Contact isolation in surgical patients: A barrier to care?

Background. Contact isolation is commonly used to prevent transmission of resistant organisms. We hypothesized that contact isolation negatively impacts the amount of direct patient care. Methods. For 2 hours per day over a 5-week period, a single observer recorded provider/patient contact in adjacent isolated and nonisolated patient rooms on both the surgical intensive care unit (ICU) and surgical wards of a university hospital. Number of visits, contact time, and compliance with isolation were recorded, as was illness severity as assessed by APACHE II score. Results. Isolated patients were visited fewer times than nonisolated patients (5.3 vs 10.9 visits/h, P < .0001) and had less contact time overall (29 ± 5 vs 37 ± 3 min/h, P = .008), in the ICU (41 ± 10 vs 47 ± 5 min/h, P = .03), and on the floor (17 ± 3 vs 28 ± 4 min/h, P = .039), in spite of higher mean APACHE II scores in the isolated (10.1 ± 1.0 vs 7.6 ± 0.8, P = .05). Among floor patients with APACHE II scores greater than 10, patients in the isolated group had nearly 40% less contact time per hour than patients in the nonisolated group (19 ± 4 vs 34 ± 7 min/h, P = .05). Conclusion. Because of the significantly lower contact time observed, particularly among the most severely ill of floor patients, we propose a reexamination of the risk-benefit ratio of this infection control method.