R KRISHNASAMY1,2, C WILKINSON2,3, CJ CLARK1,2, C MCCLURE2, M WILSON2, J BASHFORD1,2, NA GRAY1,2
1Sunshine Coast University Hospital Queensland; 2The University of Queensland, Sunshine Coast Clinical School, Queensland; 3The Townsville Hospital, Queensland,
Aim: To compare quality of life and mood of haemodialysis patients managed with contact precautions and isolation for colonisation with multi-drug resistant organisms (MDRO) with those not colonised.
Background: Contact precautions and isolation are utilised to reduce spread of MDROs. They have been associated with increased length of stay in inpatient groups, and feelings of fear and loneliness in haemodialysis patients.
Methods: Patients undergoing facility haemodialysis completed the 24 item Kidney Disease Quality of Life (KDQOL) –SFTM, Beck Depression Inventory (BDI) and Personal Wellbeing-Index Adult (PWI-A). Patients colonised with MDRO were case matched by age and gender with non-colonised patients.
Results: A total of 16 MDRO colonised patients were matched with 16 controls. Groups were well matched for demographics and co-morbidities, except a trend for older dialysis vintage in the MDRO group (7.2 years (range 2.4-10) compared to 3.2 (1.4-7.6) years, p=0.05). Comparing MDRO positive with control patients, physical (30.48±10.65 vs 34.62±7.32; p = 0.2) and mental (46.48±11.23 vs 48.52±12.5; p = 0.6) composite scores were not different between groups. The MDRO group reported poorer sleep quality (p=0.01) and sleep patterns (p=0.05), and lower social function (p=0.02). BDI scores were similar (MDRO positive 10 (3.5-21) vs. control 12 (6.5-16), p=0.6). PWI-A scores were similar (MDRO positive (60.6±14.5) versus control (66.4±14.8), p=0.3). MDRO patients reported lower scores for “feeling safe” (p=0.03).
Conclusion: While overall scores of quality of life and depression were similar between groups, the MDRO group reported poorer outcomes in several domains. A larger cohort and qualitative interviews may give more detail of the impact of contact precautions and isolation on haemodialysis patients. The necessity for contact precautions for different MDRO needs consideration.