Respiratory Hygiene in the Emergency Department

Abstract

The emergency department (ED) is an essential component of the public health response plan for control of acute respiratory infectious threats. Effective respiratory hygiene in the ED is imperative to limit the spread of dangerous respiratory pathogens, including influenza, severe acute respiratory syndrome, avian influenza, and bioterrorism agents, particularly given that these agents may not be immediately identifiable. Sustaining effective respiratory control measures is especially challenging in the ED because of patient crowding, inadequate staffing and resources, and ever-increasing numbers of immunocompromised patients. Threat of contagion exists not only for ED patients but also for visitors, health care workers, and inpatient populations. Potential physical sites for respiratory disease transmission extend from out-of-hospital care, to triage, waiting room, ED treatment area, and the hospital at large. This article presents a summary of the most current information available in the literature about respiratory hygiene in the ED, including administrative, patient, and legal issues. Wherever possible, specific recommendations and references to practical information from the Centers for Disease Control and Prevention are provided. The "Administrative Issues" section describes coordination with public health departments, procedures for effective facility planning, and measures for health care worker protection (education, staffing optimization, and vaccination). The patient care section addresses the potentially infected ED patient, including emergency medical services concerns, triage planning, and patient transport. "Legal Issues" discusses the interplay between public safety and patient privacy. Emergency physicians play a critical role in early identification, treatment, and containment of potentially lethal respiratory pathogens. This brief synopsis should help clinicians and administrators understand, develop, and implement appropriate policies and procedures to address respiratory hygiene in the ED.

Evaluation of Patients' Mask Use after the Implementation of Cough Etiquette in the Emergency Department

“…Because RH-CE should be implemented year round, there may be a need for periodic reminders to HCWs to ensure adequate practices. 6 Our study has clear limitations. The small sample size limited the study power, and the relatively low response rate may have introduced bias.…”

What influences the infection of COVID-19 in healthcare workers?

“…The emergency department is a relative high-risk department of COVID-19, and the emergency department environment in the investigated hospitals is relatively airtight. Although HCWs have adequate protections, the relatively airtight environment and high density of patients may cause aerosol transmissions in confined spaces, increasing risks of infections in the emergency department [11,12]. Further attentions need to be paid to the protection level and the environmental cleanliness of high-risk departments.…”

Use of personal protective equipment in Canadian pediatric emergency departments

“…Emergency physicians play a critical role in the early identification, treatment, and containment of potentially lethal pathogens. 1 Personal protective equipment (PPE), consisting of gowns, gloves, respiratory and eye protection, is designed to be worn by health care workers to minimize transmission of infectious agents in the workplace. 4 Hand hygiene is recognized as the best way to prevent cross-transmission of microorganisms and reduce the incidence of health care-associated infections.…”

“…5,6,[9][10][11][12][13][14][15][16] Potential barriers to maintaining infection control practices and using PPE in the ED include crowding, understaffing, lack of isolation facilities, lack of health care worker infection control education, high workload, high number of patient contacts, simultaneous management of multiple patients, high illness acuity, and significant time constraints. 1,17 The ED is a highrisk area for infection transmission because of high patient turnover and the frequent lack of a patient diagnosis at the time of presentation. 18 The purpose of this study was to examine the knowledge, self-reported behaviours, and barriers to compliance with infection control practices and the use of PPE in Canadian pediatric EDs.…”