Watching for delirium during contact precautions

By: John Palmer February 27th, 2012

A study shows that contact precautions—utilized as a safety and infection control tool to protect other patients—can be added to the list of factors that may cause patient delirium.

“Association between contact precautions and delirium at a tertiary care center” s conducted at the University of Maryland Medical Center (UMMC) and appeared in the January issue of Infection Control and Hospital Epidemiology. The study indicates that patients moved to isolation during a hospital stay are nearly twice as likely to develop delirium. Patients beginning begin their stays in isolation do not share this increased risk.

The March issue of Briefings on Hospital Safety reported on the study and interviewed experts on relationship between isolation precautions, patient delirium and healthcare worker safety. Here is an excerpt from that article.

Isolation precautions are typically used for patients who test positive for multidrug-resistant organisms such as MRSA. These patients are placed in their own room, and healthcare workers are required to wear gowns, gloves, and masks when entering (see a full list of the Centers for Disease Control and Prevention’s contact precaution recommendations on p. 12).

Hannah Day, MD, a graduate research assistant at the University of Maryland School of Medicine in Baltimore and lead author of the study, is quick to point out that contact precautions are certainly not the primary cause for delirium, but they may be a contributing factor. Patients who are put on contact precautions are generally sicker, making them predisposed to delirium to begin with.

“Unfortunately, with our study we can’t really say where it’s coming from or what is causing what,” Day says. “But a lot of delirium actually goes undetected, so having an additional infection preventionist in there knowing that they should look out for this can be helpful. It may be kind of outside their expertise, but they can keep that in the back of their mind since so much of it goes undetected.”

Recognizing delirium is as much a factor in worker safety as patient safety. Patients who become delirious may wander from their beds, or in extreme cases lash out at employees. Being able to identify some of the key factors that contribute to delirium can also help workers with patient care.

The article also cover why workers need to be cognizant of the psychological harm of contact precautions, patient and family education, room design, and CDC recommendations for contact precautions.

To read the article in its entirety, which appears on the Hospital Safety Center, login, subscribe, or try out HSC for 30 days.

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