The Impact of Contact Precautions on Depression, Anxiety, Delirium and Emotional States in General Hospital Inpatients

Abstract

Background:Contact Precautions are an infection control intervention that isolate patients in a private room and require staff to wear gown and gloves. Studies have associated Contact Precautions with negative outcomes. Objectives: To evaluate psychological outcomes associated with the use of Contact Precautions, including delirium, depression, anxiety and mood states (sadness, worry, happiness, anger, confusion). This dissertation will clarify differences between incident and prevalent psychological outcomes associated with Contact Precautions Methods: The relationship between Contact Precautions and depression, anxiety and delirium were studied using two retrospective cohort studies and a prospective cohort study. The retrospective cohort studies examined delirium, depression and anxiety in patients on Contact Precautions. The prospective cohort study enrolled patients within 36 hours of admission to the hospital and followed them over the course of hospitalization to examine incident symptoms of depression, anxiety and mood states. Results: The first retrospective cohort study of 45,266 non-psychiatric admissions to University of Maryland Medical Center (UMMC) found delirium was more common in patients newly transferred to Contact Precautions than patients never admitted to Contact Precautions (OR: 1.53, 95% CI 1.37-1.70) or patients on Contact Precautions from a previous admission (OR 1.07, 95% CI 0.92-1.25). The second retrospective cohort study found increased prevalence of depression in 28,564 non-psychiatric, non-intensive care unit patients. (OR 1.4, 95% CI 1.2, 1.5) The prospective cohort study found Contact Precautions had more depressive symptoms on their first day of admission but Contact Precautions were not associated with incident symptoms of depression, anxiety or a change in mood states. Conclusions: Contact Precautions are associated with increased delirium and depression, but do not appear to cause incident depression, anxiety or delirium in relation to duration on Contact Precautions. Although Contact Precautions may mark a population at higher risk for depression or delirium, they do not appear to cause them.