In a full conference session on March 30, 2017, at the Society for Healthcare Epidemiology of America (SHEA) Spring 2017 Conference, Thomas Sandora, MD, MPH, associate professor at Harvard University, and hospital epidemiologist and medical director of Infection Control at Boston Children’s Hospital, shared some tips with conference attendees on ways that they can manage movement outside of the room for certain patients who are on contact precautions in the hospital.
Dr. Sandora began his presentation by highlighting the current guidelines that are in place that recommend the limitation of movement outside of the room for patients who are on contact precautions, such as the Hospital Infection Control Practices Advisory Committee (HICPAC)’s Guideline for Isolation Precautions
, which was issued back in 2007. Some of the guidelines that are in place, such as the Management of MDRO in Healthcare Settings
(2006) and the Guidance for Control of CRE in Acute Care Facilities
(2009), do not specifically address movement outside the room for patients on contact precautions. Despite this, Dr. Sandora suggests that there are several reasons why institutions may choose to go against the guideline recommendations to create a more family-centered care approach that would allow patients who are on contact precautions to venture outside of their rooms.
Dr. Sandora proceeded to share a study that showed the potential adverse outcomes for patients on contact precautions who are not allowed to venture outside of their room, a study that worked to “endorse” this rationale. The systematic review
, published in 2009, looked at 15 studies, paying close attention to the adverse outcomes related to contact precautions. According to Dr. Sandora, nine out of the 15 studies had standardized data collection as well as a control group. The findings? “Contact precautions across this literature were associated with less contact between patients and healthcare workers, [as well as] delays in care, and more noninfectious adverse events. They were [also] associated with increased symptoms of depression and anxiety among [these] patients and decreased patient satisfaction with care,” Dr. Sandora reported.
Conversely, when it came to research regarding movement outside of the room, Dr. Sandora showed a startlingly blank, white slide. “This slide summarizes all of the well-designed, robust research studies that have studied how to optimize movement of patients outside the room when they’re on isolation precaution,” said Dr. Sandora. “There’s nothing. Literally. So, if anyone is interested in this topic, we could use some quality research about how to do this.”
Because of the lack of quality research, Dr. Sandora provided conference attendees with several helpful tips that he and his colleagues use at Boston Children’s Hospital, and encouraged attendees to use what might work for them in their own institution.