Infection control in the emergency department

We read with interest the articles by Leis and Gold,1 and by Mumoli and Cei.2 Infection control procedures should have been mentioned in the article by Leis and Gold entitled “Management of community-acquired pneumonia in the emergency department.” Emergency departments are high-risk areas for disease transmission because they are often overcrowded, and infectious or susceptible patients may wait in proximity to one another for several hours.3 In another CMAJ article, Quach and colleagues4 report a 3.9 odds ratio for the risk of gastrointestinal and respiratory infections among elderly residents of long-term care facilities following a visit to the emergency department. Similar findings have been described in other populations.5 The role of emergency departments in disease transmission dramatically emerged during the outbreak of severe acute respiratory syndrome (SARS).6 Subsequently, the US Centers for Disease Prevention and Control and the World Health Organization issued new infection control guidelines that introduced respiratory hygiene and cough etiquette measures (e.g., covering of nose and mouth possibly with disposable surgical mask, adequate distancing among patients and careful application of hand hygiene) as part of standard precautions to be applied in all health care settings, to all patients with cough and other respiratory symptoms.7^,8 A rigorous application of this set of infection control measures, including isolation if indicated, may significantly reduce the risk of disease transmission in emergency departments, thus protecting health care workers, patients and visitors. Mention about it should be included in all basic sets of indications for the management of community-acquired pneumonia in emergency departments.