Advertisement

Intensive Care Medicine

, Volume 39, Issue 12, pp 2153–2160 | Cite as

Impact of contact isolation for multidrug-resistant organisms on the occurrence of medical errors and adverse events

  • J. R. ZaharEmail author
  • M. Garrouste-Orgeas
  • A. Vesin
  • C. Schwebel
  • A. Bonadona
  • F. Philippart
  • C. Ara-Somohano
  • B. Misset
  • J. F. Timsit
Original

Abstract

Contact isolation of infected or colonised hospitalised patients is instrumental to interrupting multidrug-resistant organism (MDRO) cross-transmission. Many studies suggest an increased rate of adverse events associated with isolation. We aimed to compare isolated to non-isolated patients in intensive care units (ICUs) for the occurrence of adverse events and medical errors.

Methods

We used the large database of the Iatroref III study that included consecutive patients from three ICUs to compare the occurrence of pre-defined medical errors and adverse events among isolated vs. non-isolated patients. A subdistribution hazard regression model with careful adjustment on confounding factors was used to assess the effect of patient isolation on the occurrence of medical errors and adverse events.

Results

Two centres of the Iatroref III study were eligible, an 18-bed and a 10-bed ICU (nurse-to-bed ratio 2.8 and 2.5, respectively), with a total of 1,221 patients. After exclusion of the neutropenic and graft transplant patients, a total of 170 isolated patients were compared to 980 non-isolated patients. Errors in insulin administration and anticoagulant prescription were more frequent in isolated patients. Adverse events such as hypo- or hyperglycaemia, thromboembolic events, haemorrhage, and MDRO ventilator-associated pneumonia (VAP) were also more frequent with isolation. After careful adjustment of confounders, errors in anticoagulant prescription [subdistribution hazard ratio (sHR) = 1.7, p = 0.04], hypoglycaemia (sHR = 1.5, p = 0.01), hyperglycaemia (sHR = 1.5, p = 0.004), and MDRO VAP (sHR = 2.1, p = 0.001) remain more frequent in isolated patients.

Conclusion

Contact isolation of ICU patients is associated with an increased rate of some medical errors and adverse events, including non-infectious ones.

Keywords

Multidrug resistant bacteria Isolation Intensive care unit Adverse events Medical errors 

References

  1. 1.
    Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, Farr BM (2003) SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 24:362–386PubMedCrossRefGoogle Scholar
  2. 2.
    Siegel JD, Rhinehart E, Jackson M, Chiarello L (2007) 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 35:S65–S164PubMedCrossRefGoogle Scholar
  3. 3.
    Siegel JD, Rhinehart E, Jackson M, Chiarello L (2007) Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 35:S165–S193PubMedCrossRefGoogle Scholar
  4. 4.
    Cooper BS, Stone SP, Kibbler CC, Cookson BD, Roberts JA, Medley GF, Duckworth G, Lai R, Ebrahim S (2004) Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature. BMJ 329:533PubMedCrossRefGoogle Scholar
  5. 5.
    Cepeda JA, Whitehouse T, Cooper B, Hails J, Jones K, Kwaku F, Taylor L, Hayman S, Cookson B, Shaw S, Kibbler C, Singer M, Bellingan G, Wilson AP (2005) Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 365:295–304PubMedGoogle Scholar
  6. 6.
    Raineri E, Crema L, De Silvestri A, Acquarolo A, Albertario F, Carnevale G, Latronico N, Petrosillo N, Tinelli C, Zoncada A, Pan A (2007) Meticillin-resistant Staphylococcus aureus control in an intensive care unit: a 10 year analysis. J Hosp Infect 67:308–315PubMedCrossRefGoogle Scholar
  7. 7.
    Lucet JC, Paoletti X, Lolom I, Paugam-Burtz C, Trouillet JL, Timsit JF, Deblangy C, Andremont A, Regnier B (2005) Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 31:1051–1057PubMedCrossRefGoogle Scholar
  8. 8.
    Huskins WC, Huckabee CM, O’Grady NP, Murray P, Kopetskie H, Zimmer L, Walker ME, Sinkowitz-Cochran RL, Jernigan JA, Samore M, Wallace D, Goldmann DA (2011) Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 364:1407–1418PubMedCrossRefGoogle Scholar
  9. 9.
    Evans HL, Shaffer MM, Hughes MG, Smith RL, Chong TW, Raymond DP, Pelletier SJ, Pruett TL, Sawyer RG (2003) Contact isolation in surgical patients: a barrier to care? Surgery 134:180–188PubMedCrossRefGoogle Scholar
  10. 10.
    Morgan DJ, Diekema DJ, Sepkowitz K, Perencevich EN (2009) Adverse outcomes associated with contact precautions: a review of the literature. Am J Infect Control 37:85–93PubMedCrossRefGoogle Scholar
  11. 11.
    Stelfox HT, Bates DW, Redelmeier DA (2003) Safety of patients isolated for infection control. JAMA 290:1899–1905PubMedCrossRefGoogle Scholar
  12. 12.
    Garrouste-Orgeas M, Timsit JF, Vesin A, Schwebel C, Arnodo P, Lefrant JY, Souweine B, Tabah A, Charpentier J, Gontier O, Fieux F, Mourvillier B, Troche G, Reignier J, Dumay MF, Azoulay E, Reignier B, Carlet J, Soufir L (2010) Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II. Am J Respir Crit Care Med 181:134–142PubMedCrossRefGoogle Scholar
  13. 13.
    Garrouste-Orgeas M, Soufir L, Tabah A, Schwebel C, Vesin A, Adrie C, Thuong M, Timsit JF (2012) A multifaceted program for improving quality of care in intensive care units: iatroref study. Crit Care Med 40:468–476PubMedCrossRefGoogle Scholar
  14. 14.
    Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE (1981) APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 9:591–597PubMedCrossRefGoogle Scholar
  15. 15.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRefGoogle Scholar
  16. 16.
    Timsit JF, Fosse JP, Troche G, De Lassence A, Alberti C, Garrouste-Orgeas M, Bornstain C, Adrie C, Cheval C, Chevret S (2002) Calibration and discrimination by daily logistic organ dysfunction scoring comparatively with daily sequential organ failure assessment scoring for predicting hospital mortality in critically ill patients. Crit Care Med 30:2003–2013PubMedCrossRefGoogle Scholar
  17. 17.
    Calvino Gunther S, Schwebel C, Vesin A, Remy J, Dessertaine G, Timsit JF (2009) Interventions to decrease tube, line, and drain removals in intensive care units: the FRATER study. Intensive Care Med 35:1772–1776PubMedCrossRefGoogle Scholar
  18. 18.
    de Lassence A, Alberti C, Azoulay E, Le Miere E, Cheval C, Vincent F, Cohen Y, Garrouste-Orgeas M, Adrie C, Troche G, Timsit JF (2002) Impact of unplanned extubation and reintubation after weaning on nosocomial pneumonia risk in the intensive care unit: a prospective multicenter study. Anesthesiology 97:148–156PubMedCrossRefGoogle Scholar
  19. 19.
    Darmon M, Timsit JF, Francais A, Nguile-Makao M, Adrie C, Cohen Y, Garrouste-Orgeas M, Goldgran-Toledano D, Dumenil AS, Jamali S, Cheval C, Allaouchiche B, Souweine B, Azoulay E (2010) Association between hypernatraemia acquired in the ICU and mortality: a cohort study. Nephrol Dial Transpl 25:2510–2515CrossRefGoogle Scholar
  20. 20.
    Zahar JR, Nguile-Makao M, Francais A, Schwebel C, Garrouste-Orgeas M, Goldgran-Toledano D, Azoulay E, Thuong M, Jamali S, Cohen Y, de Lassence A, Timsit JF (2009) Predicting the risk of documented ventilator-associated pneumonia for benchmarking: construction and validation of a score. Crit Care Med 37:2545–2551PubMedCrossRefGoogle Scholar
  21. 21.
    Beyersmann J, Schumacher M (2008) Time-dependent covariates in the proportional subdistribution hazards model for competing risks. Biostatistics 9:765–776PubMedCrossRefGoogle Scholar
  22. 22.
    Loveday HP, Pellowe CM, Jones SR, Pratt RJ (2006) A systematic review of the evidence for interventions for the prevention and control of meticillin-resistant Staphylococcus aureus (1996–2004): report to the Joint MRSA Working Party (Subgroup A). J Hosp Infect 63(Suppl 1):S45–S70PubMedCrossRefGoogle Scholar
  23. 23.
    Cooper BS, Stone SP, Kibbler CC, Cookson BD, Roberts JA, Medley GF, Duckworth GJ, Lai R, Ebrahim S (2003) Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling. Health Technol Assess 7:1–194PubMedGoogle Scholar
  24. 24.
    Jarlier V, Trystram D, Brun-Buisson C, Fournier S, Carbonne A, Marty L, Andremont A, Arlet G, Buu-Hoi A, Carlet J, Decre D, Gottot S, Gutmann L, Joly-Guillou ML, Legrand P, Nicolas-Chanoine MH, Soussy CJ, Wolf M, Lucet JC, Aggoune M, Brucker G, Regnier B (2010) Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program. Arch Intern Med 170:552–559PubMedCrossRefGoogle Scholar
  25. 25.
    Harbarth S, Masuet-Aumatell C, Schrenzel J, Francois P, Akakpo C, Renzi G, Pugin J, Ricou B, Pittet D (2006) Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. Crit Care 10:R25PubMedCrossRefGoogle Scholar
  26. 26.
    Saint S, Higgins LA, Nallamothu BK, Chenoweth C (2003) Do physicians examine patients in contact isolation less frequently? A brief report. Am J Infect Control 31:354–356PubMedCrossRefGoogle Scholar
  27. 27.
    Kirkland KB, Weinstein JM (1999) Adverse effects of contact isolation. Lancet 354:1177–1178PubMedCrossRefGoogle Scholar
  28. 28.
    Lesko LM, Kern J, Hawkins DR (1984) Psychological aspects of patients in germ-free isolation: a review of child, adult, and patient management literature. Med Pediatr Oncol 12:43–49PubMedCrossRefGoogle Scholar
  29. 29.
    Klein BS, Perloff WH, Maki DG (1989) Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 320:1714–1721PubMedCrossRefGoogle Scholar
  30. 30.
    Bouadma L, Mourvillier B, Deiler V, Le Corre B, Lolom I, Regnier B, Wolff M, Lucet JC (2010) A multifaceted program to prevent ventilator-associated pneumonia: impact on compliance with preventive measures. Crit Care Med 38:789–796PubMedCrossRefGoogle Scholar
  31. 31.
    Ammerlaan HS, Troelstra A, Kruitwagen CL, Kluytmans JA, Bonten MJ (2009) Quantifying changes in incidences of nosocomial bacteraemia caused by antibiotic-susceptible and antibiotic-resistant pathogens. J Antimicrob Chemother 63:1064–1070PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • J. R. Zahar
    • 1
    • 2
    Email author
  • M. Garrouste-Orgeas
    • 3
  • A. Vesin
    • 1
  • C. Schwebel
    • 4
  • A. Bonadona
    • 4
  • F. Philippart
    • 3
  • C. Ara-Somohano
    • 4
  • B. Misset
    • 3
  • J. F. Timsit
    • 1
    • 4
  1. 1.University Grenoble 1-U823–Team 11: Outcome of Cancer and Critical IllnessesAlbert Bonniot InstituteCEDEXFrance
  2. 2.Microbiology and Infection Control UnitNecker Teaching HospitalParisFrance
  3. 3.Saint Joseph Hospital NetworkParisFrance
  4. 4.University Grenoble 1- Medical ICUAlbert Michallon Teaching HospitalGrenobleFrance

Personalised recommendations