Isolating infectious patients: organizational, clinical, and ethical issues.

ABSTRACT

BACKGROUND: Isolating infectious patients is essential to reduce infection risk. Effectiveness depends on identifying infectious patients, transferring them to suitable accommodations, and maintaining precautions. METHODS: Online study to address identification of infectious patients, transfer, and challenges of maintaining isolation in hospitals in the United Kingdom. RESULTS: Forty-nine responses were obtained. Decision to isolate is made by infection prevention teams, clinicians, and managers. Respondents reported situations where isolation was impossible because of the patient's physical condition or cognitive status. Very sick patients and those with dementia were not thought to tolerate isolation well. Patients were informed about the need for isolation by ward nurses, sometimes with explanations from infection prevention teams. Explanations were often poorly received and comprehended, resulting in complaints. Respondents were aware of ethical dilemmas associated with isolation that is undertaken in the interests of other health service users and society. Organizational failures could delay initaiting isolation. Records were kept of the demand for isolation and/or uptake, but quality was variable. CONCLUSION: Isolation has received the most attention in countries with under-provision of accommodations. Our study characterizes reasons for delays in identifying patients and failures of isolation, which place others at risk and which apply to any organization regardless of availability. It also highlights the ethical dilemmas of enforcing isolation.