Isolation precautions cause minor delays in diagnostics and treatment of non-COVID patients

J Paajanen; L K Mäkinen; A Suikkila; M Rehell; M Javanainen; A Lindahl; E Kekäläinen; S Kurkela; K Halmesmäki; V-J Anttila; S Lamminmäki

doi:10.1016/j.infpip.2021.100178

Isolation precautions cause minor delays in diagnostics and treatment of non-COVID patients

Infect Prev Pract. 2021 Dec;3(4):100178. doi: 10.1016/j.infpip.2021.100178. Epub 2021 Oct 5.

Authors

J Paajanen¹, L K Mäkinen¹, A Suikkila², M Rehell², M Javanainen³, A Lindahl¹, E Kekäläinen^{4

5}, S Kurkela⁴, K Halmesmäki⁶, V-J Anttila⁷, S Lamminmäki²

Affiliations

¹ Department of Pulmonary Medicine, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, 00029, Helsinki, Finland.
² Department of Otorhinolaryngology, Head and Neck Surgery, Head and Neck Center, University of Helsinki and Helsinki University Hospital, 00029, Helsinki, Finland.
³ Meilahti University Hospital, Adnominal Center, HUS, Haartmaninkatu 4, Helsinki P.O. Box 340, FIN-00029, Helsinki, Finland.
⁴ HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Finland.
⁵ Translational Immunology Research Program, University of Helsinki, Finland.
⁶ Department of Vascular Surgery, Abdominal Center, University of Helsinki and Helsinki University Hospital, 00029, Helsinki, Finland.
⁷ Department of Infectious Diseases, Inflammatory Center, University of Helsinki and Helsinki University Hospital, HUS, 00029, Finland.

Abstract

Background: Isolation precautions are essential prevent spread of COVID-19 infection but may have a negative impact on inpatient care. The impact of these measures on non-COVID-19 patients remains largely unexplored.

Aim: This study aimed to investigate diagnostic and treatment delays related to isolation precautions, the associated patient outcome, and the predisposing risk factors for delays.

Methods: This observational study was conducted in seven Helsinki region hospitals during the first wave of the COVID-19 pandemic in Finland. The study used data on all non-COVID-19 inpatients, who were initially isolated due to suspected COVID-19, to estimate whether isolation precautions resulted in diagnostic or treatment delays.

Results: Out of 683 non-COVID-19 patients, 33 (4.8%) had delays related to isolation precautions. Clinical condition deteriorated non-fatally in seven (1.0%) patients. The following events were associated with an increased risk of treatment or a diagnostic delay: more than three ward transfers (P = 0.025); referral to an incorrect speciality in the emergency department (P = 0.004); more than three SARS-CoV-2 RT-PCR tests performed (P = 0.022); and where cancer was the final diagnosis (P = 0.018). In contrast, lower respiratory tract symptoms (P = 0.013) decreased the risk.

Conclusions: The use of isolation precautions for patients who did not have COVID-19 had minor negative effects on patient outcomes. The present study underlines the importance of targeting diagnostic efforts to patients with unspecified symptoms and to those with a negative SARS-CoV-2 test result. Thorough investigations to achieve an accurate diagnosis improves the prognosis of patients and facilitates appropriate targeting of hospital resources.

Keywords: COVID-19; Isolation precaution; Non-COVID-19; Patient outcome; Treatment delay.