“Patient Isolation Precautions” by Sprague et al.
Patient isolation has been one of the staple procedures for infection control almost since the very conception of medicine. It is implemented to stop pathogen transmission and mitigate hospital-acquired infections. Since the procedure is so intuitive, not many researchers bothered to investigate its effectiveness. The clinical problem for this task is to assess the effectiveness of implementing isolation precautions in an elderly patient. The article reviewed in this paper, called “Patient isolation precautions: Are they worth it?” analyses the potential drawbacks of patient isolation and states that there is no clear indication that IP truly reaches its goals.
The article was written by Ellion Sprague, Steven Reynolds, and Peter Brindley. It was published in Canadian Respiratory Journal in 2016. The authors rationalize the need for their study by stating that the subject of patient isolation did not receive proper attention because the majority of health practitioners simply assumed it “works” (Sprague, Reynolds, & Brindley, 2016). IP is not a panacea – it does not influence the overall hospital spread of certain diseases and brings about certain disadvantages for the hospital and the patient, namely monetary costs and psychological issues (Verlee, Berriel-Cass, Buck, & Nguyen, 2014). The goal of the article is identified – to promote patient safety and patient-centred care. It is rationalized well – modern evidence-based medicine cannot afford to operate on understudied assumptions, and the article serves as a survey of the information currently available on the subject.
The article provides a large reference list with the total number of 26, which is impressive for an article that is only three pages long. All articles and journals involved are peer-reviewed and published in respectable medical journals. Thus, the information presented in them can be considered trustworthy. Dates of publications differ, ranging from as far as 1996 to recent years. While technically some of these sources could be considered outdated, the premise of the article did state that research on the effectiveness of patient isolation has been lacking and somewhat sporadic. This justifies the use of older sources to compile a comprehensible literature survey, and add to the already existing knowledge. There is only one direct reference to a randomized control trial. The articles present in the reference list allow referencing the results of other trials, albeit indirectly. The literature provides a broad representation of ideas and opinions and provides support for the premise of the study.
As it was already mentioned, the method used to compile this article is a literature survey. A literature survey assumes little to no contact with the actual patients, no experiments or observations. Instead, the researchers rely on previous studies to gather, assess, structurize, and present all the relevant information to the reader. The literature survey is one of the most ethical methods of qualitative research, as it does not have many ways of breaching said ethics, aside from blatant lying and purposefully obscuring the facts (Vergnes, Christine, Nabet, & Hamel, 2010). The use of peer-reviewed sources and randomized control trials as evidence base vouches for the article’s credibility and validity.
The article concludes that the effectiveness of patient isolation is overstated and that in many cases the risks of isolating the patient outweigh the benefits. In particular, the article reports that there is no significant change in the rate of MRSA colonization and MRSA-related infections with and without expanded barrier precautions (Sprague et al., 2016). The same goes for the VRE colonization, infection, and spread rates, however, the latter received even less official research. Thus, this conclusion cannot be considered final. The article also states that the information about when it is appropriate to deisolate patients is inconclusive. As an alternative to complete isolation of the patients, the article proposes to have a “safe space” within the patient’s room, where isolation precautions are no longer necessary (Sprague et al., 2016). This suggestion could be the first step towards designing an intermediary strategy between complete isolation and no implementation of isolation precautions.
The authors of the article realize the limitations of their research method. Since it is a literature survey, it is limited by the number and availability of sources that address the subject of their research. Throughout the article, they constantly reflect on the fact that the data is inconclusive to generate a precise answer to any particular topics. Still, certain conclusions were made and clearly stated at the end of the article. Here are several conclusions that were presented in the article (Sprague et al., 2016):
- Prolonged patient isolation can have a deep psychological impact on the patients, especially those of old age.
- Expanded barrier precautions do not have any significant impact on MRSA colonization rates.
- Developing evidence-based guidelines for patient isolation and desolation will have a significant impact on effectiveness and cost-efficiency of the process.
The authors were effective in the presentation of the problem and provided convincing arguments supported by existing evidence.
Relation to the Clinical Topic
The information provided in this article will be important to consider when answering the question posed by the clinical topic. Although the answer to the question of whether or not implementing isolation precautions affects the spread of infection seems obvious and intuitive at first (Morgan, Pineles, & Shardell, 2013), the data provided by the reviewed article states otherwise, at least when it comes to the MRSA. While the article also alluded to the fact that VRE colonization rates were also not affected by patient isolation practices, the authors themselves acknowledge that the evidence for that is inconclusive. As such, the investigation of VRE must be supported by other sources. The PICOT scenario given in this task lacks the appropriate precision to make a more in-depth analysis of whether or not this article supports it. As it stands, the article promotes the idea of avoiding unnecessary isolation precautions, especially for the elderly patients, who are psychologically vulnerable to the effects of prolonged isolation (Day, Perencevich, & Harris, 2011). However, the final decision on the matter would require additional information about the patient’s disease.
Day, H.R., Perencevich, E.N, & Harris, A.D. (2011). Do contact precautions cause depression? A two-year study at a tertiary care medical centre. Journal of Hospital Infection, 79(2), 103-107.
Morgan, D.J., Pineles, L., & Shardell, M. (2013). The effect of contact precautions on healthcare worker activity in acute care hospitals. Infection Control & Hospital Epidemiology, 34(1), 69-73.
Sprague, E., Reynolds, S., & Brindley, P. (2016). Patient isolation precautions: Are they worth it? Canadian Respiratory Journal, 2016(1), 1-5. Web.
Vergnes, J.N., Christine, M.S., Nabet, C., & Hamel, O. (2010). Ethics in systematic reviews. Journal of medical ethics, 36(12), 771-774. Web.
Verlee, K., Berriel-Cass, D., Buck, K., & Nguyen, C. (2014). Cost of isolation: Daily cost of isolation determined and cost avoidance demonstrated from the overuse of personal protective equipment in an acute care facility. American journal of infection-control, 42(4), 448-449. Web.