Tuberculosis Infection-Control Practices in United States Emergency Departments

Moran, Gregory J.; Fuchs, Mary Anne; Jarvis, William R.; Talan, David A.

doi:10.1016/s0196-0644(95)70073-0

Cited by 31 publications

(24 citation statements)

References 18 publications

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“…While such strategies undoubtedly have potential in applications where exposure times are long, their use in the waiting areas of healthcare facilities appears to be much more questionable. Despite this ultraviolet lamps were reported to be installed in 12/144 (8%) and HEPA (high efficiency particulate air) filtered air provided in 22/138 (16%) of Emergency Department waiting areas in facilities which recorded >1 case of TB per month [24]. From Figure 3 it can be seen that little impact is made on the transmission of TB and influenza by increasing the ventilation rate to 12 air changes per hour.…”

Section: Discussionmentioning

confidence: 99%

Potential for airborne transmission of infection in the waiting areas of healthcare premises: stochastic analysis using a Monte Carlo model

2010

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BackgroundAlthough many infections that are transmissible from person to person are acquired through direct contact between individuals, a minority, notably pulmonary tuberculosis (TB), measles and influenza are known to be spread by the airborne route. Airborne infections pose a particular threat to susceptible individuals whenever they are placed together with the index case in confined spaces. With this in mind, waiting areas of healthcare facilities present a particular challenge, since large numbers of people, some of whom may have underlying conditions which predispose them to infection, congregate in such spaces and can be exposed to an individual who may be shedding potentially pathogenic microorganisms. It is therefore important to understand the risks posed by infectious individuals in waiting areas, so that interventions can be developed to minimise the spread of airborne infections.MethodA stochastic Monte Carlo model was constructed to analyse the transmission of airborne infection in a hypothetical 132 m3 hospital waiting area in which occupancy levels, waiting times and ventilation rate can all be varied. In the model the Gammaitoni-Nucci equation was utilized to predict probability of susceptible individuals becoming infected. The model was used to assess the risk of transmission of three infectious diseases, TB, influenza and measles. In order to allow for stochasticity a random number generator was applied to the variables in the model and a total of 10000 individual simulations were undertaken. The mean quanta production rates used in the study were 12.7, 100 and 570 per hour for TB, influenza and measles, respectively.ResultsThe results of the study revealed the mean probability of acquiring a TB infection during a 30-minute stay in the waiting area to be negligible (i.e. 0.0034), while that for influenza was an order of magnitude higher at 0.0262. By comparison the mean probability of acquiring a measles infection during the same period was 0.1349. If the duration of the stay was increased to 60 minutes then these values increased to 0.0087, 0.0662 and 0.3094, respectively.ConclusionUnder normal circumstances the risk of acquiring a TB infection during a visit to a hospital waiting area is minimal. Likewise the risks associated with the transmission of influenza, although an order of magnitude greater than those for TB, are relatively small. By comparison, the risks associated with measles are high. While the installation of air disinfection may be beneficial, when seeking to prevent the transmission of airborne viral infection it is important to first minimize waiting times and the number of susceptible individuals present before turning to expensive technological solutions.

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Section: Discussionmentioning

confidence: 99%

Potential for airborne transmission of infection in the waiting areas of healthcare premises: stochastic analysis using a Monte Carlo model

2010

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“…A 1995 study found that less than 20% of EDs had negative-pressure isolation rooms. 17 In a recent press release from November 2005, American College of Emergency Physicians leaders warned that there is an urgent need for increased ED and hospital planning, specifically citing lack of adequate surge capacity, isolation facilities, and staff to treat the large increase in the number of patients that may result from an inf luenza pandemic. 18 Depending on the circumstances of the outbreak, public health officials may recommend keeping suspected noncritical infectious patients at home.…”

Section: Figurementioning

confidence: 99%

“…Several hospital-and ED-based studies provide data that demonstrate that lack of either provider education or adherence to institutional guidelines or inadequate diagnostic evaluation of patients at risk results in increased risk of disease transmission. 3,5,16,17,39 Underscoring this is the findings from one epidemiologic outbreak of SARS in Toronto that found that 36% of new infections in the hospital occurred in health care workers, with the highest rates in those working in EDs and ICUs. 5 Both the World Health Organization and the CDC provide general recommendations for handling of patients with suspected respiratory infections that include having triage staff adhere to proper hand hygiene procedures and donning face masks and eye protection.…”

Section: Ed Triage and Waiting Roommentioning

confidence: 99%

“…The CDC has issued specific screening tools to be used for rapid detection and isolation of possible SARS patients, depending on the absence or presence of person-to-person transmission in the world (Figures 6 and 7). Various similar ED-based triage guidelines for specific agents (eg, TB, inf luenza and avian inf luenza) 13,17,34 that include use of early radiography have been developed, and the CDC Web site (available online at http://www.cdc.gov) should be consulted for the most up-to-date recommendations, as well as the current threat level of SARS. 44 From the ED perspective, development of decision guidelines may be based on the characteristics of the epidemic and may require development and modification in real time.…”

Section: Ed Triage and Waiting Roommentioning

confidence: 99%

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Respiratory Hygiene in the Emergency Department

Rothman¹,

Irvin²,

Moran³

et al. 2007

Journal of Emergency Nursing

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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.

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“…A 1993-1994 study of 305 United States municipal, Veterans Affairs, university-affiliated, and other large hospitals revealed that tuberculosis-isolation rooms fulfilling guidelines of the Centers for Disease Control and Prevention (CDC) existed in only 20% of emergency departments [76]. Of those departments without isolation rooms, high-efficiency particulate filtration and ultraviolet germicidal radiation were employed in only 19% and 10%, respectively.…”

Section: Fever In the Intravenous Drug Usermentioning

confidence: 99%

Infectious Disease Issues in the Emergency Department

Talan¹

1996

Clinical Infectious Diseases

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Tuberculosis Infection-Control Practices in United States Emergency Departments

Cited by 31 publications

References 18 publications

Potential for airborne transmission of infection in the waiting areas of healthcare premises: stochastic analysis using a Monte Carlo model

Potential for airborne transmission of infection in the waiting areas of healthcare premises: stochastic analysis using a Monte Carlo model

Respiratory Hygiene in the Emergency Department

Infectious Disease Issues in the Emergency Department

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