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The Risk of Cross Infection in the Emergency Department: A Simulation Study

  • Vicki Stover Hertzberg (a1), Yuke A. Wang (a2), Lisa K. Elon (a2) and Douglas W. Lowery-North (a3)

Abstract

OBJECTIVES

The risk of cross infection in a busy emergency department (ED) is a serious public health concern, especially in times of pandemic threats. We simulated cross infections due to respiratory diseases spread by large droplets using empirical data on contacts (ie, close-proximity interactions of ≤1m) in an ED to quantify risks due to contact and to examine factors with differential risks associated with them.

DESIGN

Prospective study.

PARTICIPANTS

Health workers (HCWs) and patients.

SETTING

A busy ED.

METHODS

Data on contacts between participants were collected over 6 months by observing two 12-hour shifts per week using a radiofrequency identification proximity detection system. We simulated cross infection due to a novel agent across these contacts to determine risks associated with HCW role, chief complaint category, arrival mode, and ED disposition status.

RESULTS

Cross-infection risk between HCWs was substantially greater than between patients or between patients and HCWs. Providers had the least risk, followed by nurses, and nonpatient care staff had the most risk. There were no differences by patient chief complaint category. We detected differential risk patterns by arrival mode and by HCW role. Although no differential risk was associated with ED disposition status, 0.1 infections were expected per shift among patients admitted to hospital.

CONCLUSION

These simulations demonstrate that, on average, 11 patients who were infected in the ED will be admitted to the hospital over the course of an 8-week local influenza outbreak. These patients are a source of further cross-infection risk once in the hospital.

Infect Control Hosp Epidemiol 2018;39:688–693

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. All rights reserved.

Corresponding author

Address correspondence to Vicki Stover Hertzberg, PhD, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd NE, Atlanta, GA 30322 (vhertzb@emory.edu).

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