Limited multi-drug resistant organism related stigma in carriers exposed to isolation precautions: an exploratory quantitative questionnaire study

R Wijnakker,M.M.C Lambregts,B Rump,K.E Veldkamp,R Reis,L.G Visser,M.G.J De Boer

doi:10.1016/j.jhin.2020.06.034

Abstract

Isolation precautions are applied to control the risk of transmission of multi-drug resistant organisms (MDROs). These precautions have been associated with adverse effects, such as anxiety and depression. This study aimed to quantify stigma among MDRO carriers and its association with perceived mental health and experienced quality of care. A quantitative questionnaire study was performed in MDRO carriers exposed to ≥3 days of isolation precautions during hospitalization. Items derived from the Consumer Quality Index questionnaire (CQI) were used to assess perception of care. Stigma scores were calculated using the recently modified Berger Stigma Scale for meticillin-resistant Staphylococcus aureus (MRSA). Mental health was measured with the RAND Mental Health Inventory. The Spearman rank correlation test was used to assess the association between stigma score and RAND mental health score. Of the 41 included carriers, 31 (75.6%) completed both questionnaires. The experienced quality of care was 'good' according to CQI score. Twenty-four percent reported not to have received proper explanation about MDRO carriership from healthcare workers (HCWs). MDRO-associated stigma was reported in 1/31 (3.2%). Poor mental health was self-reported in 3/31 (9.7%). There was no correlation between stigma score and RAND mental health score (Spearman correlation coefficient: 0.347). In this study, MDRO carriers exposed to ≥3 days of isolation precautions did not report stigma. This contrasts with a recent study that investigated MRSA-associated stigma and may be explained by contact plus airborne isolation protocols in MRSA compared with contact isolation alone in most other MDROs. Also, the psychological impact may be of a different magnitude due to as yet unknown reasons.

Highlights

In 2014, the WHO stated that antimicrobial resistance (AMR) is a worldwide problem requiring urgent action [1]
This study aims to quantify the stigmatization perceived by patients who isolated during their hospitalization due to multidrug resistant organisms (MDROs) colonization
A total of 639 alerts for 330 MDRO carriers were sent during the study period from 1st September until 28th February 2019

Summary

Introduction

In 2014, the WHO stated that antimicrobial resistance (AMR) is a worldwide problem requiring urgent action [1]. For standard contact precautions in our hospital the patient is placed in a single-bed room and healthcare workers (HCWs) wear gowns and gloves during contact. For contact plus airborne isolation, HCWs wear gowns, gloves and masks, and single-patient rooms equipped with special air handling and ventilation capacity are used [2]. Patients may be at increased risk of preventable adverse events such as pressure ulcers [3,4]; this may be one impact of HCWs entering the rooms of isolated patients less frequently than the rooms of patients without isolation precautions [5]. HCWs are perceived as uncaring and carriers are more likely to express dissatisfaction with their care This can be stigmatizing for the social interaction within healthcare [14e19]

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Results

Discussion

Conclusion