Growing evidence documents the fact that language barriers indirectly impact the quality of the healthcare that patients receive. Language barriers contribute to reducing both patient and medical provider satisfaction, as well as communication between medical providers and patients. Patients who face language barriers are more likely to consume more healthcare services2 and experience more adverse events.7 A recent study conducted in six hospitals in the US found that adverse events occurred more frequently among patients with limited proficiency in English than among those who were proficient in English.
This review includes studies that address the impact of language barriers on the delivery of healthcare. It excludes studies into the impacts of communication barriers other than language barriers on the delivery of healthcare, studies that were not primarily conducted in healthcare organizations, and non-peer-reviewed articles. The search strategy was limited to articles published from 2000 to 2019 to find the most recent literature on the topic.
Table 2 presents the most important findings of the 14 studies in this review. Seven of the studies focused on language barriers and patient satisfaction, two on the impact of language barriers on healthcare provider satisfaction, one on the impact of language barriers on both healthcare providers and patient satisfaction, two on the cost of interpretation services, one on the quality of interpretation services, and one on online translation tools. The findings of studies can be divided into three categories: the impact of language barriers on medical providers (such as physicians and nurses), patients, and the cost and quality of healthcare services.
Communication between patients and medical providers is at the heart of effective healthcare. In Pytel,17 94.3% of nurses reported that it was very important for their work environment and communication to understand the language of their patients. Physicians also have difficulty understanding patients who do not speak their language, leading to wrong diagnosis and medications.18 In Norway, medical providers reported that they had trouble understanding between 36% and 43% of the patients who do not speak the local language, necessitating interpreters.15 Indeed, 37% of physicians indicated that they felt that patients hide some information because of language barriers.15 In addition, all South African nurses in Saudi Arabia had difficulty communicating with patients and their family members, as well as nurses from other countries, because of language barriers.19
We also found that patients who do not speak the local language will have less satisfaction with their healthcare and less access to usual sources of healthcare. Even when patients with language barriers have access to healthcare, they have decreased satisfaction with that healthcare, decreased understanding of their diagnoses, and increased medication complications.25,26 A study conducted in Saudi Arabia showed that 25% of foreign patients reported that they had difficulty communicating with medical professionals and decreased satisfaction with their healthcare; 20% of medical professionals reported that health outcomes (i.e., healthcare errors, understanding patient needs, feeling satisfaction, and trust in nursing care needs) were always affected by language barriers.27 Interpreter services are necessary to solve the problem of language barriers in healthcare institutions and to increase the satisfaction of both medical professionals and patients.
To overcome language barriers, some healthcare institutions provide interpreter services; however, these services pose critical challenges in terms of access and financial burden. Previous studies have shown that most healthcare institutions have poor access to interpreter services or no services at all.12,14 The use of interpreter services contributes to increased patient satisfaction and improved patient care among patients with language barriers.28 Interpreter services have a significant association with increased physician visits, prescription drugs by physicians, and receipt of preventative services among patients.29 However, providing interpreter services also increases the length and cost of physician visits.
This review has some limitations. First, there are few existing studies on the application of online translation tools in healthcare to address the problem of language barriers. Second, there are few studies evaluating the challenges of language barriers in private healthcare organizations. The impact of language barriers must be evaluated in both the public and the private sectors to address this problem.
With the need for an effective response to the detection of serious antibiotic resistance threats, there is growing evidence that the traditional implementation of Contact Precautions in nursing homes is not implementable for most residents for prevention of MDRO transmission.
This document is intended to provide guidance for PPE use and room restriction in nursing homes for preventing transmission of MDROs, including as part of a public health response. For the purposes of this guidance, the MDROs for which the use of EBP applies are based on local epidemiology. At a minimum, they should include resistant organisms targeted by CDC but can also include other epidemiologically important MDROs [9, 10].
This document is not intended for use in acute care or long-term acute care hospitals and does not replace existing guidance regarding use of Contact Precautions for other pathogens (e.g., Clostridioides difficile, norovirus) in nursing homes.
Enhanced Barrier Precautions expand the use of PPE and refer to the use of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDROs to staff hands and clothing [11-15]. MDROs may be indirectly transferred from resident-to-resident during these high-contact care activities. Nursing home residents with wounds and indwelling medical devices are at especially high risk of both acquisition of and colonization with MDROs [3,5,6]. The use of gown and gloves for high-contact resident care activities is indicated, when Contact Precautions do not otherwise apply, for nursing home residents with wounds and/or indwelling medical devices regardless of MDRO colonization as well as for residents with MDRO infection or colonization.
At the core of the barrier nursing concept is the need to provide for the protection of the clinical personnel and to prevent the escape of a highly contagious disease into the environment while, at the same time, not neglecting the treatment of the patient. Appropriate use of the personal protective equipment (PPE) is an essential factor here. The PPE is a pressurised full body suit, with breathing and body protection apparatus that makes it possible for personnel to treat the patient without exposing themselves to the risk of infection. Personnel are subject to specific physical and psychological difficulties while wearing such a biohazard suit.
Since 2006, the Department of Tropical Medicine of Hamburg Bundeswehr Hospital has shared personnel and expertise with Hamburg-Eppendorf University Hospital in order to care for patients with highly contagious, life-threatening diseases. As part of this programme, a medical officer consultant for anaesthesiology and intensive care, a medical officer undergoing training in internal medicine, two intensive care orderly sergeants and two medical orderly sergeants have been incorporated in the routine schedules at the civilian hospital. They thus form part of the team that will deal with the patient should an genuine case be transferred to Hamburg specialised treatment centre. In 2006, Hamburg Bundeswehr Hospital provided assistance to the Frankfurt specialised treatment centre by assigning there a medical officer consultant for infectiology and internal medicine for several weeks treatment of a patient with Lassa fever, and also provided support to Hamburg specialised treatment centre for several days in connection with a suspected case of Ebola fever in 2009. As part of the 2007 barrier nursing course, a collaborative exercise was undertaken, involving the transfer of a patient from the intensive care unit of Hamburg Bundeswehr Hospital to Hamburg specialised treatment centre (Fig. 4). The joint training of all groups involved (Hamburg Bundeswehr Hospital, Hamburg fire services, specialised treatment centre at Hamburg-Eppendorf University Hospital) made possible the constructive exchange of experience and strengthened local ties between the military and civilian organisations. Members of other specialised treatment centres participated in the course, and presented their own concepts for the transport and treatment of these patients. The course has since developed into a forum in which information is exchanged between the various groups and organisations.
It is also planned to supply prepared material kits to the various Bundeswehr hospitals. These kits will include PPE and air pump equipment together with decontamination and isolation material designed for clinical use. The kits will enable personnel to provide for temporary isolation of patients under barrier nursing conditions until they can be transferred to a specialised treatment unit. The same material kits will also be made available to the relevant units during deployment abroad, although there will be differences to the kits provided in the homeland in quantitative aspects. The materials, currently in store, conform to the corresponding civilian quality and certification standards.
 7a63b62549