; King, Marco‐Felipe; Wigglesworth, Neil; Purssell, Edward

doi:10.1016/j.ajic.2018.05.024

Cited by 7 publications

(7 citation statements)

References 24 publications

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“…The model assumed that 95% of patients who acquired a HCAI had an increased length of stay. Once a patient acquired a HCAI, the model assumed that 90% remained on the ward to which they were admitted, 10% would be isolated21 and 0.04% went into intensive care (ICU) 16 22 23. Using NHS estimates of length of hospital stay, the model also assumed that a patient remained on the ward or in an isolation unit for a mean of 9.1 additional days (derived from a mean of 95 International Classification of Diseases 10th Revision (ICD 10) classification codes pertaining to 1.66 million finished consultant episodes of patients with an infection in the hospital episode statistics for 2016/2017) 16.…”

Section: Methodsmentioning

confidence: 99%

Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England

et al. 2020

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ObjectivesTo estimate the annual health economic impact of healthcare-associated infections (HCAIs) to the National Health Service (NHS) in England.DesignA modelling study based on a combination of published data and clinical practice.SettingNHS hospitals in England.Primary and secondary outcome measuresAnnual number of HCAIs, additional NHS cost, number of occupied hospital bed days and number of days front-line healthcare professionals (HCPs) are absent from work.ResultsIn 2016/2017, there were an estimated 653 000 HCAIs among the 13.8 million adult inpatients in NHS general and teaching hospitals in England, of which 22 800 patients died as a result of their infection. Additionally, there were an estimated 13 900 HCAIs among 810 000 front-line HCPs in the year. These infections were estimated to account for a total of 5.6 million occupied hospital bed days and 62 500 days of absenteeism among front-line HCPs. In 2016/2017, HCAIs were estimated to have cost the NHS an estimated £2.1 billion, of which 99.8% was attributable to patient management and 0.2% was the additional cost of replacing absent front-line HCPs with bank or agency staff for a period of time. When the framework of the model was expanded to include all NHS hospitals in England (by adding specialist hospitals), there were an estimated 834 000 HCAIs in 2016/2017 costing the NHS £2.7 billion, and accounting for 28 500 patient deaths, 7.1 million occupied hospital bed days (equivalent to 21% of the annual number of all bed days across all NHS hospitals in England) and 79 700 days of absenteeism among front-line HCPs.ConclusionThis study should provide updated estimates with which to inform policy and budgetary decisions pertaining to preventing and managing these infections. Clinical and economic benefits could accrue from an increased awareness of the impact that HCAIs impose on patients, the NHS and society as a whole.

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Section: Methodsmentioning

confidence: 99%

Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England

et al. 2020

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“…Its purpose is to prevent the transmission of antibiotic-resistant pathogens, those that are highly contagious or cause serious infection 1. The effectiveness of isolation has been questioned however2–5 and it can be challenging to undertake, especially if patients’ lack of understanding of the need for segregation, boredom or distress result in uncooperative behaviour 6. A recent survey exploring the care of patients isolated for infectious conditions suggests that in clinical practice the main issues are identifying which patients need to be isolated as quickly as possible and prioritising which patients should be segregated when isolation accommodation is in short supply.…”

Section: Introductionmentioning

confidence: 99%

“…A recent survey exploring the care of patients isolated for infectious conditions suggests that in clinical practice the main issues are identifying which patients need to be isolated as quickly as possible and prioritising which patients should be segregated when isolation accommodation is in short supply. Infection preventionists were aware that isolation could have negative effects on patients, such as increased risk of anxiety, depression and falls, and felt that more should be done to prevent these risks 6…”

Section: Introductionmentioning

confidence: 99%

Impact of isolation on hospitalised patients who are infectious: systematic review with meta-analysis

2020

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Strengths and limitations of this study► This review covers a wide variety of the literature from a range of different clinical areas. ► Data collected and the methods of collecting data on the impact of isolation is varied across studies. ► These data do not show if these effects are temporary, or in most cases if they are clinically significant. AbStrACtObjective To systematically review the literature exploring the impact of isolation on hospitalised patients who are infectious: psychological and non-psychological outcomes.Design Systematic review with meta-analysis. Data sources Embase, Medline and PsycINFO were searched from inception until December 2018. Reference lists and Google Scholar were also handsearched.results Twenty-six papers published from database inception to December 2018 were reviewed. A wide range of psychological and non-psychological outcomes were reported. There was a marked trend for isolated patients to exhibit higher levels of depression, the pooled standardised mean difference being 1.28 (95% CI 0.47 to 2.09) and anxiety 1.45 (95% CI 0.56 to 2.34), although both had high levels of heterogeneity, and worse outcomes for a range of care-related factors but with significant variation.Conclusion The review indicates that isolation to contain the risk of infection has negative consequences for segregated patients. Although strength of the evidence is weak, comprising primarily single-centre convenience samples, consistency of the effects may strengthen this conclusion. More research needs to be undertaken to examine this relationship and develop and test interventions to reduce the negative effects of isolation.

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“…Once an adult inpatient acquires a HCAI, 90% would remain on the ward to which they were admitted, 10% would be isolated28 and 0.04% would be transferred into intensive care (ICU) 21 29 30…”

Section: Methodsmentioning

confidence: 99%

Modelling the costs and consequences of reducing healthcare-associated infections by improving hand hygiene in an average hospital in England

et al. 2019

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ObjectiveTo assess the potential clinical and economic impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance in a hypothetical general hospital in England, to reduce the incidence of healthcare-associated infections (HCAIs).MethodsDecision analysis estimated the impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance among front-line healthcare practitioners (HCPs).ResultsThe model assumed 4.7% of adult inpatients (ie, ≥18 years of age) and 1.72% of front-line HCPs acquire a HCAI in current practice. The model estimated that if use of the electronic audit and feedback system could lead to a reduction in the incidence of HCAIs of between 5% and 25%, then the annual number of HCAIs avoided could range between 184 and 921 infections per hospital and HCAI-related mortality could range between 6 and 31 deaths per annum per hospital. Additionally, up to 86 days of absence among front-line HCPs could be avoided and up to 7794 hospital bed days could be released for alternative use. Accordingly, the total annual hospital cost attributable to HCAIs could be reduced by between 3% and 23%, depending on the effectiveness of the electronic audit and feedback system. If introduction of the electronic audit and feedback system into current practice could lead to a reduction in the incidence of HCAIs by at least 15%, it would have a ≥0.75 probability of affording the National Health Service (NHS) a cost-effective intervention.ConclusionIf the introduction of the electronic audit and feedback system into current practice in a hypothetical general hospital in England can improve hand hygiene compliance among front-line HCPs leading to a reduction in the incidence of HCAIs by ≥15%, it would potentially afford the NHS a cost-effective intervention.

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Isolating infectious patients: organizational, clinical, and ethical issues

Cited by 7 publications

References 24 publications

Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England

Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England

Impact of isolation on hospitalised patients who are infectious: systematic review with meta-analysis

Modelling the costs and consequences of reducing healthcare-associated infections by improving hand hygiene in an average hospital in England

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