Methicillin-resistant Staphylococcus aureus: psychological impact of hospitalization and isolation in an older adult population

doi:10.1053/jhin.2001.1098

Journal of Hospital Infection

Volume 49, Issue 4, December 2001, Pages 250-254

https://doi.org/10.1053/jhin.2001.1098 Get rights and content

Abstract

A cross-sectional matched control study was designed to investigate the impact of hospitalization and MRSA isolation on the psychological functioning of older adults undergoing rehabilitation.

Twenty-two MRSA-positive and 20 MRSA-negative older adults completed standardized measures relating to depression, anxiety and anger.

Both groups of participants had higher scores for anger than those estimated for community-based older adults. The level of depressive and anxious symptoms amongst the isolated group was significantly higher than that found for the MRSA-negative group or estimates for community-based older adults. There was no correlation between length of hospitalization or isolation and the outcome measures.

The results suggest that, amongst older adult inpatients, isolation has a negative impact on mood in addition to that resulting from hospitalization. Those involved in caring for hospitalized older adults should be made aware of the potential psychological distress of isolation, and alternative approaches to isolation (such as hand hygiene, antibiotic restriction, surveillance) should be used in the management of MRSA whenever possible. Future studies should examine the best ways of managing the detrimental effects of isolation.

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Cited by (128)

Hospital patient experiences of contact isolation for antimicrobial resistant organisms in relation to health care–associated infections: A systematic review and narrative synthesis of the evidence
2023, American Journal of Infection Control
The alarming growth of antimicrobial resistance organisms (AMRs) and the threat caused by health care–associated infections require hospitalized individuals who are infected or colonized with AMRs to be cared for in isolation, predominantly in single rooms. None of the existing reviews focus on or specifically address the patient’s experience of being cared for in contact isolation when affected by AMRs exploring this specific context.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance for the conduct of systematic reviews was applied. Five databases were searched from inception to April 2019, with keywords related to adult patient experiences, AMR, and contact isolation. The evidence was certified by 2 reviewers. Principles of thematic analysis were used to produce a narrative synthesis of the findings.
Eighteen eligible studies were identified. Narrative synthesis resulted in 3 overarching categories reflecting the patient experience: privacy versus loneliness; emotional responses to isolation; quality of care, recovery, and safety in isolation.
This review synthesizes existing evidence reflecting the patient experience of contact isolation. Study findings were often contradictory and may not reflect contemporary health care, such as shorter hospital stays, or societal preferences for greater privacy. Further research focusing on contemporary health care contexts is recommended.
Carbapenemase-producing Enterobacteriaceae in an inpatient post-acute care facility: Impact on time to functional recovery
2022, Annals of Physical and Rehabilitation Medicine
The carriage of carbapenemase-producing Enterobacteriaceae (CPE) might lengthen the time to functional recovery (TTFR) for inpatients in post-acute care (PAC) units.
We aimed to assess the impact of CPE carriage on TTFR in a PAC facility.
This 2-year retrospective cohort study included 20 CPE-positive patients and 54 CPE-negative patients admitted to 3 PAC units (general, orthopaedic and neurological rehabilitation units) in a teaching hospital from January 2017 to December 2019. Potential risk factors and demographic data were collected from patients’ medical records, the French national hospital discharge database, and the hospital's CPE surveillance database. Functional recovery was defined as the median difference in functional independence measure (FIM) between admission and discharge from each unit. Survival analysis and multiple Cox regression models were used to predict the TTFR and identify factors associated with functional recovery.
The overall median [interquartile range] TTFR was 50 days [36–66]. Longer median TTFR was associated with CPE carriage (63 vs 47 days in the CPE-negative group; adjusted hazard ratio (aHR) 0.35, 95% CI 0.13–0.97) and presence of a peripheral venous catheter (aHR 3.51, 1.45–8.46); shorter TTFR was associated with admission to an orthopaedic versus general rehabilitation unit (aHR 3.11, 1.24–7.82).
CPE carriage in inpatient PAC facilities was associated with long TTFR. Further studies are needed to explore the mechanisms involved in these adverse events and to identify possible preventive measures.
Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities
2021, Journal of Hospital Infection
Citation Excerpt :
These studies focused specifically on the impact of isolation for MRSA colonisation or infection. These studies concluded that isolation had an impact on patient experience and resulted in increased anxiety and low mood. [203–207] Additionally, in a study of 57 Dutch MRSA colonised patients, [208] it was reported that a substantial proportion of MRSA carriers reported stigma due to MRSA, and stigma was associated with poor mental health.
Interprofessional perceptions and emotional impact of multidrug-resistant organisms: A qualitative study
2019, American Journal of Infection Control
Hospital-acquired infections caused by multidrug-resistant organisms (MDROs) are a threat to patient safety and hospital economy. Training in hygiene precautions is known to limit MDRO spread and patient morbidity. As infection prevention is a collaborative task, we developed an interprofessional educational intervention, including a reflective unit about MDRO. This article reports on the perceptions of professionals for MDRO management.
In 2017, we conducted 8 trainings, including facilitated group discussions focusing on the question how participants think others experience MDRO. Results were analyzed using a socio-constructivist qualitative approach.
A total of 51 health care workers from 13 professions and 5 hospitals participated, generating 366 items for coding. Three main themes could be identified: (1) significant barriers in educating clinicians and informing lay persons, (2) emotional reactions–especially anxiety and anger–from the perspective of lay persons and professionals evoked by MDRO, and (3) perceived economic burden.
MDROs generate psychosocial side effects with an impact on health care management and on professional-patient relationships and interprofessional relationships. Specifically, emotions evoked by insufficient information and transparency play a major role. Therefore, hygiene trainings must not be limited to basic skills. In addition, they should be comprised of communication and educational techniques and evoke attentiveness for emotional stress.
Experiences of carriers of multidrug-resistant organisms: a systematic review
2019, Clinical Microbiology and Infection
Citation Excerpt :
The capability of emotion relates to how a person's emotional development can be affected by anxiety, fear or traumatic events such as abuse or neglect, and how this interferes with being able to experience the appropriate emotion for a situation. Carriage does not affect this capability in terms of experiencing the appropriate emotions, but 17 of 27 studies report on how the situation triggers certain emotions that carriers presumably would prefer not to experience (Loveday H et al., ‘The patient experience of the MRSA screening process’) [20–23,25,26,28,29,33,35,37,40,41,43–45]. Lindberg et al. [33] summarizes the experience as ‘invaded, unsecure and alone’ and Skyman et al. [40] as ‘violated, unclean and scared.’
A comprehensive overview of the ways control measures directed at carriers of multidrug-resistant organisms (MDRO) affect daily life of carriers is lacking. In this systematic literature review, we sought to explore how carriers experience being a carrier and how they experience being subjected to control measures by looking at the impact on basic capabilities.
We searched Medline, Embase and PsychINFO until 26 May 2016 for studies addressing experiences of MDRO carriers. Twenty-seven studies were included, addressing experiences with methicillin-resistant Staphylococcus aureus (n = 21), ESBL (n = 1), multiple MDRO (n = 4) and other (n = 1, not specified). We categorized reported experiences according to Nussbaum's capability approach.
Carriage and control measures were found to interfere with quality of care, cause negative emotions, limit interactions with loved ones, cause stigmatization, limit recreational activities and create financial and professional insecurity. Further, carriers have difficulties with full comprehension of the problem of antimicrobial resistance, thus affecting six out of ten basic capabilities.
Applying Nussbaum's capability approach visualizes an array of unintended consequences of control measures. Carriers experience stigmatization, especially in healthcare settings, and have limited understanding of their situation and the complexities of antimicrobial resistance.
Prevalence and molecular analysis of virulence genes of Methicillin-resistant Staphylococcus aureus colonized among inpatients in hospitals of Duhok Province, Iraq
2023, Journal of Wildlife and Biodiversity

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^f1: Author for correspondence: Dr P. Kennedy, Department of Clinical Psychology, Stoke Mandeville Hospital NHS Trust, Aylesbury, Buckinghamshire, UK. Fax: 01296 315868; E-mail:[email protected]

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Journal of Hospital Infection

Abstract

References (23)

Does isolation of patients with infections induce mental illness?

J Infect

The guiding hands of our teachers (evidence base for hand-hygiene)

Lancet

Psychological and physiological effects of isolation

Clin Prac Edu Manag

The psychological consequences of source isolation: A review of the literature

J Clin Nurs

Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs

Int J Nurs Pract

Psychological impact of the management of methicillin-resistant Staphylococcus aureus (MRSA) in patients with spinal cord injury

Spinal Cord

Methicillin resistant Staphylococcus aureus (MRSA) in elderly acute medical admissions: morbidity, mortality, clearance and relapse

Age Aging

Managing methicillin resistant Staphylococcus aureus in hospital: the balance of risk

Age Ageing

Hazards of hospitalization of the elderly

Ann Intern Med

Surviving a fate worse than death: the plight of the homebound elderly

Loss Grief Care

Cited by (128)

Hospital patient experiences of contact isolation for antimicrobial resistant organisms in relation to health care–associated infections: A systematic review and narrative synthesis of the evidence

Carbapenemase-producing Enterobacteriaceae in an inpatient post-acute care facility: Impact on time to functional recovery

Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities

Interprofessional perceptions and emotional impact of multidrug-resistant organisms: A qualitative study

Experiences of carriers of multidrug-resistant organisms: a systematic review

Prevalence and molecular analysis of virulence genes of Methicillin-resistant Staphylococcus aureus colonized among inpatients in hospitals of Duhok Province, Iraq

Regular ArticleMethicillin-resistant Staphylococcus aureus: psychological impact of hospitalization and isolation in an older adult population

Abstract

J Infect

Lancet

Psychological and physiological effects of isolation

Clin Prac Edu Manag

The psychological consequences of source isolation: A review of the literature

J Clin Nurs

Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs

Int J Nurs Pract

Psychological impact of the management of methicillin-resistant Staphylococcus aureus (MRSA) in patients with spinal cord injury

Spinal Cord

Methicillin resistant Staphylococcus aureus (MRSA) in elderly acute medical admissions: morbidity, mortality, clearance and relapse

Age Aging

Managing methicillin resistant Staphylococcus aureus in hospital: the balance of risk

Age Ageing

Hazards of hospitalization of the elderly

Ann Intern Med

Surviving a fate worse than death: the plight of the homebound elderly

Loss Grief Care

Regular Article
Methicillin-resistant Staphylococcus aureus: psychological impact of hospitalization and isolation in an older adult population