ED Infectious Disease Drills Show Room for Improvement

Lara C. Pullen, PhD

September 18, 2017

In unannounced mystery-patient infectious disease drills at hospital emergency departments (EDs), staff correctly put patients in masks and isolation 78% of the time. However, only 36% of staff performed personal hand hygiene, and even fewer (16%) instructed patients to do so. These screening and isolation exercises evaluated the abilities of the EDs to respond to communicable diseases of public health concern.

The drills identified two main ways that EDs could do better. First, they revealed that inquiry into a patient's recent travel should be routine because it was very helpful in identifying patients who might be infectious. In addition, they found that EDs need to do a better job with basic, routine, infection-control practices, such as handwashing.

Mary M.K. Foote, MD, senior medical coordinator for communicable disease preparedness at New York City Department of Health and Mental Hygiene, and colleagues performed the drills and published the results online September 15 in Morbidity and Mortality Weekly Report.

The assessment comes in response to the revelation of significant healthcare system vulnerabilities  during recent outbreaks of infectious diseases. In particular, studies have shown that EDs and their waiting areas facilitate the transmission of infections. EDs are thus a critical point of entry into the healthcare system.

The team designed exercises in accordance with the US Department of Homeland Security Exercise and Evaluation Program. They focused on the 50 New York City hospitals with EDs that participate in the 911 system and receive Hospital Preparedness Program funding. All but one hospital participated in the exercises.

The researchers performed 95 drill scenarios for Middle East respiratory syndrome (MERS) and measles during December 2015 to May 2016.

Patients were masked and isolated 78% of the time (83% of MERS scenarios passed and 74% of measles scenarios passed). The median time from when the patient entered the ED to when the patient donned a mask was 1.5 minutes (range, 0 - 47 minutes), and the median time from ED entry to isolation in an airborne infection isolation room was 8.5 minutes (range, 1 - 57 minutes).

Approximately 40% of hospitals failed at least one drill.

The researchers also found suboptimal adherence to key infection control practices. For example, only one third (36%) of staff members performed personal hand hygiene and 16% of staff members instructed patients to do so.

The authors note that they were not able to evaluate factors that may be beyond the control of the hospital and staff, such as ED patient volume and staffing levels.

The team has also developed a toolkit to help healthcare facilities and health departments conduct similar drills. The toolkit should make it possible for health departments to identify areas for improvement and enhance readiness.

The authors have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep.  Published online September 14, 2017.  Full text

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