Clinical deterioration and hospital‐acquired complications in adult patients with isolation precautions for infection control: A systematic review

• Published in: Journal of advanced nursing Vol. 76; no. 9; pp. 2235 - 2252
• Main Authors: Berry, Debra, Wakefield, Erin, Street, Maryann, Considine, Julie
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-09-2020
• Subjects: Acquired; Acute services; Adults; Appraisal; Bias; Citations; Clinical assessment; clinical deterioration; Complications; Deterioration; Disease control; hospital acquired; hospitals isolation; infection; infection control; Infections; isolation; Length of stay; Literature reviews; Nurses; Nursing; nursing assessment; patient isolation; Precautions; Quality of care; review; Systematic review; Vital signs; Hospitals; Nursing; Complications; Systematic Review; Infection Control; Patient Isolation; Isolation; Clinical Deterioration; Nursing Assessment
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/jan.14435

Aim
To review and synthesize literature examining clinical deterioration and hospital‐acquired complications in adult patients with isolation precautions for infection control.
Background
Isolation precautions are a common infection prevention and control strategy which may have impact on safety and quality of care.
Design
The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines guided this systematic review, which was registered with PROSPERO [CRD42019131573].
Data sources
A search of Medline, Embase, and Cumulative Index to Nursing and Allied Health Literature was conducted for studies published in English up to 5 April 2019.
Review methods
Risk of bias was determined using Critical Appraisal Skills Program tools. Quality appraisal was performed using the Grades of Recommendation, Assessment, Development, and Evaluation approach. The primary outcomes of interest were clinical deterioration events and hospital‐acquired complications. In‐hospital death and hospital length of stay were secondary outcomes. Data were synthesized using a narrative approach.
Results
The search yielded 785 citations after removal of duplicates, of which, six studies were relevant. Certainty of evidence for outcomes of interest was low to very low.
Conclusion
There is no strong evidence that adult medical and surgical ward patients in isolation precautions for infection control are more or less likely to experience clinical deterioration or hospital‐acquired complications.
Impact
What problem did the study address?
Are patients in isolation precautions more likely to experience clinical deterioration or hospital‐acquired complications than non‐isolated patients?
What were the main findings?
There is no strong evidence that clinical deterioration and hospital‐acquired complications are more likely to occur to patients in isolation precautions for infection control.
This research is of relevance to acute care nurses.
目的
回顾和综合研究采取隔离预防措施控制感染的成人患者临床恶化和院内感染并发症的的参考文献。
背景
隔离预防措施是一种常见的感染预防和控制策略,可能会对护理安全和质量产生影响。
设计
系统性评价和荟萃分析的首选报告项目指南对该系统性评价提供了指导,该系统性评价已在PROSPERO[CRD42019131573]注册。
数据来源
对截至2019年4月5日以英文发布的研究进行了医学文献联机数据库(Medline)、荷兰医学文摘数据库(Embase)和护理与联合卫生文献累积索引方面的检索。
评估方法
使用关键评估技能计划工具确定偏差风险。使用推荐、评估、发展和评价等分级方法进行质量评价。主要结果是临床恶化事件和院内感染并发症。院内死亡和住院时间为次要结果。采用叙述性方法进行数据综合。
结果
删除重复的内容后,检索得到785条引文,其中,6项研究是相关的。有关结果的证据确定性较低至非常低。
结论
没有强有力的证据表明处于隔离预防感染控制的成人内外科病房患者或多或少会出现临床恶化或院内感染并发症。
影响
该研究解决了什么问题?
与未采取隔离措施的患者相比,采取隔离预防措施的患者是否更容易出现临床恶化或院内感染并发症?
主要研究结果是什么?
没有强有力的证据表明采取隔离预防措施控制感染的患者更容易发生临床恶化和院内感染并发症。该研究对于急诊护士而言有借鉴意义。