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January 28, 2004

Quality of Care and Satisfaction Among Patients Isolated for Infection Control

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(4):420-422. doi:10.1001/jama.291.4.421-a

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.

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