Quality, equipment hold keys to infection control
Watch staff members wash their hands
While developing and maintaining effective infection control procedures involves a large range of issues in the ED, many of them fall within two major areas: quality control and equipment/facilities. And while the basics are familiar to experienced ED managers, two facilities have devised some unique strategies for going the extra mile to protect patients and staff from infectious disease.
At Gaston Memorial Hospital in Charlotte, NC, for example, Michelle Dickerson, RN, the manager of the ED, has devised a new method for eliminating a lack of consistency in hand washing. As a result, compliance rates in her ED have gone from 92% to 100% in the past year.
"We observe a certain number of staff members and their techniques to make sure they are doing things in the right sequence and at the right times," she says. About 10 people per month are observed at random, out of a total of 120.
As a rule, hand washing is expected before and after seeing every patient, she says. "As the staff member is washing, when an auditor sees an issue they will stop them, and make them go back and do it right," says Dickerson. She and another RN act as auditors.
Speaking of audits, Dickerson has gained even greater control over staff infection control activities and equipment with the hiring of a clinical quality analyst — an RN with ED experience — who monitors or audits performance and makes recommendations for improvement.
"She has worked on the reorganization of supplies, which includes supplies of staff to use for infected patients, making sure the supplies are there so staff does not need to cut corners when they are in a rush," says Dickerson.
They also have looked at the organization of patient care rooms. "We want the positioning of supplies to be the same in every single room, in order to organize the chaos," she says.
ED design assists in process
At Emory Healthcare in Atlanta, the EDs are given a head start in infection control simply by virtue of their design, explains Marilyn Margolis, RN, MN, director of nursing for emergency services.
"In terms of our physical plant, we have a higher percentage of our rooms that are isolation rooms, with better air exchange," she says. "Our psych room also has isolation capabilities."
At the Emory Crawford Long Hospital ED, which is part of the Emory system in Atlanta, about 40% of the rooms are isolation rooms, which was part of the plan when the newer ED facility was built. "At Emory University Hospital, we did an expansion of the ED and made all the rooms isolation rooms," Margolis shares.
The large percentage of isolation rooms proved helpful in dealing with the flu last year, she reports.
The ED followed the Centers for Disease Control guidelines, Margolis adds. "Every person who was triaged who had a cough or [other flulike] symptom got masked and was asked to wash their hands," says Margolis, adding the ED has hand gel outside every ED room and waiting room. "We also have backup areas to separate out if there is a pandemic," she says.
After the patients were triaged, if they fit the criteria for flu, they were sent to an isolation room. "Everyone who was immunosuppressed went into isolation, too, so they would not be subjected to the flu," adds Margolis. "One of our triage guidelines is to keep people who are immunosuppressed out of the waiting room."
Little changes, big difference
Sometimes small changes can go a long way in ED infection control. For example, staff at Gaston used to use spray bottles of cleaning solutions from housekeeping to wipe down stretchers. "Now, we use sani-wipes — Clorox-based pop-ups — which are real strong, so when the staff needs to change over stretchers, they don’t have to run around the room looking for a bottle and wipes. In a crisis, they don’t have to wait on housekeeping," notes Dickerson.
And at Emory, new signs have gone up this year in the waiting rooms. Their main message: "We welcome you — but not with the flu."
"Something that can be a big issue if you have pandemic flu is to triage patients who need to stay home," explains Margolis. She says her facilities use the Severity Index Risk Classifications included in the Department of Health and Human Services’ "Pandemic Influenza Plan" to help determine which patients should go home, which should be admitted, and which should go to a clinic.
Reinforcement of staff education also is critical, adds Dickerson. "At every staff meeting we review our compliance with our educational audits, so the staff hears how we are doing with hand washing, environment of care compliance, and so on," she notes.
Sources/Resource
For more information on infection control, contact:
- Michelle Dickerson, RN, ED Manager, Gaston Memorial Hospital, Charlotte, NC. Phone: (704) 834-2440.
- Marilyn Margolis, RN, MN, Director of Nursing, Emergency Services, Emory Healthcare, Atlanta. Phone: (404) 712-4567.
To download a free copy of the Department of Health and Human Services’ "Pandemic Influenza Plan," go to: www.hhs.gov/pandemicflu/plan.
While developing and maintaining effective infection control procedures involves a large range of issues in the ED, many of them fall within two major areas: quality control and equipment/facilities.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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