[Journals]: Patient isolation associated with hospital delirium: study
December 12, 2011
A new study finds that patients who are moved into isolation during a hospital stay are nearly twice as likely to develop delirium, a potentially dangerous change in mental status that often affects hospital patients. Patients who began their stay in isolation were not at increased risk.
The study, published in the January issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, is the largest of its kind to examine the link between delirium and measures taken to prevent the spread of hard-to-treat infections such as MRSA. The measures, known as contact precautions, require patients to be isolated in their own room, and for healthcare personnel to wear masks, gowns, and other protective equipment. Some clinicians have been concerned that contact precautions may be disorienting to patients, making delirium more likely. Though delirium is generally a temporary condition, it can often adversely affect patient care. Symptoms include confusion, an inability to pay attention, and fluctuations in alertness.
A team of researchers led by Dr. Hannah Day of the University of Maryland School of Medicine examined two years of data from the university’s 662-bed medical center. They found that patients who were placed on contact precautions at some point after admission to the hospital were 1.75 times more likely to develop delirium. However, patients on contact precautions starting at admission were no more likely to develop delirium. That finding, the researchers say, suggests that it may not be the precautions themselves causing delirium.
“Patients in our study who were placed on contact precautions later in their hospitalization were generally sicker than those who were on contact precautions from the outset,” said Dr. Day. “So it’s possible that the underlying illness rather than the precautions themselves is responsible for the association with delirium.”
“Regardless of cause, we hope clinicians will view a move to isolation as a marker for increased risk of delirium and take appropriate precautions.”
Dr. Day and her colleagues say patients on contact precautions should be educated about the reasons for and the goals of the intervention so they might be more comfortable with it. Clinicians should also take extra care to monitor medications and try not to interrupt patients’ sleep patterns. In addition, isolation rooms should have clocks, calendars, and other orienting objects to help avoid sensory deprivation.
Hannah R. Day, Eli N. Perencevich, Anthony D. Harris, Ann L. Gruber-Baldini, Seth S. Himelhoch, Clayton H. Brown, Emily Dotter, and Daniel J. Morgan, “The Association between Contact Precautions and Delirium at a Tertiary Care Center.” Infection Control and Hospital Epidemiology 33:1 (January 2012).
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 15 out of 140 journals in its discipline in the latest 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 www.shea-online.org.