User:LaurenMYC/sandbox

Article Evaluation: Disease Surveillance

Evaluating Content

Relevant

The article is quite short in length for such a broad topic. It does not contain a lot of information. The information available is relevant to an extent. The article's introduction is not very helpful at introducing what disease surveillance is.

To my knowledge, this article seems to be out of date. The oldest referenced site for the WHO is from 2006. During this time, we have had Ebola and Zika epidemics, which are no where listed on the wikipedia page. In addition, the wikipedia page only cites WHO for disease surveillance. It does not mention any other institution, such as the CDC or NIH and does not list disease surveillance within various states. It does not mention any benefits of disease surveillance and only lists the challenges.

Improvement

I think this page is on a good start. However, given how broad the topic disease surveillance is, I believe that a lot more information could be added. For instance, giving background as to why we need disease surveillance, the history as to how we started/needed disease surveillance, comparing disease surveillance within the states and across different countries, more examples of disease surveillance outside of H1N1, etc. Also, more sources need to be added. Many statements were made throughout the wikipedia page and are not given any citation or reference.

Evaluating Tone

Tone

The article clearly favors disease surveillance and doesn't give any position on the option of not having disease reporting. I think it would have been beneficial for the content creators of this wikipedia page to indicate the effects of disease management within countries without disease surveillance or compare the differences in disease management within states. However, the article doesn't appear to have any strong stance regarding the topic of disease surveillance.

Viewpoints

The main viewpoint of disease surveillance is through the WHO and with the example of H1N1. No other viewpoints are provided.

Evaluating Sources:

Citations

I have reviewed the available citations within this page. Although the citations included in this wikipedia page are not broken and work, many citations are missing. Whole sections within this page lack any citations. For instance, the section on "Mandatory reporting" does not have any citations.

References

I have reviewed all of the links in the article. Although none of the links are broken, many do not support the source of the information claimed within the article. For instance, within the introduction, which contains information such as what is disease surveillance, how are cases reported, and what is disease reporting like now, the source for this large body of text is claimed to be WHO's Severe acute respiratory syndrome (SARS) page, which does not indicate any of the mentioned text in the wikipedia page. In addition, a quote in the section "H5N1" is supposedly referenced to an ABC article. However, upon clicking on the link, the user is directed simply to ABC's "Health News" page.

There is very little diversity in references for this wikipedia page. Out of the 9 references, 5 claim to be from the WHO, 3 are from news articles, and 1 is from a peer reviewed journal. Although the WHO is a neutral and reliable reference, as mentioned above, it does not match the wikipedia text it claims to be referencing.

Checking the Talk Page:

In the Talk Page, there are conversations regarding whether a section on "WHO reporting lag" should be added given that WHO has apparently been lagging in releasing data/information in comparison to various news platforms.

In addition, a long list of unsourced content was addressed in the Talk Page.

Conversations

It appears that the Talk Page's conversations are predominantly among 3 users. They seem to be very supportive of one another and have a history of working together. For instance, a user would address a topic that needs to be added while others would provide feedback and assist with adding citations.

Article Rating

This article is rated as a C-Class on the project's quality scale. This article is also rated as Mid-Important. This is part of the WikiProject Medicine page.

Article Selection: Isolation (Health Care)

Critique

This article is within the scope or WikiProject Medicine and is rated as a C-Class on the project's quality scale and Mid-Importance on the project's importance scale.

Relevant Content

A lot of relevant content is covered within this article. However, not a lot of information is provided under each heading. There is definitely lots of room for improvement in terms of adding relevant content and citing claimed information.

The article does a good job defining the different types of precautions and forms of isolation, but again, each definition is not matched with a cited source.

Neutrality

Upon my review, this article appears to have a neutral tone. It does not favor or disfavor medical isolation.

Lack of Citations

The article needs additional cites and verification. There are many claims throughout the article that need a citation.

Twelve citations are provided for this article. The citations provided range in publication date from 1985 to 2014. The peer reviewed articles identified also are referring to specific examples rather than general topics on isolation.

The "universal/standard precautions" section from the article is referencing a case study published in 1985 set in a workplace regarding a very specific virus. I know that guidelines and protocols for universal isolation has been revised since 1985.

For instance, the article states the following:

Universal precautions refer to the practice, in medicine, of avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields.

A study in University of Michigan showed that wearing a mask alone did not reduce symptoms. Regular hygiene, such as good hand washing, coupled with an appropriate type of mask was more effective to reduce risk of illness.

Talk Page

I have reviewed the Talk Page and unfortunately, there is not a lot of activity here in this page. There is one comment from a user back in 2009 that questioned whether a statement in the article is accurate. The statement is the following:

Isolation is most commonly used when a patient has a viral illness.

No citation is included with this statement. In addition, the user brings up a good point that different regions and scenarios vary in terms of isolation protocols. The user indicated that isolation protocols vary between areas with tuberculosis.

Recommendations

I hope to make the following recommendations to this article:

• Provide citations to claims made throughout article
• Verify content in article is accurate and up-to-date
• Provide examples to the definitions in the article
• Add more settings for isolation. For instance, I know that isolation within schools is a major public health intervention but is not mentioned anywhere in the article
• Address the variation of isolation protocols within different regions. I know that isolation varies between jurisdictions. For instance, Los Angeles County's isolation protocols vary from San Diego County's isolation protocols. The fact for differences in protocols based on region is not mentioned anywhere in this article.
• Link article to more topics in field. This article was pretty hard to come by. The current title "Isolation (health care)" can be improved as well to help make this article more easy to find. For instance, the article I evaluated "Disease Surveillance" is not linked to this article "Isolation" when I feel that the two articles compliment each other.
• Increase list of diseases needing isolation. No list of infectious diseases that require isolation is listed. I know that there is at least a list generated by the federal government and each health department within a region has its own list as well. I also know this list includes more than just viruses, so I will be sure to include other disease etiologies such as bacteria, fungi, etc.
• Address complications/concerns regarding disease isolation. During isolation, infectious person cannot be in contact with healthy persons. This may include persons being isolated for long periods of time, missing a great deal of work, school etc. For instance, those with measles must be isolated for at least 21 days since onset. This can be very taxing on a person who has to therefore miss 21 days of work or school due to illness.
• Address benefits of isolation. The article does mention the purpose of isolation, which is to prevent further spread of disease. I think this topic can be elaborated more. For instance, why is it important to prevent further spread of disease? What could happen if we let an infant with chickenpox continue to attend daycare without any isolation from other infants?

Adding Citations + Edits: 2/19/2019

I added 3 citations and revised the Definitions section to my article, Isolation (healthcare):

Definitions[edit]

According to the CDC, isolation and quarantine are actions used to protect the general public from possible exposure of a contagious disease.

• Isolation is the act of separating a sick individual with a contagious disease from health individuals without that contagious disease.
• Quarantine is the compulsory separation and confinement, with restriction of movement, of healthy individuals or groups who have potentially been exposed to an agent to prevent further infections should infection occur.
• Biocontainment refers to laboratory biosafety in microbiology laboratories in which the physical containment (BSL-3, BSL-4) of highly pathogenic organisms is accomplished through built-in engineering controls.

List of Potential Articles

Name of Article	Author	Source of Article	Publication Date	Website
Type and Duration of Precautions Recommended for Selected Infections and Conditions	CDC	CDC	September 2018	https://www.cdc.gov/infectioncontrol/guidelines/isolation/appendix/type-duration-precautions.html
Facemasks, Hand Hygiene, and Influenza among Young Adults: A Randomized Intervention Trial	Aiello AE, Perez V, Coulborn RM, Davis BM, Uddin M, Monto A	PLoS ONE	2012	https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0029744
Does Wearing a Mask Prevent the Flu?	Story C, Cherney K, Krucik G	Healthline	2015	https://www.healthline.com/health/cold-flu/mask#1
Respiratory Protection For Reducing Disease Transmission	American Industrial Hygiene Association	American Industrial Hygiene Association	Unknown	https://www.aiha.org/about-ih/Pages/Respiratory-Protection-For-Reducing-Disease-Transmission.aspx
Disease outbreaks	WHO	WHO	February 2019	https://www.who.int/emergencies/diseases/en/
Loneliness, Social Isolation, and Cardiovascular Health	Xia N and Li Huige	Antioxidants and Redox Signaling	March 2018	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831910/
The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study	Tran K, Bell C, Stall N, et al.	Journal of General Internal Medicine	March 2017	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330996/
The growing problem of loneliness	Cacioppo J and Cacioppo S	The Lancet	February 2018	https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30142-9/fulltext
Outcomes of an Infection Prevention Project Focusing on Hand Hygiene and Isolation Practices	Aragon D and Brown S	Advanced Critical Care	2005	http://acc.aacnjournals.org/content/16/2/121.short

Lead Section

Disease isolation is a form of infection prevention and control used to prevent the spread of a communicable disease to others.Various forms of isolation exist, including strict isolation, contact isolation, respiratory isolation, and high isolation. The Centers for Disease Control and Prevention created these precaution measures to protect the general community. These precautions are reviewed and implemented at the local level among public health and health care facilities. Disease isolation could include patients with a communicable disease and contacts to a communicable disease who are at risk of spreading it to others. Contacts are anyone who have been in contact with a communicable and are at risk of developing the disease. This can include family members, friends, and health care workers. Isolation can occur within a health care setting, a person’s home, and other environments, such as schools, prisons, etc. However, these precautions may have negative consequences on an isolated individual. Therefore, this topic is discussed and reviewed regarding the ethics of disease isolation when comparing the right of the individual versus the right of the community.

Importance of disease isolation

Various types of prevention measures exist to protect individuals from disease, including vaccines, antibiotics and antivirals, treatments, microbe awareness, and government policies. Disease isolation is an essential public health precaution used to reduce disease transmission from either a person with a disease or a person who has possibly been infected and is at risk of developing the disease and spreading it to others. Diseases can be spread to others by contact, droplet, or airborne transmission. Isolation can be used if a patient is contagious (transmissible person-to-person) with a viral or bacterial illness. This can protect the spread of contagious diseases from a patient to other patients, health care workers, and visitors, or from outsiders to a particular patient (reverse isolation). Various forms of isolation exist. Disease isolation can occur within a healthcare facility such as a hospital or at a person’s home. Public health programs usually monitor infection control interventions. Disease isolation can prevent healthcare-acquired infections of hospital-acquired infections (HCAIs), reduce threats of antibiotic resistance infections, and respond to new and emerging infectious disease threats globally.  

Types of Precautions

The U.S. Centers for Disease Control and Prevention (CDC) created various levels of disease isolation (also described "precaution"). These precautions are also reviewed and revised by the CDC.^[1]

Isolation

According to the CDC, isolation is used to protect the general public from possible exposure of a contagious disease. Isolation is the act of separating a sick individual with a contagious disease from health individuals without that contagious disease.

Special equipment is used in the management of patients in the various forms of isolation. These most commonly include items of personal protective equipment (gowns, masks, and gloves) and engineering controls (positive pressure rooms, negative pressure rooms, laminar air flow equipment, and various mechanical and structural barriers). Dedicated isolation wards may be pre-built into hospitals, or isolation units may be temporarily designated in facilities in the midst of an epidemic emergency.

Isolation should not be mistaken as the same as quarantine or biocontainment. Quarantine is the compulsory separation and confinement, with restriction of movement, of healthy individuals or groups who have potentially been exposed to an agent to prevent further infections should infection occur. Biocontainment refers to laboratory biosafety in microbiology laboratories in which the physical containment (BSL-3, BSL-4) of highly pathogenic organisms is accomplished through built-in engineering controls.

Many forms of isolation exist.

Strict isolation [edit source]

Strict isolation is used for diseases spread through the air and in some cases by contact. Patients must be placed in isolation to prevent the spread of infectious diseases. Those who are kept in strict isolation are often kept in a special room at the facility designed for that purpose. Such rooms are equipped with a special lavatory and caregiving equipment, and a sink and waste disposal are provided for workers upon leaving the area.^[10]

Contact isolation [edit source]

Contact isolation is used to prevent the spread of diseases that can be spread through contact with open wounds. Health care workers making contact with a patient on contact isolation are required to wear gloves, and in some cases, a gown.

Respiratory isolation [edit source]

Respiratory isolation is used for diseases that are spread through particles that are exhaled. Those having contact with or exposure to such a patient are required to wear a mask.

Reverse isolation [edit source]

Reverse isolation is a way to prevent a patient in a compromised health situation from being contaminated by other people or objects. It often involves the use of laminar air flow and mechanical barriers (to avoid physical contact with others) to isolate the patient from any harmful pathogens present in the external environment.

High isolation [edit source]

High isolation is used to prevent the spread of unusually highly contagious, or high consequence, infectious diseases (e.g., smallpox, Ebola virus). It stipulates mandatory use of: (1) gloves (or double gloves if appropriate), (2) protective eyewear (goggles or face shield), (3) a waterproof gown (or total body Tyvek suit, if appropriate), and (4) a respirator (at least FFP2 or N95 NIOSH equivalent), not simply a surgical mask. Sometimes negative pressure rooms or powered air-purifying respirators (PAPRs) are also used. The Aeromedical Biological Containment System (ABCS) is an air-transportable high isolation module for movement of highly contagious patients.

Universal/standard precautions [edit source]

Main article: Universal precautions

Universal precautions refer to the practice, in medicine, of avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields. The practice was widely introduced in 1985–88. In 1987, the practice of universal precautions was adjusted by a set of rules known as body substance isolation. In 1996, both practices were replaced by the latest approach known as standard precautions. Use of personal protective equipment is now recommended in all health settings.

Transmission-based precautions [edit source]

Main article: Transmission-based precautions

Transmission-based precautions are additional infection control precautions — over and above universal/standard precautions — and the latest routine infection prevention and control practices applied for patients who are known or suspected to be infected or colonized with infectious agents, including certain epidemiologically important pathogens. The latter require additional control measures to effectively prevent transmission.

There are three types of transmission-based precaution:

Contact precautions are intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, which are spread by direct or indirect contact with the patient or the patient’s environment.

Droplet precautions are intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions.

Airborne precautions prevent transmission of infectious agents that remain infectious over long distances when suspended in the air (e.g., rubeola virus [measles], varicella virus [chickenpox], M. tuberculosis, and possibly SARS-CoV).

Isolation of health care workers [edit source]

Disease isolation is relevant to the work and safety of health care workers. Health care workers may be regularly exposed to various types of illnesses and are at risk of being getting sick. Disease spread can occur between a patient and a health care worker, even if the health care workers takes all necessary precautions to minimize transmission, including proper hygiene and being up-to-date with vaccines. If a health care gets sick with a communicable disease, possible spread may occur to other health care workers or susceptible patients within the health care facility. This can include patients with a weakened immune system and may be at risk for serious complications.

Health care workers who become infected with certain contagious agents may not be permitted to work with patients for a period of time. The Occupational Safety and Health Administration (OSHA) has implemented several standards and directives applicable to protecting health care workers from spread of infectious agents. These include blood borne pathogens, personal protective equipment, and respiratory protections. The CDC has also released resource for health care facilities to assist in assessing and reducing risk for occupational exposure to infectious diseases. The purpose of these standards and guidelines are to prevent the spread of disease to others in a health care facility.

Effects of isolation [edit source]

Disease isolation is rarely disputed for its importance in protecting others from disease. However, it is important to consider the consequences disease isolation may have on an individual. For instance, patients may not be able to receive visitors, and in turn, become lonely. Patients may experience depression, anxiety, and anger. Small children may feel their isolation is a punishment. Staff may need to spend more time with patients. Patients may not be able to receive certain types of care due to the risk that other patients may become contaminated. This includes forms of care that involve use of equipment common to all patients at the facility, or that involve transporting the patient to an area of the facility common to all patients. Given the impact of isolation on patients, social and emotional support may be needed.

Although a majority of health care professionals advocate for disease isolation as an effective means of reducing disease transmission. However, some health care professionals are concerned with implementing such control protocols given the possible negative consequences on patients. Patients isolated with Methicillin Resistant Staphylococcus Aureus (MRSA) can also be negatively impacted by having less documented care/bedside visits from attending and residents.

Ethics of Disease Isolation [edit source]

Disease isolation serves as an important method to protect the general community from spread of disease, especially in a hospital or community-wide outbreak. However, this invention poses an ethical question on rights of the individual versus rights of the general community.

Infectious diseases, including isolation precaution measures, are not be considered a primary topic of importance among bioethics in comparison to other topics such as euthanasia, assisted reproduction, genetics, etc. This may be due the bias for topics toward high-tech, wealthy-world topics such as euthanasia and assisted reproduction, the blinding optimism that infectious diseases are no longer a threat or in need of further discussion due to the success of antibiotics and vaccines, and the labeling of “other” among certain infectious diseases such as AIDS, tuberculosis, Ebola, etc.

In cases of disease outbreaks, such as measles or Ebola, disease isolation can be argued as an ethical and necessary precaution for protecting the community from further disease transmission. This can be justified using felicific calculus to predict the outcomes (consequences) of moral action between the individual rights versus the rights of the general public during disease isolation. This justifies that disease isolation is most likely to result in the greatest amount of positive outcomes for the largest number of people.

Disease isolation can also be justified as a morally legitimate ethical practice in public health based on the reciprocal relationship between the individual and the state:

The individual is obligated to protect others by preventing further spread of disease, respect the instructions from public health authorities and sequester themselves in their homes and not attend public gatherings, and act as a first responder (if a healthcare professional) by providing services to protect and restore public health. The state, on the other hand, is obligated to provide support to individuals burdened as a result of restrictive measures (e.g. compensation for missed work, providing access to food and other necessities for those quarantined and isolated, assistance for first responders to balance personal/professional obligations), ensure several legal protections are in place for those subjected to restrictive measures, and communicate all relevant information regarding the necessity of restriction.

External links

• Chart showing recommendations for various forms of isolation

Category:Health care Category:Infectious diseases Category:Prevention Category:Nursing Category:Medical hygiene