Summary: The segregation of patients with communicable or other diseases for a specified time. Isolation may be strict, in which movement and social contacts are limited; modified, where an effort to control specified aspects of care is made in order to prevent cross infection; or reverse, where the patient is secluded in a controlled or germ-free environment in order to protect him or her from cross infection.
- Happell B, Koehn S. Attitudes to the use of seclusion: has contemporary mental health policy made a difference?. J Clin Nurs. 2010;19:3208-17 pubmed publisher..The implementation and evaluation of alternative approaches to the care of consumers is necessary to reduce reliance and seclusion and introduce changes to practice. ..
- Fusco F, Puro V, Baka A, Bannister B, Brodt H, Brouqui P, et al. Isolation rooms for highly infectious diseases: an inventory of capabilities in European countries. J Hosp Infect. 2009;73:15-23 pubmed publisher..HIRs could also have a role in the initial phases of an influenza pandemic. However, large outbreaks due to natural or to bioterrorist events will need management strategies involving healthcare facilities other than HIRs. ..
- Stuart R, Cheng A, Marshall C, Ferguson J. ASID (HICSIG) position statement: infection control guidelines for patients with influenza-like illnesses, including pandemic (H1N1) influenza 2009, in Australian health care facilities. Med J Aust. 2009;191:454-8 pubmed
- Domenech de Cellès M, Zahar J, Abadie V, Guillemot D. Limits of patient isolation measures to control extended-spectrum beta-lactamase-producing Enterobacteriaceae: model-based analysis of clinical data in a pediatric ward. BMC Infect Dis. 2013;13:187 pubmed publisher..Mathematical models could prove useful for those estimations and guide decisions concerning the most effective control strategy. ..
- Johnson D, Lynch R, Mead K. Containment effectiveness of expedient patient isolation units. Am J Infect Control. 2009;37:94-100 pubmed publisher..Our findings demonstrate that effective isolation may be possible using low-technology, low-cost, easily built structures that can be readily constructed within hospital and other environments in emergency response situations. ..
- Harrison J, Bukhari S, Harrison R. Medical response planning for pandemic flu. Health Care Manag (Frederick). 2010;29:11-21 pubmed publisher..The study has managerial implications associated with local medical disaster response and policy implications on the allocation of disaster resources. ..
- Wassenberg M, Kluytmans J, Box A, Bosboom R, Buiting A, van Elzakker E, et al. Rapid screening of methicillin-resistant Staphylococcus aureus using PCR and chromogenic agar: a prospective study to evaluate costs and effects. Clin Microbiol Infect. 2010;16:1754-61 pubmed publisher..79 per patient. Rapid diagnostic testing safely reduces the number of unnecessary isolation days, but only chromogenic screening, and not PCR-based screening, can be considered as cost saving. ..
- Lee S, Chowell G, Castillo Chavez C. Optimal control for pandemic influenza: the role of limited antiviral treatment and isolation. J Theor Biol. 2010;265:136-50 pubmed publisher..The role of isolation strategies is highlighted in this study particularly when access to antiviral resources is limited. ..
- Mann Poll P, Smit A, de Vries W, Boumans C, Hutschemaekers G. Factors contributing to mental health professionals' decision to use seclusion. Psychiatr Serv. 2011;62:498-503 pubmed publisher..Because perceived approachability of the patient was a key factor, seclusion reduction policies should focus on supporting professionals in their efforts to manage inpatients with problem behaviors in an appropriate way. ..
- Vos M, Behrendt M, Melles D, Mollema F, de Groot W, Parlevliet G, et al. 5 years of experience implementing a methicillin-resistant Staphylococcus aureus search and destroy policy at the largest university medical center in the Netherlands. Infect Control Hosp Epidemiol. 2009;30:977-84 pubmed publisher..Our results show that, during a rigorous search and destroy policy, a low incidence of MRSA in our medical center was continuously observed and that this policy most likely contributed to a very low nosocomial transmission rate. ..
- Adams N, Johnson D, Lynch R. The effect of pressure differential and care provider movement on airborne infectious isolation room containment effectiveness. Am J Infect Control. 2011;39:91-7 pubmed publisher..Provider traffic adversely affected containment. Containment improved with an increasing pressure differential. The anteroom plays an important role in limiting net particle escape, especially during provider movement through the space. ..
- Kirkland K. Taking off the gloves: toward a less dogmatic approach to the use of contact isolation. Clin Infect Dis. 2009;48:766-71 pubmed publisher..This review considers what we do and do not know about the potential benefits and harms of isolation as a public health measure and proposes a framework for considering under what circumstances it might optimally be used. ..
- . Guideline for isolation precautions in hospitals. Part II. Recommendations for isolation precautions in hospitals. Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1996;24:32-52 pubmed
- Wernitz M, Swidsinski S, Weist K, Sohr D, Witte W, Franke K, et al. Effectiveness of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers at hospital admission to prevent hospital-acquired MRSA infections. Clin Microbiol Infect. 2005;11:457-65 pubmed..The screening programme was performed with minimal effort and can therefore be recommended as an effective measure to help prevent hospital-acquired MRSA infections. ..
- Catalano G, Houston S, Catalano M, Butera A, Jennings S, Hakala S, et al. Anxiety and depression in hospitalized patients in resistant organism isolation. South Med J. 2003;96:141-5 pubmed..The results of this preliminary study suggest that placement in resistant organism isolation may increase hospitalized patients' levels of anxiety and depression. ..
- Evans H, Shaffer M, Hughes M, Smith R, Chong T, Raymond D, et al. Contact isolation in surgical patients: a barrier to care?. Surgery. 2003;134:180-8 pubmed..05). 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. ..
- Wong T, Tam W. Estimating SARS incubation period. Emerg Infect Dis. 2004;10:1503-4; author reply 1504 pubmed
- Sax H, Perneger T, Hugonnet S, Herrault P, Chraiti M, Pittet D. Knowledge of standard and isolation precautions in a large teaching hospital. Infect Control Hosp Epidemiol. 2005;26:298-304 pubmed..0005). Despite a training effort targeting opinion leaders, knowledge of transmission precautions for pathogens remained insufficient. Nevertheless, specific training proved to be the major determinant of "good knowledge". ..
- Verity P, Wilcox M, Fawley W, Parnell P. Prospective evaluation of environmental contamination by Clostridium difficile in isolation side rooms. J Hosp Infect. 2001;49:204-9 pubmed..difficile. In particular, improved cleaning of frequently touched sites in the immediate bed space area is required. ..
- Bitekyerezo M, Kyobutungi C, Kizza R, Mugeni J, Munyarugero E, Tirwomwe F, et al. The outbreak and control of Ebola viral haemorrhagic fever in a Ugandan medical school. Trop Doct. 2002;32:10-5 pubmed..The implications for similar institutions in East Africa are discussed. ..
- Donovan A, Plant R, Peller A, Siegel L, Martin A. Two-year trends in the use of seclusion and restraint among psychiatrically hospitalized youths. Psychiatr Serv. 2003;54:987-93 pubmed..National reforms and institutional efforts can lead to downward trends in the use of seclusion and restraint among psychiatrically hospitalized youths. The active elements of these interventions warrant further study and replication. ..
- Gastmeier P, Schwab F, Geffers C, Ruden H. To isolate or not to isolate? Analysis of data from the German Nosocomial Infection Surveillance System regarding the placement of patients with methicillin-resistant Staphylococcus aureus in private rooms in intensive care units. Infect Control Hosp Epidemiol. 2004;25:109-13 pubmed..36; CI95, 0.17-0.79). Many (34.4%) of the German ICUs have not isolated MRSA patients in private rooms or cohorts, a procedure associated with lower MRSA infection rates in this study. ..
- Fraser C, Riley S, Anderson R, Ferguson N. Factors that make an infectious disease outbreak controllable. Proc Natl Acad Sci U S A. 2004;101:6146-51 pubmed..Direct estimation of the proportion of asymptomatic and presymptomatic infections is achievable by contact tracing and should be a priority during an outbreak of a novel infectious agent. ..
- Farr B, Bellingan G. Pro/con clinical debate: isolation precautions for all intensive care unit patients with methicillin-resistant Staphylococcus aureus colonization are essential. Crit Care. 2004;8:153-6 pubmed..In this issue of Critical Care, two experts face off over the need to isolate patients infected with methicillin-resistant Staphylococcus aureus. ..
- Jernigan J, Titus M, Groschel D, Getchell White S, Farr B. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol. 1996;143:496-504 pubmed..These data confirm the results of previous studies which have suggested that contact isolation was effective in controlling the epidemic spread of methicillin-resistant Staphylococcus aureus. ..
- El Badri S, Mellsop G. A study of the use of seclusion in an acute psychiatric service. Aust N Z J Psychiatry. 2002;36:399-403 pubmed..More research is required to examine the most effective use of seclusion and also the development and use of alternative strategies in controlling aggressive behaviour. ..
- Marklund L. Patient care in a biological safety level-4 (BSL-4) environment. Crit Care Nurs Clin North Am. 2003;15:245-55 pubmed
- Markel H, Lipman H, Navarro J, Sloan A, Michalsen J, Stern A, et al. Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic. JAMA. 2007;298:644-54 pubmed..In planning for future severe influenza pandemics, nonpharmaceutical interventions should be considered for inclusion as companion measures to developing effective vaccines and medications for prophylaxis and treatment. ..
- Bowers L, van der Werf B, Vokkolainen A, Muir Cochrane E, Allan T, Alexander J. International variation in containment measures for disturbed psychiatric inpatients: a comparative questionnaire survey. Int J Nurs Stud. 2007;44:357-64 pubmed..National clinical audit and injury reporting systems would also enable the identification of methods that are truly physically injurious to patients, aiding in the rational selection of appropriate containment measures. ..
- Smith P, Anderson A, Christopher G, Cieslak T, Devreede G, Fosdick G, et al. Designing a biocontainment unit to care for patients with serious communicable diseases: a consensus statement. Biosecur Bioterror. 2006;4:351-65 pubmed..The consensus recommendations are presented to standardize the planning, design, construction, and operation of BPCUs as one element of the U.S. preparedness effort. ..
- Huckshorn K. Re-designing state mental health policy to prevent the use of seclusion and restraint. Adm Policy Ment Health. 2006;33:482-91 pubmed..Endorsed by the State Mental Health Directors, July 13, 1999). (NASMHPD 1999, NASMHPD Position Statement on Seclusion and Restraint. Alexandria, VA: National Technical Assistance Center for State Mental Health Planning.). ..
- Bowers L. On conflict, containment and the relationship between them. Nurs Inq. 2006;13:172-80 pubmed..This exercise challenges our perception of the severity of some containment measures that are becoming more commonly used in acute psychiatry. ..
- Zun L, Downey L. The use of seclusion in emergency medicine. Gen Hosp Psychiatry. 2005;27:365-71 pubmed..8, df=1, P=.001). Seclusion rooms are used in a minority of EDs across the country. It also identified many outstanding concerns with complications, use in children, addition of chemical sedation, training and seclusion policy. ..
- Gaskin C, Elsom S, Happell B. Interventions for reducing the use of seclusion in psychiatric facilities: review of the literature. Br J Psychiatry. 2007;191:298-303 pubmed..Reducing seclusion rates is challenging and generally requires staff to implement several interventions. ..
- Riley S, Fraser C, Donnelly C, Ghani A, Abu Raddad L, Hedley A, et al. Transmission dynamics of the etiological agent of SARS in Hong Kong: impact of public health interventions. Science. 2003;300:1961-6 pubmed..We estimate that most currently infected persons are now hospitalized, which highlights the importance of control of nosocomial transmission. ..
- Mupere E, Kaducu O, Yoti Z. Ebola haemorrhagic fever among hospitalised children and adolescents in northern Uganda: epidemiologic and clinical observations. Afr Health Sci. 2001;1:60-5 pubmed..Health education to children and adolescents to avoid contact with sick and their body fluids should be emphasized. ..
- Bootsma M, Diekmann O, Bonten M. Controlling methicillin-resistant Staphylococcus aureus: quantifying the effects of interventions and rapid diagnostic testing. Proc Natl Acad Sci U S A. 2006;103:5620-5 pubmed..RDT can markedly enhance feasibility. ..
- Saint S, Higgins L, Nallamothu B, Chenoweth C. Do physicians examine patients in contact isolation less frequently? A brief report. Am J Infect Control. 2003;31:354-6 pubmed..49; 95% confidence interval, 0.30-0.79; P <.001). Attending physicians are about half as likely to examine patients in contact isolation compared with patients not in contact isolation. ..
- Smith G, Davis R, Bixler E, Lin H, Altenor A, Altenor R, et al. Pennsylvania State Hospital system's seclusion and restraint reduction program. Psychiatr Serv. 2005;56:1115-22 pubmed..Many factors contributed to the success of this effort, including advocacy efforts, state policy change, improved patient-staff ratios, response teams, and second-generation antipsychotics. ..
- Cooper B, Stone S, Kibbler C, Cookson B, Roberts J, Medley G, et al. Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature. BMJ. 2004;329:533 pubmed..Four of these provided evidence that intensive control measures including patient isolation were effective in controlling MRSA. In two others, isolation wards failed to prevent endemic MRSA...
- Kaltiala Heino R, Tuohimäki C, Korkeila J, Lehtinen V. Reasons for using seclusion and restraint in psychiatric inpatient care. Int J Law Psychiatry. 2003;26:139-49 pubmed
- Harries A, Maher D, Nunn P. Practical and affordable measures for the protection of health care workers from tuberculosis in low-income countries. Bull World Health Organ. 1997;75:477-89 pubmed
- Yang C, Chang H, Chou C, Peng S. Isolation effectively prevents the transmission of hepatitis C virus in the hemodialysis unit. J Formos Med Assoc. 2003;102:79-85 pubmed..These results support the use of an isolation policy to combat HCV infection among hemodialysis patients, particularly in high prevalence units. ..
- Chowell G, Fenimore P, Castillo Garsow M, Castillo Chavez C. SARS outbreaks in Ontario, Hong Kong and Singapore: the role of diagnosis and isolation as a control mechanism. J Theor Biol. 2003;224:1-8 pubmed..We explain this as the result of an increase in the diagnostic rate and in the effectiveness of patient isolation after March 26th...
- Wynn R. Staff's attitudes to the use of restraint and seclusion in a Norwegian university psychiatric hospital. Nord J Psychiatry. 2003;57:453-9 pubmed..There is a need for informing all staff about the negative effects of restraint and seclusion and for training staff in less restrictive ways in dealing with aggressive and violent patients. ..
- Huang S, Yokoe D, Hinrichsen V, Spurchise L, Datta R, Miroshnik I, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis. 2006;43:971-8 pubmed..In contrast, no similar decrease was attributable to the other infection control interventions. ..
- Manian F, Ponzillo J. Compliance with routine use of gowns by healthcare workers (HCWs) and non-HCW visitors on entry into the rooms of patients under contact precautions. Infect Control Hosp Epidemiol. 2007;28:337-40 pubmed..In the care of ICU patients under MCP, HCW compliance with gown use may be used as a proxy for their compliance with glove use. ..
- Chaberny I, Ziesing S, Mattner F, Bärwolff S, Brandt C, Eckmanns T, et al. The burden of MRSA in four German university hospitals. Int J Hyg Environ Health. 2005;208:447-53 pubmed
- Barril G, Traver J. Decrease in the hepatitis C virus (HCV) prevalence in hemodialysis patients in Spain: effect of time, initiating HCV prevalence studies and adoption of isolation measures. Antiviral Res. 2003;60:129-34 pubmed..Time was the most important factor (although interacting with the isolation measures) and was independent of the initial HCV prevalence. ..
- Donat D. Encouraging alternatives to seclusion, restraint, and reliance on PRN drugs in a public psychiatric hospital. Psychiatr Serv. 2005;56:1105-8 pubmed..Given the wealth of supportive data to confirm the value of behavioral applications, there is no excuse for failing to aggressively pursue these options. ..
- Wybo I, Blommaert L, de Beer T, Soetens O, de Regt J, Lacor P, et al. Outbreak of multidrug-resistant Acinetobacter baumannii in a Belgian university hospital after transfer of patients from Greece. J Hosp Infect. 2007;67:374-80 pubmed..Introduction of single-use ventilator circuits was considered but the outbreak was controlled before implementation. ..