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Identify an infection at triage? Notify others!
Nurses can stop cross-contamination
[Editor's Note: This is the second of a two-part series on identifying infections at triage. This month, we cover how to notify others so appropriate precautions can be taken. Last month, we gave assessment tips to identify infections at triage.]
Multidrug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), and diseases such as bacterial meningitis, influenza, and shingles often are first diagnosed in the ED, says Elizabeth Henderson, RN, BSN, MS, an ED nurse at Massachusetts General Hospital in Boston. Although inpatient units generally are able to isolate their patients according to their primary diagnosis, this is not typically the case for EDs.
"Many EDs have a limited number of closed door rooms where patients with such afflicting organisms can be isolated from the general population," says Henderson. "Further complicating matters within the ED patient population is the sheer number and variation of disease states and diagnosis that are treated within the same shared spatial location by numerous health care personnel."
These factors "greatly increase the risk of cross contamination," she says.
Your patient might not appear to be infectious, but test results might reveal the need for precautions. "Essentially, the ED serves as a screening agent for inpatient units, which then make accommodations based on patient lab results and diagnosis," says Henderson. To protect yourself and your patients, follow these three tips:
Screen all immunocompromised patients and those in long-term care or assisted living environments.
These patients are at higher risk for MRSA, VRE, Clostridium difficile, H-pylori, and several resistant gram-negative bacteria, says Rhonda Morgan, RN, MSN, CEN, CNRN, CCNS, ANP, vice president of nursing and former emergency department director at Wellmont Health System in Kingsport, TN.
"Identify the multidrug-resistant organism infections early in the hospital visit so appropriate precautions can be enacted," says Morgan. "This protects staff from infection and from transmitting infections to other patients."
Share this information during verbal reports, and document it on handoff sheets. "Include this information in any handoff, whether it is inside the facility to an inpatient area, a diagnostic area, or a procedural area or a transport out of the facility," says Morgan.
Educate patients and families about infection control measures.
You should tell patients and families the reason for the lab screening, teach proper hand hygiene and use of personal protective equipment, and explain what "isolation' actually means in that particular case, Morgan says.
Identify readmitted or transferred patients who are positive for a multidrug-resistant organism.
Code letters such as "MRSA" or "VRE" could be added to your triage forms or nursing notes, Morgan says.
"These codes could be included in an area where the appropriate choice could be circled to avoid time-consuming narratives," she says.
For more information on assessment of infection at triage, contact:
Elizabeth Henderson, RN, BSN, MS, Emergency Department, Massachusetts General Hospital, Boston. Phone: (781) 706-7517. E-mail: firstname.lastname@example.org.
Protect patients at highest risk
Do not place immunocompromised ED patients in close proximity to those with multi-drug resistant organism presence, warns Rhonda Morgan, RN, MSN, CEN, CNRN, CCNS, ANP, vice president of nursing and former emergency department director at Wellmont Health System in Kingsport, TN.
"Both the room and the equipment should undergo the same cleaning measures as an inpatient room after being vacated by a patient with a multidrug-resistant organism," Morgan says.