More research, standardization needed to prevent ER infections

A lack of both standardization and studies on emergency department (ED) practices complicates comparing research on infection control, according to a literature review published in the American Journal of Infection Control.

Researchers from Columbia University reviewed 23 available studies on:

  • ED hand hygiene adherence rates during routine patient care

  • Urinary catheter insertion guidelines

  • Equipment contamination rates

  • Aseptic technique during central venous and urinary catheter placement

Hand hygiene was the most common infection-prevention protocol in the literature review, according to the researchers. Rates of compliance varied widely--researchers found a range of 7.7 percent to nearly 90 percent in the eight studies analyzed. Variations in guidelines prevented researchers from reliably comparing the studies, according to the review.

Researchers reviewed four studies on the appropriateness of urinary catheter insertion, one of which found only 69.7 percent of ED-based urinary catheters were warranted, with elderly women at increased risk for inappropriate catheterization. The other three studies analyzed the effectiveness of interventions to reduce inappropriate catheterization, none of which found any significant reduction after educational sessions, according to the review.

Four papers focused on equipment contamination, primarily focusing on methicillin-resistant Staphylococcus aureus (MRSA). The rates of MRSA found in the review ranged from 0 percent in a sample taken from computer mice in an ED in Northern Ireland to 7 percent of environmental surfaces at a large ED in an American tertiary care hospital.

Researchers made several suggestions to improve available literature, including increased standardization, increased effort to reduce unnecessary urinary catheterization in the ED and further research "to examine the impact of infection prevention practices in the ED on subsequent risk of infection."

To learn more:
- here's the literature review