The lived experience of haemodialysis patients managed with transmission-based precautions for MDRO colonisation: A qualitative study

  • Nicholas A. Gray
    Corresponding author. Renal Unit, Sunshine Coast University Hospital, 6 Doherty St, Birtinya, Queensland, 4575, Australia. Fax: +61 7 5202 2055.
    Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia

    University of the Sunshine Coast, Sippy Downs, Queensland, Australia

    Sunshine Coast Health Institute, Birtinya, Queensland, Australia
    Search for articles by this author
  • Author Footnotes
    1 Current address: Synergy Rehab Solutions, Moffat Beach, Queensland, Australia
    Lisa Toy
    1 Current address: Synergy Rehab Solutions, Moffat Beach, Queensland, Australia
    University of the Sunshine Coast, Sippy Downs, Queensland, Australia
    Search for articles by this author
  • Kim Dalla-Bona
    Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
    Search for articles by this author
  • Jennifer Broom
    Infectious Diseases Research Network, Sunshine Coast University Hospital, Birtinya, Queensland, Australia

    The University of Queensland, Herston, Queensland, Australia
    Search for articles by this author
  • Marion Gray
    University of Southern Queensland, Ipswich, Queensland, Australia
    Search for articles by this author
  • Author Footnotes
    1 Current address: Synergy Rehab Solutions, Moffat Beach, Queensland, Australia


      • Communication of the implications of MDRO was often insufficient and inconsistent.
      • Isolation resulted in positive (privacy) and negative (reduced interaction) effects.
      • Psychological impacts included health concern/anxiety and stigma.
      • Inconsistent management of MDRO by staff and location resulted in frustration.
      • Patient experience is important when developing and implementing MDRO policy.



      Patients undergoing haemodialysis colonised with multi-drug resistant organisms (MDROs) are commonly managed with transmission-based precautions (TBP) to prevent nosocomial transmission. TBP have been linked to mixed effects on patient psychological well-being and clinical care. This study was designed to report the lived experience of dialysis patients managed with TBP.


      A qualitative study of 15 patients undergoing haemodialysis managed with TBP was performed. Participants took part in individual semi-structured interviews. Data was analysed utilising an interpretive phenomenological approach.


      Four themes were identified.
      1. Communication of what MDRO screening meant, the results, and implications of MDRO positivity was perceived by many patients as insufficient and inconsistent.
      2. Experiences of care in isolation were described, with both positive (privacy) and negative (reduced interaction) experiences identified.
      3. Psychosocial and emotional responses including concern about health implications and stigma were reported, but also screening was described by some as increasing their perception of being cared for by health care workers, as they felt all health risks were being managed.
      4. Confusion around perceived inconsistencies of management, particularly across different environments (eg hospital vs home) and staff.


      TBP have complex positive and negative impacts on patients which should be considered when developing MDRO management policy and communication around such policy. Strategies to improve communication, patient and staff education, and remove (or explain) perceived inconsistencies of practice may reduce the negative consequences of TBP leading to improved delivery of quality, person-centred care.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Infection, Disease & Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Salazar-Ospina L.
        • Vanegas J.M.
        • Jiménez J.N.
        High intermittent colonization by diverse clones of β-lactam-resistant Gram-negative bacilli suggests an excessive antibiotic use and different sources of transmission in haemodialysis patients.
        J Hosp Infect. 2021; 107: 76-86
        • Zacharioudakis I.M.
        • Zervou F.N.
        • Ziakas P.D.
        • Rice L.B.
        • Mylonakis E.
        Vancomycin-resistant enterococci colonization among dialysis patients: a meta-analysis of prevalence, risk factors, and significance.
        Am J Kidney Dis : the official journal of the National Kidney Foundation. 2015; 65: 88-97
        • Zacharioudakis I.M.
        • Zervou F.N.
        • Ziakas P.D.
        • Mylonakis E.
        Meta-analysis of methicillin-resistant Staphylococcus aureus colonization and risk of infection in dialysis patients.
        J Am Soc Nephrol : JASN (J Am Soc Nephrol). 2014; 25: 2131-2141
        • Chang H.J.
        • Hsu P.C.
        • Yang C.C.
        • Kuo A.J.
        • Chia J.H.
        • Wu T.L.
        • et al.
        Risk factors and outcomes of carbapenem-nonsusceptible Escherichia coli bacteremia: a matched case-control study.
        J Microbiol Immunol Infect. 2011; 44: 125-130
        • Bleumin D.
        • Cohen M.J.
        • Moranne O.
        • Esnault V.L.
        • Benenson S.
        • Paltiel O.
        • et al.
        Carbapenem-resistant Klebsiella pneumoniae is associated with poor outcome in hemodialysis patients.
        J Infect. 2012; 65: 318-325
        • Humphreys H.
        Controlling the spread of vancomycin-resistant enterococci. Is active screening worthwhile?.
        J Hosp Infect. 2014; 88: 191-198
        • Lee B.Y.
        • Song Y.
        • McGlone S.M.
        • Bailey R.R.
        • Feura J.M.
        • Tai J.H.
        • et al.
        The economic value of screening haemodialysis patients for methicillin-resistant Staphylococcus aureus in the USA.
        Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2011; 17: 1717-1726
        • Magiorakos A.P.
        • Burns K.
        • Rodríguez Baño J.
        • Borg M.
        • Daikos G.
        • Dumpis U.
        • et al.
        Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from the European Centre for Disease Prevention and Control.
        Antimicrob Resist Infect Control. 2017; 6: 113
        • Servais A.
        • Mercadal L.
        • Brossier F.
        • Venditto M.
        • Issad B.
        • Isnard-Bagnis C.
        • et al.
        Rapid curbing of a vancomycin-resistant Enterococcus faecium outbreak in a nephrology department.
        Clin J Am Soc Nephrol : CJASN. 2009; 4: 1559-1564
        • Siegel J.D.
        • Rhinehart E.
        • Jackson M.
        • Chiarello L.
        Guideline for isolation precautions: preventing transmission of infectious agents in health care settings.
        Am J Infect Control. 2007; 35 (2007): S65-S164
        • Tran K.
        • Bell C.
        • Stall N.
        • Tomlinson G.
        • McGeer A.
        • Morris A.
        • et al.
        The effect of hospital isolation precautions on patient outcomes and cost of care: a multi-site, retrospective, propensity score-matched cohort study.
        J Gen Intern Med. 2017; 32: 262-268
        • Garner S.E.
        • Polkinghorne K.R.
        • Kotsanas D.
        • Kerr P.G.
        • Korman T.M.
        • Stuart R.L.
        Vancomycin-resistant enterococci colonization does not increase mortality in end-stage kidney failure: a case-control study.
        J Hosp Infect. 2013; 85: 289-296
        • Abad C.
        • Fearday A.
        • Safdar N.
        Adverse effects of isolation in hospitalised patients: a systematic review.
        J Hosp Infect. 2010; 76: 97-102
        • Morgan D.J.
        • Diekema D.J.
        • Sepkowitz K.
        • Perencevich E.N.
        Adverse outcomes associated with Contact Precautions: a review of the literature.
        Am J Infect Control. 2009; 37: 85-93
        • Livorsi D.J.
        • Kundu M.G.
        • Batteiger B.
        • Kressel A.B.
        Effect of contact precautions for MRSA on patient satisfaction scores.
        J Hosp Infect. 2015; 90: 263-266
        • Findik U.Y.
        • Ozbaş A.
        • Cavdar I.
        • Erkan T.
        • Topcu S.Y.
        Effects of the contact isolation application on anxiety and depression levels of the patients.
        Int J Nurs Pract. 2012; 18: 340-346
        • Wassenberg M.W.
        • Severs D.
        • Bonten M.J.
        Psychological impact of short-term isolation measures in hospitalised patients.
        J Hosp Infect. 2010; 75: 124-127
        • Chittick P.
        • Koppisetty S.
        • Lombardo L.
        • Vadhavana A.
        • Solanki A.
        • Cumming K.
        • et al.
        Assessing patient and caregiver understanding of and satisfaction with the use of contact isolation.
        Am J Infect Control. 2016; 44: 657-660
        • Krishnasamy R.
        Contact precautions for colonisation with multidrug-resistant organisms and haemodialysis patient quality of life and mood: a pilot case-control study.
        Renal Society of Australasia Journal, 2019: 19-25
        • Miller H.M.
        • Tong A.
        • Tunnicliffe D.J.
        • Campbell D.
        • Pinter J.
        • Commons R.J.
        • et al.
        Identifying and integrating patient and caregiver perspectives for clinical practice guidelines on the screening and management of infectious microorganisms in hemodialysis units.
        Hemodialysis international International Symposium on Home Hemodialysis. 2017; 21: 213-223
        • Health Q.
        Management of multi-resistant organisms.
        (Accessed on 14/4/2022 at)
        • Clarke C.
        An introduction to interpretative phenomenological analysis: a useful approach for occupational therapy research.
        Br J Occup Ther. 2009; 72: 37-39
        • Finnegan-John J.
        • Thomas V.J.
        The psychosocial experience of patients with end-stage renal disease and its impact on quality of life: findings from a needs assessment to shape a service.
        ISRN Nephrol. 2013; 2013: 308986
        • McQuoid J.
        • Jowsey T.
        • Talaulikar G.
        Contextualising renal patient routines: everyday space-time contexts, health service access, and wellbeing.
        Soc Sci Med. 2017; 183 (1982): 142-150
        • Rao J.K.
        • Anderson L.A.
        • Inui T.S.
        • Frankel R.M.
        Communication interventions make a difference in conversations between physicians and patients: a systematic review of the evidence.
        Med Care. 2007; 45: 340-349
        • Fraser S.
        • Taal M.
        Helping people to live well with chronic kidney disease.
        Br J Hosp Med. 2020; 81: 1-10
        • See I.
        • Shugart A.
        • Lamb C.
        • Kallen A.J.
        • Patel P.R.
        • Sinkowitz-Cochran R.L.
        Infection control and bloodstream infection prevention: the perspective of patients receiving hemodialysis.
        Nephrol Nurs J : journal of the American Nephrology Nurses' Association. 2014; 41 (50; quiz 40): 37-39
        • Seale H.
        • Novytska Y.
        • Gallard J.
        • Kaur R.
        Examining hospital patients' knowledge and attitudes toward hospital-acquired infections and their participation in infection control.
        Infect Control Hosp Epidemiol. 2015; 36: 461-463
        • Guilley-Lerondeau B.
        • Bourigault C.
        • Guille des Buttes A.C.
        • Birgand G.
        • Lepelletier D.
        Adverse effects of isolation: a prospective matched cohort study including 90 direct interviews of hospitalized patients in a French University Hospital.
        Eur J Clin Microbiol Infect Dis : official publication of the European Society of Clinical Microbiology. 2017; 36: 75-80
        • Gasink L.B.
        • Singer K.
        • Fishman N.O.
        • Holmes W.C.
        • Weiner M.G.
        • Bilker W.B.
        • et al.
        Contact isolation for infection control in hospitalized patients: is patient satisfaction affected?.
        Infect Control Hosp Epidemiol. 2008; 29: 275-278
        • Bushuven S.
        • Dietz A.
        • Bushuven S.
        • Dettenkofer M.
        • Langer T.
        Interprofessional perceptions and emotional impact of multidrug-resistant organisms: a qualitative study.
        Am J Infect Control. 2019; 47: 876-882