Assessment of Hospital Emergency Department Response to Potentially Infectious Diseases Using Unannounced Mystery Patient Drills — New York City, 2016

Foote, Mary; Styles, Timothy; Quinn, Celia

doi:10.15585/mmwr.mm6636a2

Cited by 39 publications

(34 citation statements)

References 9 publications

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“…Furthermore, clinicians perceived less risk to themselves when the patient was wearing a protective mask for a potential respiratory disease and felt protected enough not to wear a mask. Public Health guidelines recommend that symptomatic persons in hospital waiting rooms and other public spaces are given a mask to wear to prevent transmission of respiratory infection [50,51]. This measure is largely accepted by the public and has had some success in community settings [52][53][54].…”

Section: Discussionmentioning

confidence: 99%

Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

Barratt

Gilbert

Shaban

et al. 2020

Australasian Emergency Care

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a b s t r a c tBackground: The risk of healthcare-acquired infection increases during outbreaks of novel infectious diseases. Emergency department (ED) clinicians are at high risk of exposure to both these and common communicable diseases. Personal protective equipment (PPE) is recommended to protect clinicians from acquiring, or becoming vectors of, infection, yet compliance is typically sub-optimal. Little is known about factors that influence use of PPE-specifically gloves and masks-during routine care in the ED. Methods: This was an ethnographic study, incorporating documentation review, field observations and interviews. The theoretical domains framework (TDF) was used to aid thematic analysis and identify relevant enablers of and barriers to optimal PPE use. Results: Thirty-one behavioural themes were identified that influenced participants' use of masks and gloves. There were significant differences, namely: more reported enablers of glove use vs more barriers to mask use. Reasons included more positive unit culture towards glove use, and lower perception of risk via facial contamination. Conclusion: Emerging infectious diseases, spread (among other routes) by respiratory droplets, have caused global outbreaks. Emergency clinicians should ensure that, as with gloves, the use of masks is incorporated into routine cares where appropriate. Further research which examines items of PPE independently is warranted. (R. Barratt).severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and pandemic influenza A [2]. Healthcareassociated transmission of these viral infections, into previously unaffected communities, was a key feature of the early stages of, for example, SARS in Toronto and MERS in Seoul [3,4]. A notable feature of both outbreaks was the high proportion of those affected who were healthcare workers, with reports of up to 27% and 57% for MERS and SARS, respectively [5]. First responders and emergency department (ED) clinicians are at high risk of exposure to both common and emerging communicable diseases of high consequence, as they are in close contact with symptomatic patients before a diagnosis is made [5][6][7]. For example, ED staff are among

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Section: Discussionmentioning

confidence: 99%

Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

Barratt

Gilbert

Shaban

et al. 2020

Australasian Emergency Care

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“…In a simulation of a 'mystery' infectious patient, 95 drills including 42 drills specifically for patients with possible MERS were conducted in 49 emergency departments in New York, USA. Hospitals were variable in the identification of potentially infectious patients and implementation of appropriate infection control measures, such as suboptimal adherence to hand hygiene, PPE use and isolation signage posting [52].…”

Section: Discussionmentioning

confidence: 99%

“…In conclusion, MERS-CoV, like severe acute respiratory syndrome (SARS), requires leadership insisting on formal and continued training of HCWs to be sufficiently prepared for emerging respiratory infectious diseases. Hospitals have varied in their ability to correctly identify potentially infectious patients and quickly implement appropriate infection control measures [52]. Prompt recognition, isolation and management of the suspected cases are vital factors for the prevention of MERS transmission.…”

Section: Discussionmentioning

confidence: 99%

Healthcare-associated infections: the hallmark of Middle East respiratory syndrome coronavirus with review of the literature

Al‐Tawfiq

Auwaerter

2019

Journal of Hospital Infection

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Middle East respiratory syndrome coronavirus (MERS-CoV) is capable of causing acute respiratory illness. Laboratory-confirmed MERS-CoV cases may be asymptomatic, have mild disease, or have a life-threatening infection with a high case fatality rate. There are three patterns of transmission: sporadic community cases from presumed non-human exposure, family clusters arising from contact with an infected family index case, and healthcare-acquired infections among patients and from patients to healthcare workers. Healthcare-acquired MERS infection has become a well-known characteristic of the disease and a leading means of spread. The main factors contributing to healthcare-associated outbreaks include delayed recognition, inadequate infection control measures, inadequate triaging and isolation of suspected MERS or other respiratory illness patients, crowding, and patients remaining in the emergency department for many days. A review of the literature suggests that effective control of hospital outbreaks was accomplished in most instances by the application of proper infection control procedures. Prompt recognition, isolation and management of suspected cases are key factors for prevention of the spread of MERS. Repeated assessments of infection control and monitoring of corrective measures contribute to changing the course of an outbreak. Limiting the number of contacts and hospital visits are also important factors to decrease the spread of infection.

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“…Despite CDC recommendations and the presumed importance of this screening, there is little known regarding the success of such travel screening programs. In one multicenter study in New York City, mystery patients with simulated measles and Middle East Respiratory Syndrome who presented to the ED during unannounced drills were significantly less likely to be given a mask and then isolated when travel screening questions were not asked at triage (10). Due to the low prevalence of EVD in the United States, it has not been possible to quantify the accuracy of screening.…”

Section: Objectivesmentioning

confidence: 99%

Adherence to Universal Travel Screening in the Emergency Department During Epidemic Ebola Virus Disease

Burkholder

Dziadkowiec

Bookman

et al. 2019

The Journal of Emergency Medicine

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Background: During the 2014 West African Ebola Virus Disease (EVD) outbreak, the U.S. Centers for Disease Control and Prevention recommended that all emergency department (ED) patients undergo travel screening for risk factors of importing EVD. Objectives: We sought to determine the overall adherence rate to the recommended travel screening protocol and to identify factors associated with nonadherence to the protocol. Methods: We conducted a multicenter, retrospective analysis of adherence to the travel screening program in an academic hospital and three affiliated community hospitals. A regression model identified patient and hospital factors associated with nonadherence. Results: Of the 147,062 patients included for analysis, 93.7% (n = 137,834) had travel screenings completed. We identified several characteristics of patients that were most likely to be missed by the screening protocol-patients with low English proficiency, patients who arrive via ambulance or helicopter, and patients with more severe illness or injury based on initial triage acuity. Conclusions: These findings should be used to improve adherence to the travel screening protocol for future emerging infectious disease threats. Ó

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Assessment of Hospital Emergency Department Response to Potentially Infectious Diseases Using Unannounced Mystery Patient Drills — New York City, 2016

Cited by 39 publications

References 9 publications

Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

Healthcare-associated infections: the hallmark of Middle East respiratory syndrome coronavirus with review of the literature

Adherence to Universal Travel Screening in the Emergency Department During Epidemic Ebola Virus Disease

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