Impact of isolation on hospitalised patients who are infectious: systematic review with meta-analysis

Purssell, Edward; Gould, Dinah; Chudleigh, Jane

The data from the comparative studies suggest that although in many cases contact precautions makes little difference to psychological outcomes, where it does make a difference this is primarily negative. There were significant declines in mean scores related to control and self-esteem, and in many studies increases in the mean scores for risk of anxiety and depression. However, these findings were not consistent, and some larger studies showed little or no difference between the groups for these outcomes. These are shown in Figures 1 and 2 Studies not reporting the raw data showed that contact precautions were associated with depression OR 1.4 (95% CI 1.2 to 1.5) but not anxiety OR 0.8 (95% CI 0.7 to 1.1) in a non-ICU population. [40] There was also an association with delirium OR, 1.40 (95% CI 1.24 to 1.51); although this was primarily among those who were newly diagnosed as needing isolation OR, 1.75 (95% CI 1.60 to 1.92, p<0.01) rather than those who had been under contact precautions for their entire stay OR 0.97 (95% CI 0.86 to 1.09, p=0.60). [16] Another study showed no difference in the median values for the Hospital Anxiety and Depression Scale anxiety or depression scores (HADS-A and -D), or the EuroQol Visual Analogue Scale EQ VAS scores. [41] For non-psychological outcomes, using a difference in the risk of +/-20% of an event as being a measure of clinical significance it appears there was a trend for less attention to be given to, and for more errors to occur in those who were isolated.