Development of a Screening and Isolation Protocol for Patients Presenting to the Emergency Department (ED) with Communicable Diseases

ISSUE: The 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) underscored the importance of rapid recognition and isolation of patients with highly communicable diseases to prevent nosocominal spread to other patients, staff, and visitors. The SARS issue and a recent outbreak of measles in New York City (NYC) highlighted the need for EDs to have effective measures to rapidly triage and isolate patients with potentially communicable illnesses. PROJECT: A multidisciplinary team at a NYC hospital developed a screening and isolation protocol in collaboration with the NYC Department of Health and Mental Hygiene. Education and training was provided through classroom instruction using a train the trainer format. This training included a power point presentation along with interactive case scenarios. Pre and post tests, and a series of unannounced drills were used to evaluate the process. RESULTS: Ninety percent of registered nurses, 67% of emergency medical physicians, 82% of emergency service assistants, 63% of patient access workers and 73% of social workers in the ED were in-serviced. Patient access workers failed to follow the quick registration process for patients presenting with a cough. The triage nurse was able to isolate the patient based on symptoms and travel history, and knew the appropriate mask to be worn by the patient versus the medical staff. However, basic infection control including hand hygiene was not consistently practiced. Personal Protective Equipment was not readily available in the triage area. LESSONS LEARNED: Although a large proportion of the ED staff received training, breaches in basic infection control were observed. Consistency of educational in-service was difficult to assure using the train the trainer format. Increased involvement of Infection Control Professionals is needed to help translate education into practice, and to improve compliance with procedures.