Autonomy and Justice; experiences of patients and clinicians experiencing Contact Precautions implemented to manage hospital transmission of multi-resistant organisms

Mrs Joanna Harris1

1Illawarra Shoalhaven Local Health District, Warrawong, Australia



Respect for autonomy, and Justice are fundamental bioethical principles demonstrated in activities such as disclosure of information that enables hospital patients to make informed decisions relating to their care. Contemporary infection prevention and control principles require patients identified as colonised with a multi-resistant organism (MRO) to be informed so that they fully understand the precautions that may be implemented. Health professionals need a strong understanding of the justification of, and rationale for, Contact Precautions in order to fully inform and advise their patients.


A mixed methods approach involving semi-structured interviews analysed using interpretive description to explore patients’ experience of being informed about their MRO colonisation, and a survey of healthcare professionals’ self-assessed ability to explain MROs and Contact Precautions to their patients, and their experiences of doing so.


Patients reported an inconsistent approach to the disclosure of this information. Many did not recall being told of their colonisation. Patients felt their health professionals had suboptimal understanding of MROs to confidently and comprehensively answer their questions. Health professionals reported difficulty in finding the time to explain MROs in ‘plain english’ and answer patients’ questions effectively. There was also evidence of a lack of clarity about who is responsible for having these discussions with patients.


Health professionals report that they have difficulties in explaining MROs to their patients, and health professionals describe lack of confidence and lack of time as factors in their ability to properly inform their patients. These factors lead to patients’ autonomy being undermined.


Joanna came to Australia from the UK with an established nursing career in both acute and community based settings. She has a strong interest in communicable diseases and has specialised in infection prevention and control since 1996. During this time there have been a number of significant changes in our understanding of healthcare associated infections and emerging challenges continue to arise. Joanna believes that infection prevention and control specialists have a responsibility to use their skills to responsibly challenge practices as new information becomes available. To do otherwise risks ‘getting what we always get because we’re doing what we’ve always done’.  She has published a number of papers on a range of topics including listeria, headlice, MRSA prevalence and most recently a commentary questioning whether Contact Precautions are ethically justifiable in contemporary hospital care.

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