Exploring link between patient isolation and delirium

January 12th, 2015

One would think intuitively that being placed in isolation behind the various barriers of precautions – gloves, gowns, masks – could have a disassociating affect, exacting a mental toll on the patient. In some patients it appears isolation contributes to onset of delirium, particularly if they were admitted under normal conditions and then placed in isolation during their stay.

To examine the link between being placed in contact isolation and delirium, the authors of a recent study reviewed administrative data on all patients admitted during a 2-year period. They excluded patients with underlying schizophrenia or bipolar disorder, those admitted to the psychiatry service, and alcohol-related admissions, as well as patients under age 18. Patients placed into contact isolation during hospitalization were stratified into those assigned this status on admission (because of pre-existing risk or documented infection) and those subsequently moved into isolation (because of positive surveillance or clinical cultures, acquired risk, or other factors). Of 70,275 admissions during the study period, 60,151 (in 45,266 unique patients; 9869 ICU admissions) were evaluated after a priori exclusions. Contact precautions were used in 9684 admissions (15%), 58% of them from the time of admission and 42% commencing at some point following admission. The authors’ criteria for delirium were met in 7721 admissions (13.5%). Overall, patients placed in contact isolation at any time during hospitalization were twice as likely to have delirium compared to non-isolated patients (16.1% vs 7.6%, respectively). There was no relationship between contact precautions and delirium among patients who were placed in isolation immediately on admission. However, being moved into isolation sometime after admission because of identification of a multiple-drug-resistant bacterium was associated with increased risk for delirium. For more on this story, including an expert commentary on the findings, see the March 2012 issue of Hospital infection Control & Prevention.