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A Novel Protocol for Contact Isolation for Multidrug‐Resistant Organisms in Children on Inpatient Rehabilitation and Effects on Functional Outcomes: A Noninferiority Study
Author(s) -
Pham Kelly L.D.,
Bjornson Kristie F.,
Osorio Marisa,
Whitlock Kathryn B.,
Massagli Teresa L.
Publication year - 2018
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2017.11.006
Subject(s) - medicine , functional independence measure , rehabilitation , isolation (microbiology) , physical therapy , psychological intervention , retrospective cohort study , protocol (science) , surgery , nursing , microbiology and biotechnology , biology , alternative medicine , pathology
Background The incidence of contact isolation for multidrug‐resistant organisms is increasing in acute hospitals and inpatient rehabilitation units alike. There is limited evidence on the effect of contact isolation on functional outcomes during inpatient rehabilitation. Objective To determine whether the use of a modified contact isolation protocol (MCI) resulted in noninferior functional outcomes compared with children without contact isolation (NCI) on inpatient rehabilitation. Design This is a retrospective noninferiority study. Setting One academically affiliated pediatric inpatient rehabilitation unit located in a children's hospital. Patients All children with any diagnosis admitted to inpatient rehabilitation from January 1, 2007, to December 31, 2014. Methods or Interventions We compared functional outcomes for 2 groups of children. Main Outcome Measurements Primary outcome measures included the Functional Independence Measure for Children (WeeFIM) efficiency and the change in the Developmental Functional Quotient (DFQ) for the WeeFIM. Noninferiority margins of 0.63 for the WeeFIM efficiency and 0.092 for the change in DFQ for the WeeFIM were used. Results There were a total of 949 patients of whom 899 were NCI, 48 MCI, and 2 excluded due to missing information. Patients with MCI had functional outcomes that were noninferior to those with NCI including the WeeFIM efficiency (mean difference 0.002, 95% CI –0.38 to 0.404) and the change in DFQ for the WeeFIM (mean difference –0.05, 95% CI –0.058 to 0.003). Conclusions The modified contact isolation protocol, having resulted in noninferior functional outcomes in inpatient rehabilitation may provide adequate contact isolation while allowing for noninferior functional outcomes. This may be a guide in the face of an ever‐increasing need for contact isolation. Level of Evidence III