New paper calls for more infection control surveillance, standardization in the emergency department

When researchers searched the literature to determine adherence rates for various infection prevention protocols in the emergency department (ED), they discovered both a dearth of studies reporting ED practices and a lack of standardization that rendered some studies incomparable, according to a literature review published in the September issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

A team of researchers from Columbia University performed a literature review of the available medical literature to determine adherence rates in the ED for hand hygiene during routine patient care, aseptic technique during the placement of central venous catheters and urinary catheters, urinary catheter insertion guidelines, and rates of equipment contamination. Of the 853 records they identified, 589 abstracts were screened, and ultimately 23 papers were included in the study.

Of studies that reported hand hygiene rates, the use of multiple guidelines prevented meaningful comparisons, despite disparate rates of compliance ranging from 7.7 percent to 89.7 percent. Four studies examined the appropriateness of urinary catheter insertions, with one finding that only 69.7 percent of urinary catheters in the ED were warranted. Seven studies examined central venous catheter insertions and determined that video-based online training led to increased compliance. In only one study was aseptic technique observed during urinary catheter insertion, and while 27 percent adherence was reported in one hospital and 58 percent in another, these percentages reflect aseptic technique during various procedures and not solely urinary catheter insertion.

"To our knowledge, this is one of the first literature reviews detailing adherence rates with common infection prevention practices in the ED setting," said lead author Eileen J. Carter, RN, BSN. "While this review adds new information about infection prevention practices in the ED, there is clearly more to be learned, since EDs are a vital and important component of our health care system."