Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Although we share the concerns
of Dr Stelfox and colleagues1 about the
negative outcomes of isolation, these must be weighed against the risks of
infection with and transmission of resistant organisms. The authors' study
design may have led to overestimation of the adverse effects of isolation.
Although patients who were colonized with MRSA were similar to uncolonized
control patients with respect to most baseline factors, the authors did not
control for previous hospitalization. Prior hospitalization and contact with
the health care system are risk factors for MRSA colonization and infection.2 Previous hospitalization is also related to several
of the outcomes measured in the study, such as pressure ulcers and falls,
and may influence the diagnostic workup performed during subsequent admissions.
For example, a patient with congestive heart failure is unlikely to undergo
assessment of ventricular function if the same study had been performed during
a recent hospitalization. The authors also did not adjust for the time-dependent
nature of several of the outcomes. Because isolated patients had significantly
longer hospital stays than did controls, they would be expected to be at higher
cumulative risk for many of the outcomes measured, including falls, pressure
ulcers, and greater levels of dissatisfaction.
Weber SG, Perl TM, Cosgrove SE. Quality of Care and Satisfaction Among Patients Isolated for Infection Control. JAMA. 2004;291(4):420-422. doi:10.1001/jama.291.4.421-a