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There are substantial regional differences in the use of coercive measures in mental health in Norway. The Norwegian Directorate of Health is working with a national standardized package of procedures for improving and reducing use of coercion in mental health care and commissioned an updated systematic review to support this work. We summarized 21 studies about interventions for reducing seclusion and restraint in mental health care for adults. The report is an update of a previous systematic review on the same topic conducted in 2012. We included eight new studies in the updated report. Main findings:1. Joint crisis plans probably reduce the number of compulsory admissions.2. Systematic evaluation of aggressive behaviour in patients admitted to an acute psychiatric ward, may reduce the use of restraint and seclusion.3. Couselling towards staff in high security wards may reduce seclusion and restraint.4. For the other interventions (such as community-care network, involuntary outpatient commitment program and personal advocacy for inpatients) conclusions could not be drawn. Further research is needed in order to draw more robust conclusions about the effect of interventions intended to reduce coercive measures, seclusion and restraint, in mental health services. We included 21 studies, of which two were conducted in Norway. All included studies, examined the effect of interventions that are used in Norway, for example joint crisis plans, risk assessment, Assertive Community Treatment teams (ACT-teams), crisis resolution teams and use of written patient contracts.

Coercion. --- Isolation (Hospital care)

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Hensikt: Hensikten med studien var å undersøke om enerom reduserer forekomsten av Clostridium difficile hos innlagte pasienter i sykehus. Metode: En deskriptiv epidemiologisk undersøkelse som benyttes for å kartlegge insidensen av C.difficile infeksjon hos innlagte pasienter på fire norske sykehus i perioden 2001-2010 knyttet til antall enerom. Det ble i tillegg gjennomført en retrospektiv undersøkelse der vi så på risikoen for C. difficile infeksjon i en avdeling før flytting i gammelt sykehus med få enerom, til nytt sykehus med bare enerom for nesten alle pasienter. Resultat: I denne studien fant vi ingen sammenheng mellom insidens av C. difficile og økt tilgang på enerom. Det var stor forskjell i insidens av C. difficile mellom fire store norske sykehus. Det ser ut til at risikoen for C. difficile infeksjon var høyere i gammelt sykehusbygg enn nytt sykehus i en avdeling med en høy forekomst av C. difficile infeksjon, men dette var ikke statistisk signifikant. Denne undersøkelsen kan ikke vise lavere risiko for C. difficile infeksjon for pasienter som ligger på enerom. Konklusjon: Andel enerom har økt ved flere sykehus i løpet av studieperioden, men denne studien har ikke klart å vise om enerom har en smitteforebyggende effekt i sykehus ved C. difficile infeksjon. Enerom kan sannsynlig tilrettelegge for bedre smitteforbyggende atferd hos helsepersonell. Det må til flere forebyggende tiltak, som blant annet enerom, for å forbygge spredning av C. difficile infeksjon.

Isolation (Hospital care) --- Infection --- Control.

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In Norway there are substantial regional differences in the use of coercive measures in mental health care. There is also variation in use of coercion between mental health care institutions. At present Norwegian authorities are revising an Action Plan from 2006, aiming to reduce the use of coercion and to improve the quality of mental health services when coersive measures are used in accordance with the mental health act. In this systematic review interventions intended to reduce the use of coercive measures in mental health services for adults have been examined. Main findings:1. Joint crisis plans may reduce the number of compulsory admissions, but the documentation was of low quality.2. Systematic evaluation of aggressive behaviour in patients admitted to an acute psychiatric ward, may reduce the use of restraint and seclusion, but the documentation was of low quality.3. For the other interventions conclusions could not be drawn. Further research is needed in order to draw more robust conclusions about the effect of interventions intended to reduce coercive measures, seclusion and restraint, in mental health servies for adults. We included 12 studies. None of the included studies were conducted in Norway. However, the studies examined the effect of interventions that are used in Norway, such as joint crisis plans, risk assessment, Assertive Community Treatment teams (ACT-teams), crisis resolution teams, and use of written patient contracts, such as booklets containing treatment options.

Isolation (Hospital care) --- Medical policy.

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The Norwegian Knowledge Centre was asked by the Health Directorate to review available research about the effect of single rooms vs. contact isolation containment rooms. There are many ongoing projects in Norwegian hospitals, the construction of new buildings and the refurbishment of existing buildings. A review of available research on the effect of single rooms vs. contact isolation containment rooms will be important. We did not identify any studies evaluating the effect of single rooms vs. contact isolation containment rooms for patients infected by communicable diseases or patients colonized with pathogens that triggers isolation precaustions. There is a lack of evidence on the effect of single rooms compared to contact isolation containment rooms for spreading of infections, therefore, we do not know if the effect of these rooms is comparable.

Isolation (Hospital care) --- Hospital wards. --- Patients --- Care.

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Tuberculosis --- Isolation (Hospital care) --- Home care services. --- Transmission.