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Effective infection prevention is one of the most pressing problems that emergency departments (ED) have to face. Since overcrowding is not a rare case in EDs, patients have to stay in close proximity to one another for a considerable period of time, which increases the risk of infection transmission. Acutely ill patients not only put the personnel and other patients at risk of catching the infections but can also acquire new diseases as their immune system is highly vulnerable.
Moreover, such a rapid-paced and complex clinical environment makes decision making and risk recognition highly challenging: in case of life-threatening issues, infection prevention can simply be overlooked, which will have substantial consequences for patients. The situation with elderly people is aggravated by the fact that their resistance to infections is low. It is highly important to provide such patients with personal protective equipment or to put them in isolation to protect from infections (Hallak et al., 2016).
The paper at hand is going to examine the use of isolation precautions compared to the application of PPE in male and female patents aged 70-90 being admitted to the ED in terms of their ability to affect the levels of hospital acquired infections within one month. It is postulated that isolation wards are more effective in preventing infections in elderly patients. The literature review encompassing five articles will attempt to prove this claim. The opposing viewpoint will also be considered to present a holistic picture of the issue.
Methods
Five peer-reviewed articles have been covered by the analysis. For this purpose, the search of academic databases (such as PubMed and Google Scholar) was conducted. The year of publication of the articles chosen for further consideration ranges from 2011 to 2016.
This is an important factor ensuring that the information is relevant. The keywords used for the search are directly related to the topic of the paper: e.g. hospital acquired infections, elderly patients, isolation precautions, personal protection equipment. Another criterion of choosing the articles was the study design: to ensure that the research will be multifaceted, both qualitative and quantitative studies were selected (2 and 3 articles respectively). Only two of the five articles use literature review as a method whereas three others present research results obtained by the authors (laboratory screenings and tests, statistical analysis, experiment), which allows claiming that the materials are not altogether secondary.
Review of Literature
Key Components of the Articles
In the study conducted by Hallak et al. (2016), the effectiveness of Ultrarapid PCR in combination with preemptive precautions is compared to traditional screening and isolation methods. The authors of the research analyzed a number of cases of infection for 15 months before any intervention was made. After that, they performed laboratory screening and tests in order to find out the results of applying Ultrarapid PCR and preemptive precautionary methods during one month.
The research proved high effectiveness of Ultrarapid PCR in conjunction with isolation, especially for high-risk patients. Such results are significant for the current paper as they not only allow seeing the statistics of isolation precautions in patients that run high risks of being infected but also reveal that the effectiveness of isolation implemented as the only measure is considerably lower than when it is applied in combination with modern methods.
Hinkin, Gammon, & Cutter (2013) attempted to evaluate the effectiveness of PPE in hospital settings in order to improve its application. For this purpose, they conducted an extensive search in CINAHL for studies on the subject of PPE and related terms, dated between 1995 and 2007. This allowed identifying all key types of PPE applied for infection prevention, estimate their impact, and dwell upon the ways to increase it. The authors of the study conclude that PPE is effective in infection control; however, they also admit that this effectiveness can be diminished owing to the lack of knowledge and compliance with standard PPE protocols. Compliance should be ensured by introducing related policies. The information obtained if valuable for the present research as PPE assessment is required to be able to compare it to isolation.
Avci, Ozgenc, Coskuner, & Olut (2012) did a research to identify how HAI affect elderly patients (over 65) compared to younger patients (below 65) in terms of frequency, outcome, type, and microbiological characteristics. They performed statistical analysis of 60585 using the T-test for numeric and Chi-square and Fishers test for exact variables. The results showed that HAI rate per 100 admissions was 1.95 for elderly and 1.05 for younger patients. To improve this situation, dedicated geriatric wards were recommended for the risk group. This article is especially valuable for the given research since it promotes isolation proposed by this study as an effective measure.
Adams, Johnson, & Lynch, (2011) studied the effects of pressure differentials on the containment of airborne pathogens and observed the impact produced by care provider movements on isolation effectiveness. They conducted an experiment releasing fluorescent microspheres into the test room with negative pressure, and studied the effects of changing pressure and movements of care providers on containment levels. It was found out that containment levels improved with increased negative pressure whereas increased movement from care providers diminished containment effectiveness. The researches recommended equipping all isolation wards with negative pressure apparatuses while decreasing needless movement. The article is helpful for this study as it presents an innovative way to improve effectiveness of an isolation ward.
Sprague, Reynolds, & Brindley (2016) questioned the benefits provided by isolation as there is too little evidence to make conclusions. Researchers reviewed literature for the last 25 years to single out various factors that involve the use of isolation, including effectiveness, costs, and psychological effects on patients. They also considered de-isolation as an alternative, which was admitted to be more advantageous in some cases. The article is necessary for this study as it provides an alternative and opposing view to the proposed intervention, which cannot be ignored before making final conclusions.
Comparison of the Articles
All the articles taken for the analysis are quite different in their focus, methods, and conclusions. Only two articles resorted to literature review as the major method of the study. However, the scope of the review is quite different: Hinkin et al. (2013) managed to analyze studies from 1995 to 2007 whereas Sprague et al. (2016) covered a longer period of 25 years, which makes their research more comprehensive and relevant. Besides, the focus of these studies is also different: the former is concerned with proving the effectiveness of PPE while the latter dwells upon ineffectiveness of isolation (Hinkin et al., 2013; Sprague et al., 2016).
The research by Avci et al. (2012) stands apart from all the others since the authors are the only ones to resort to statistical analysis. Moreover, this is the only research that touches upon the difference between infection risks in young and elderly patients (Avci et al., 2012). Like Hallak et al. (2016) and Adams et al. (2011), the researchers recommend using isolation ward as a preventive measure. Yet, the two latter articles have more in common than the rest. Both studies come to the conclusion that the effectiveness of an isolation ward can be increased if modern methods are applied in combination with it.
However, the methods they propose are different and include Ultra-rapid PCR and negative pressure apparatuses (Hallak et al., 2016; Adams et al., 2011). The research performed by Sprague et al. (2016) can be called the most controversial one as the position of the authors concerning isolation is rather vague. Still, they managed to indicate the major limitation of all the mentioned studies: the primary research on the topic is too scarce to be able to make definite conclusions. Another limitation is the time of the experiments (not exceeding one month of close supervision), which was too short to be positive about the effectiveness of the intervention. In addition, all the researchers took a one-sided perspective to prove their points and did not provide any alternatives to the proposed measure.
Areas of Further Study
There are ample opportunities to use isolation wards for prevention of the ED-associated infections. There is too little support of any particular method, which makes it reasonable to state that comparative studies in a variety of settings and populations are required to make conclusions (Hallak et al., 2016). The criteria to assess each area should include the percentage of prevented infections, the speed of the implementation, resources required to introduce the method, and obstacles that may arise in the process.
What is already known is that both PPE and isolation wards can be effective; however, the conditions under which one method is preferable over the other are unknown. Thus, the given research will rely upon the following thesis: Despite the fact that both PPE and isolation wards are currently applied for decreasing infection risks in elderly patients, the latter are still more effective, especially in combination with other interventions.
References
Adams, N. J., Johnson, D. L., & Lynch, R. A. (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.
Avci, M., Ozgenc, O., Coskuner, S. A., & Olut, A. I. (2012). Hospital acquired infections (HAI) in the elderly: Comparison with the younger patients. Archives of Gerontology and Geriatrics, 54(1), 247-250.
Hallak, G., Neuner, B., Schefold, J. C., Gorzelniak, K., Rapsch, B., Pfüller, 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. H., & Cutter, J. (2013). Review of personal protection equipment used in practice. British Journal of Community Nursing, 13(1), 15-19.
Sprague, E., Reynolds, S., & Brindley, P. (2016). Patient isolation precautions: Are they worth it?. Canadian Respiratory Journal. Web.
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