Well I am back in the USA as some of you blog followers may already know. Admittedly, it is a bit difficult to re-adjust to the practice of medicine in the USA. Strangely, I miss the chaos and grime of Central America. Changing the focus of my blog to '1st world' medical issues is challenging too, but here goes.
There is ongoing debate about the adverse, unintended consequences of contact precautions. The literature suggests that patients in contact precautions suffer greater feeling of isolation, depression, fewer provider visits and greater adverse events.
A large, retrospective analysis published in Journal of Hospital Infection assessed the relationship between contact precautions and depression or anxiety. During the two-year period, there were 70, 275 admissions. After adjusting for confounders, contact precautions were associated with depression [odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2–1.5] but not with anxiety (OR 0.8, 95% CI 0.7–1.1). Depression was highly prevalent among patient on contact precautions.
Widespread implementation of active detection and isolation for MRSA, VRE colonized patients is bound to have adverse consequences. Perhaps the focus should be on a least restrictive alternative, such as meticulous and relentless pursuit of hand hygiene compliance.
Back to the daily grind.
