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Hospitalized patients who are infected with multidrug-resistant bacteria are usually placed in contact isolation, which requires hospital personnel to put on a gown and gloves before examining the patient. Contact isolation with active surveillance of bacterial culture appears to help prevent the spread of drug-resistant infections. However, contact isolation may discourage attending physicians from examining patients as a result of the additional effort and time required to gown and glove, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS11540).
During morning rounds, attending physicians at two hospitals were about half as likely to examine patients in contact isolation compared with patients not under contact precautions. This means that many patients in contact isolation will not be examined by their attending physicians, even though they usually are seriously ill and may have more complicated problems than patients not in contact isolation, explains University of Michigan researcher, Sanjay Saint, M.D., M.P.H. Dr. Saint and his colleagues compared examination of patients in contact isolation and not in contact isolation by second- and third-year medical residents and attending physicians during morning rounds from October 1999 to March 2000 at two university-affiliated medical centers.
Of the total 139 patients, 22 percent were in contact isolation. Senior medical residents examined 84 percent of patients in contact isolation versus 87 percent of those not in contact isolation. However, attending physicians examined only 35 percent of patients in contact isolation versus 73 percent of non-isolated patients. Thus, nearly two-thirds of patients in contact isolation were not examined during morning rounds by the attending physicians.
See "Do physicians examine patients in contact isolation less frequently? A brief report," by Dr. Saint, Leigh Ann Higgins, M.D., Brahmajee K. Nallamothu, M.D., M.P.H., and Carol Chenoweth, M.D., in the October 2003 American Journal of Infection Control 31, pp. 354-356.
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