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

Purssell, Edward; Gould, Dinah; Chudleigh, Jane

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors Isolation is an established part of any infection prevention programme. Its purpose is to prevent the transmission of antibiotic-resistant pathogens, those that are highly contagious or cause serious infection. [1] The effectiveness of isolation has been questioned however [2] [3] [4] [5] and it can be challenging to undertake, especially if patients' lack of understanding of the need for segregation, boredom or distress result in uncooperative behaviour. [6] Although single rooms are assumed to reduce infection risk, evidence of ability to contain spread is equivocal [7, 8] and a recent study conducted in an all-single-room hospital was unable to demonstrate lower infection rates than in hospitals where most care takes place in open wards. [9] This study identified advantages and disadvantages of single room accommodation, whereas isolating infectious patients is generally assumed to result in adverse outcomes. [10] A systematic review reported eight years ago indicated higher levels of anxiety, depression, perceptions of stigmatisation and a higher incidence of falls, medication errors and other incidents that detract from patient safety among patients who were isolated compared to those who were not. [11] This review reported studies undertaken before 2010 and included patients whose experiences are unlikely to be comparable: children and adults and those isolated to reduce their own risk of infection as well as infectious patients. The review was not reported according to standards currently expected for systematic reviews [12] and presents a qualitative description of patient outcomes only. A more rigorous and up-to-date systematic review is indicated in view of increasing concern about satisfaction with health care and patient safety and increasing emphasis on infection prevention as part of the global strategy to reduce risks of antimicrobial resistance. [13] We undertook a systematic review of the literature to establish the effects of infection related isolation on psychological and non-psychological care-related outcomes in adults. This review is therefore more focussed than that previously undertaken which also included those in protective isolation, and contains a significant body of literature published since 2010.