ED Accreditation Update

Hospital-acquired infections are a major focus of National Patient Safety Goals for 2009

When The Joint Commission announced its National Patient Safety Goals for 2009, it became clear that the recent interest in hospital-acquired infections (HAIs) has only intensified. Among the major changes for 2009 are three new hospital and critical access hospital requirements related to preventing HAIs due to multiple drug-resistant organisms (MDROs), central line-associated bloodstream infections, and surgical site infections.

While noting the difficulty of complying with some of those goals in a busy ED, ED managers nevertheless agree these are important concerns.

"We all play a part in helping to reduce these infections, and ours is an important part," says Christopher Beach, MD, vice chair, Department of Emergency Medicine at the Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital in Evanston, IL.

In truth, he says, the original case of infection is often not acquired in the hospital, but the ED sees many of these patients first and must minimize the risk of it spreading to other hospital patients. "When people come in, it's common that they've already been afflicted," Beach says. "Our job is not as much to prevent, but to correctly identify the infection and provide appropriate treatment and management."

A difficult challenge

While recognizing the need to prevent HAIs, David John, MD, FACEP, director of the ED at Caritas Carney Hospital in Boston, says it often is difficult in a fast-paced ED to practice optimal infection control measures. For example, when it comes to surgical sites, "It's 'crash'; it's heroic action," he notes. "You may not have five minutes to think about everything when time is of the essence."

Peter Angood, MD, vice president and chief patient safety officer for The Joint Commission, says his organization is well aware of the challenges faced by the ED. "We recognize that of the three areas, [practices to prevent] multiple drug-resistant organisms would be a little difficult to implement within the ED, and we actually debated whether or not to exclude them," he admits. "The ED is a complicated area within the hospital, but these goals are targeted to the hospital in its entirety, so while it will be hard, we felt it was important that it be applicable to the ED."