Impact of contact isolation for multidrug-resistant organisms on the occurrence of medical errors and adverse events
- 1.8k Downloads
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.
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.
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.
Contact isolation of ICU patients is associated with an increased rate of some medical errors and adverse events, including non-infectious ones.
KeywordsMultidrug resistant bacteria Isolation Intensive care unit Adverse events Medical errors
- 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
- 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
- 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
- 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.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.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
- 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.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.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.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