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Letters

Infection control in the emergency department

Francesco M. Fusco and Vincenzo Puro
CMAJ June 12, 2012 184 (9) 1065; DOI: https://doi.org/10.1503/cmaj.112-2038
Francesco M. Fusco
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Vincenzo Puro
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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.

References

  1. ↵
    1. Leis JA,
    2. Gold WL
    . Management of community-acquired pneumonia in the emergency department. CMAJ 2012;184:559.
    OpenUrlFREE Full Text
  2. ↵
    1. Mumoli N,
    2. Cei M
    . Community-acquired pneumonia. CMAJ 2012;184:560.
    OpenUrlFREE Full Text
  3. ↵
    1. Rothman RE,
    2. Irvin CB,
    3. Moran GJ,
    4. et al
    . Respiratory hygiene in the emergency department. [published erratum appears in Ann Emerg Med 2007; 49:61]. Ann Emerg Med 2006;48:570–82.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Quach C,
    2. McArthur M,
    3. McGeer A,
    4. et al
    . Risk of infection following a visit to the emergency department: a cohort study. CMAJ 2012;184:E232–9.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Farizo KM,
    2. Stehr-Green PA,
    3. Simpson DM,
    4. et al
    . Pediatric emergency room visits: a risk factor for acquiring measles. Pediatrics 1991;87:74–9.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Chen YC,
    2. Huang LM,
    3. Chan CC,
    4. et al
    . SARS in hospital emergency room. Emerg Infect Dis 2004; 10:782–8.
    OpenUrlPubMed
  7. ↵
    1. Siegel JD,
    2. Rhinehart E,
    3. Jackson M,
    4. et al
    . 2007 guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Atlanta (GA): Centers for Disease Control and Prevention; 2007. Available: www.cdc.gov/hicpac/2007ip/2007isolationprecautions.html (accessed 2012 Feb. 06).
  8. ↵
    World Health Organization. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. Geneva (Switzerland): The Organization; 2007. Available: www.who.int/csr/resources/publications/WHO_CD_EPR_2007_6/en/ (accessed 2012 Feb. 06).
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Canadian Medical Association Journal: 184 (9)
CMAJ
Vol. 184, Issue 9
12 Jun 2012
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Infection control in the emergency department
Francesco M. Fusco, Vincenzo Puro
CMAJ Jun 2012, 184 (9) 1065; DOI: 10.1503/cmaj.112-2038

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Infection control in the emergency department
Francesco M. Fusco, Vincenzo Puro
CMAJ Jun 2012, 184 (9) 1065; DOI: 10.1503/cmaj.112-2038
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