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An Australian interpretive description of Contact Precautions through a bioethical lens; recommendations for ethically improved practice

  • Joanna Harris
    Correspondence
    Address correspondence to Joanna Harris, PhD, Infection Management and Control Service (IMACS), Illawarra Shoalhaven Local Health District (ISLHD), Level 1 Lawson House, Wollongong Hospital, Loftus St, Wollongong 2500, NSW, Australia.
    Affiliations
    Infection Management and Control Service (IMACS), Illawarra Shoalhaven Local Health District (ISLHD), Level 1 Lawson House, Wollongong Hospital, Loftus St NSW, Australia
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  • Hazel Maxwell
    Affiliations
    School of Health Sciences, University of Tasmania, Sydney, Australia
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  • Susan Dodds
    Affiliations
    Research and Industry Engagement, La Trobe University, Melbourne, Victoria, Australia

    School of Humanities and Languages, UNSW, Australia

    School of Humanities, University of Tasmania, Australia
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Published:August 21, 2022DOI:https://doi.org/10.1016/j.ajic.2022.08.010

      Highlights

      • Patients and health professionals are negatively impacted by Contact Precautions.
      • Contact Precautions conflict with all four principles of biomedical ethics.
      • Holistic cost-benefit assessment situates Contact Precautions as low-value practice.
      • Recommendations for ethically-improved management of MRO-colonised patients are made.
      • Interpretive description provides a useful framework for infection control research.

      Abstract

      Background

      Contact Precautions (CP) were developed to control multi-resistant organisms (MROs) in hospitals. However, MROs persist and harms are associated with CP. Research objectives were to understand the bioethical impact of CP on patients and health-professionals, and make recommendations for ethically-improved management of MRO-colonized patients.

      Methods

      Interpretive description methodology scaffolded upon bioethical principles framed this qualitative study. Findings were explored alongside contemporary published reports to make recommendations for practice and research.

      Results

      Nine patients and 24 health professionals participated. Four themes were found: Powerlessness moving to acceptance; You feel a bit of a pariah; Others need protection, but I need looking after too; Doing Contact Precautions is not easy.

      Discussion

      CP conflict with the principle of respect for autonomy due to non-adherence to informed consent, and sub-optimal communication. Patients experience health care inequality, and discriminatory practices breaching the principle of justice. CP elicit stigma for patients, and moral distress and inter-personal conflict for staff, breaching the principle of non-maleficence. Under the principle of beneficence, pluralistic cost–benefit assessment situates CP as low-value practice.

      Conclusions

      CP challenge organizational culture, professional well-being, and person-centered ethical care. Ethical costs of CP outweigh benefits, obliging policy-makers to reconsider CP in managing MRO-colonized patients.

      Key Words

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