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Abstract
Isolation precautions and personal protective equipment are the two most common methods of infection control in most hospital settings. This literature review analyzes the data from 5 qualitative and quantitative articles, each dedicated to a particular part of the PICOT: effectiveness of IP and PPE in reducing HAI in older patients.
Introduction
Isolation Precautions, along with personal protective equipment, are some of the staple measures used in infection control. At the same time, isolation precautions (IP) have been notorious. This literature review will analyze quantitative and qualitative sources dedicated to the effectiveness of isolation precautions and personal protective equipment in older patients between 70 and 90 years of age.
Methods
When gathering appropriate literature for this research, each source had to adhere to a very distinct set of criteria. First, the sources had to relate to the subject of our research in some way or another, by providing information about isolation precautions, personal protective equipment, their effectiveness, comparisons between the two, infection control in elderly patients, and all related material. Other than that, I chose sources that are recent and published between 2011-2016. The articles used in this research were published in famous medical journals. They are peer-reviewed and trustworthy.
Synthesis
Pre-Emptive Isolation Precautions of Patients at High Risk for Methicillin-Resistant Staphylococcus Aureus in Combination with Ultrarapid Polymerase Chain Reaction
Screening as an Effective Tool for Infection Control
This article is a quantitative study, which analyses the effects of pre-emptive isolation precautions and preemptive against airborne nosocomial diseases such as Staphylococcus Aureus. To understand how these measures affect the spread of HAI in a hospital setting, the researchers performed a longitudinal study which analyzed the results of over 85,000 admissions and readmissions over the course of 31 months (Hallac et al., 2016). Primary methods of obtaining information about the disease from patients included laboratory screening tests. The results showed that isolation precautions in combination with ultra-rapid screening helped reduce the number of HAI by more than 50% (Hallac et al., 2016). This study is important for our PICOT research, as it provides rationale and evidence for the effectiveness of Isolation Precautions against airborne nosocomial infections.
Review of Personal Protection Equipment
This is a qualitative article that provides information about effectiveness, advantages, disadvantages, and methods of use of standard personal protective equipment available in all hospital seconds. Drawing on numerous sources, this study allowed for creating a wholesome view of personal protective equipment and its effectiveness. The research found that all available measures of personal protection equipment are effective in counteracting and preventing the spread of HAI. It also notes that the effectiveness of PPE is severely undermined by the unwillingness of the staff to use them (Hinkin, Gammon, & Cutter, 2013). This study supports our PICOT through providing information and reaffirming the effectiveness of PPE.
Hospital Acquired Infections (HAI) in the Elderly: Comparison with the Younger Patients
This article studies the spread of HAI in older patients in a standard hospital setting without a geriatric ward. This is a retrospective analysis, which used data from over 60,585 individual patients to detect HAI-induced incidents and readmissions. The research found that without a geriatric ward to provide isolation precautions for older patients, the rate of HAI contraction is almost twice as high for the older patients as it is for, the younger patients (1.95 vs. 1.05 per 100 admissions) (Meltem, Onur, Ayten, & Ilgin, 2012). This article supports our research in that it provides comparison data for a situation where isolation precautions are not used. It stresses the need for a geriatric ward as the primary tool for combating HAI in older patients.
The Effect of Pressure Differential and Care Provider Movement on Airborne Infectious Isolation Room Containment Effectiveness
This article describes the result of an experiment, which used a pressure-differentiated Isolation room to help reduce the number of transmitted HAI infections. The experiment used colorized fluorescent micro particles to represent the bacteria. The results of the experiment showed several things a pressurized isolation room is more effective than a standard isolation room at containing the bacteria, and that increased movement decreased containment effectiveness (Miller et al., 2011). The results of this experiment are important to our research as they suggest improving IP through low-pressure isolation wards.
Patient Isolation Precautions: Are They Worth It?
This quantitative article reflects on the relative lack of research on the effectiveness of Isolation Precautions as measures of infection control. The authors reviewed all available literature on the subject to highlight the advantages, drawbacks, and effectiveness of IP, reflecting on psychological effects on older patients, cost-effectiveness, and efficiency against certain diseases. The study found that in some cases IP might be ineffective, as it is with the cases of VRE infections (Sprague, Reynolds, & Brindley, 2016). In addition, IP may cause depression in older patients and increase costs of treatment and nurse workload in hospital facilities. This study contributes to our research by offering an opposing view on the effectiveness of IP.
Analysis
Every study presented in this literature review is different one from another, yet tied with a central theme they research the effectiveness of IP or PPE in prevention of HAI in patients. So far, the literature available to our research covers these points: effectiveness of IP, effectiveness of PPE, ways to improve IP and PPE effectiveness, necessity and cost-effectiveness of IP in certain situations, and necessity of IP in elderly patients. Quantitative studies are limited by the setting of research and state that the results cannot be applied universally, while qualitative studies are limited by potential bias and literature available at the start of research. No controversies were found.
Areas of Further Study
To further this study, more information is required. Finding articles closer and similar to the topic of our PICOT would allow representing the subject more accurately. In addition, finding information on the topic similar to the articles presented above would allow eliminating any potential bias by comparing the results of researches and identifying similarities and differences, incorporating them into our research.
References
Hallac, G., Neuner, B., Schefold, J.C., Gorzelniak, K., Rapsch, B., Pfuller, R., Walter, M. (2016). Preemptive isolation precautions of patients at high risk for methicillin-resistant Staphylococcus Aureus in combination with ultrarapid polymerase chain reaction screening as an effective tool for infection control. Infection Control & Hospital Epidemiology, 37(12), 1489-1491.
Hinkin, J., Gammon, J., & Cutter, J. (2013). Review of personal protection equipment used in practice. British Journal of Community Nursing, 13(1), 14-19.
Meltem, A., Onur, O., Ayten, S., & Ilgin, A. (2012). Hospital acquired infections (HAI) in the elderly: Comparison with the younger patients. Archives of Gerontology and Geriatrics, 54(1), 247-250.
Miller, S.L., Clements, N., Elliot, S.A., Subhash, S.S., Eagan, A., & Radonovich, L.J. (2011). The effect of pressure differential and care provider movement on airborne infectious isolation room containment effectiveness. American Journal of Infection Control, 39(2), 91-97.
Sprague, E., Reynolds, S., & Brindley, P. (2016). Patient isolation precautions: Are they worth it? Canadian Respiratory Journal, 2016(1), 1-5.
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