The Impact of Contact Isolation on the Quality of Inpatient Hospital Care

Background: Contact Isolation is a key component of hospital infection prevention that may improve certain outcomes and decrease other outcomes of quality of care.

Objective: Evaluate the impact of Contact Isolation on process of care quality measures.

Methods: Centers for Medicare and Medicaid Services (CMS) Hospital Compare process measures for Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), Pneumonia (PNA) and Surgical Care Improvement Project (SCIP). From January 1, 2007 through May 30, 2009.

Results: We included 1259 admissions with AMI, 834 with CHF, 1377 with PNA and 3246 in SCIP. Isolation had no association with adherence to 19 individual measures and was associated with not meeting 4 individual measures: SCIP3 (prophylactic antibiotics discontinued ≤24h after surgery end) (14.7% missed measure vs. 9.7%, odds ratio (OR) 1.7, p=0.05), PNA2 (pneumococcal vaccine prior to discharge > 65 years of age) (29.4% vs. 16.4%, OR 2.1, p=0.02), PNA4 (smoking cessation advice/counseling) (9.3% vs. 3.8%, OR 2.6, p=0.02), PNA7 (influenza vaccination) (23.8% vs. 13.9%, OR 1.9, p=0.04). A composite pneumonia process-of-care measure was significantly less likely to be reached in isolated patients after adjusting for other factors using logistic regression (OR 3.8, 95% CI 1.5, 9.5). The combined smoking cessation measure (from CHF, AMI and PNA cohorts) was lower in isolated patients (7.9% missed measure vs. 2.4% missing measure, OR 3.5, p < 0.01).

Conclusions: Contact Isolation was associated with lower adherence to some quality of care process measures on inpatient wards. Determination of comparative effectiveness of infection prevention interventions that utilize Contact Isolation should incorporate these findings.