Protect your patients, yourself from flu, TB

In ED waiting rooms, there is growing concern that patients are spreading influenza to staff and patients during long waits.

"Flu is a great concern in the ED," says Philip Ragusa, RN, MBA, manager of emergency and trauma services at North Broward Medical Center in Deerfield Beach, FL. "In our ED, we try to isolate the patients who present as a possible risk by having them wear a mask, and using universal precautions when caring for them."

Any patient who is coughing or sneezing at Barnes-Jewish Hospital in St. Louis is asked to put on a mask at triage, with signs posted stating, "If you have a fever or a cough, please ask for a mask. Protect yourself and others," says Jennifer Williams, MSN, RN, BC, M-S CNS, CEN, CCRN, clinical nurse specialist for emergency services at Barnes-Jewish. "We also have hand sanitizer attached to these signs to help remind people that germs are spread by hand," she says.

A recent study presents another low-cost option for preventing transmission of infectious diseases such as flu and tuberculosis (TB): Use of natural ventilation.1 Researchers compared the airflow in 70 naturally ventilated rooms in eight hospitals in Peru, including areas where the potential risk of airborne contagion spread was high, such as EDs, with airflow in 12 mechanically ventilated negative-pressure respiratory isolation rooms. Even with low wind speeds, natural ventilation replaced air more quickly than mechanical ventilation. EDs are a hotspot for TB transmission, says Rod Escombe, MD, the study's lead author and an infectious disease physician at Imperial College London. "Waiting rooms and triage areas are particular hazards," he adds.

It usually is the most infectious TB patients who come to EDs, such as patients with new diagnoses and those with treatment failures, adds Escombe. In another study, the same group of researchers found a 30% incidence of TB infection in ED staff in a Lima hospital.2 EDs are never likely to have high air exchange ventilation, Escombe says. "This is reserved for respiratory isolation rooms," he says. "Natural ventilation therefore offers a good alternative, but it depends on your climate."

At North Broward's ED, two dedicated isolation rooms are used for patients with infectious illnesses, both with negative air-pressure systems, says Ragusa. Ventilation is done in accordance with Lenexa, KS-based American College of Healthcare Architects regulations, he adds. "Opening windows may be a good solution for this issue, but not one I have ever used," he says. "Natural ventilation is something I would consider, but I cannot make this call on my own. Epidemiology and facility maintenance must be involved."

Other EDs say opening windows simply is not possible logistically. "We have no windows, so this is not an option for us," says Williams. "However, I would highly recommend it if we did. In the ED, we tend to keep out the normal bacterial flora and keep in problematic flora."


  1. Escombe AR, Oeser CC, Gilman RH, et al. Natural ventilation for the prevention of airborne contagion. PLoS Med 2007; 4(2). Accessed at e68 doi:10.1371/journal.pmed.0040068.
  2. Escombe AR, Huaroto L, Ticona E. Defining tuberculosis transmission risk in a hospital emergency department in a high-prevalence area. Abstract presented at The First Global Symposium on Interferon-Gamma Assays. Vancouver, British Columbia, Canada; Feb.21-22, 2007.


For more information on preventing transmission of infectious diseases in the ED, contact:

  • Philip Ragusa, RN, MBA, Regional Manager of Emergency Services, North Broward Medical Center, 201 E. Sample Road, Deerfield Beach, FL 33064. Phone: (954) 786-6866. E-mail:
  • Jennifer Williams, MSN, RN, BC, M-S CNS, CEN, CCRN, Clinical Nurse Specialist, Emergency Services, Barnes-Jewish Hospital, Mail Stop 90-21-330, St. Louis, MO 63110. Phone: (314) 747-8764. Fax: (314) 362-2495. E-Mail: