Do physicians examine patients in contact isolation less frequently? A brief report

Background: Patients who are hospitalized and infected with multidrug-resistant bacteria are usually placed in contact isolation, which requires hospital personnel to gown and glove before patient examination. Contact isolation with active culture surveillance appears beneficial in preventing the spread of drug-resistant infections; however, contact isolation may impede the ability to examine patients as a result of the additional effort required to gown and glove. We assessed whether patients who are hospitalized and placed under contact precautions are examined less often by second- and third-year medical residents (ie, senior medical residents), and attending physicians during morning rounds. Method: We conducted a prospective cohort study on the inpatient medical services at 2 university-affiliated medical centers. We directly observed senior medical residents and attending physicians during morning rounds, and recorded the contact precaution status of the patient and whether they were examined by either physician. Results: Of a total of 139 patients, 31 (22%) were in contact isolation. Senior medical residents examined 26 of 31 patients (84%) in contact isolation versus 94 of 108 patients (87%) not in contact isolation (relative risk, 0.96; 95% confidence interval, 0.81-1.14; P=.58). In comparison, attending physicians examined 11 of 31 patients (35%) in contact isolation versus 79 of 108 patients (73%) not in contact isolation (relative risk, 0.49; 95% confidence interval, 0.30-0.79; P < .001). Discussion: Attending physicians are about half as likely to examine patients in contact isolation compared with patients not in contact isolation.