Impact of admission screening for methicillin-resistant Staphylococcus aureus on the length of stay in an emergency department.
Preventing and controlling methicillin-resistant Staphylococcus aureus (MRSA) includes early detection and isolation. In the emergency department (ED), such measures have to be balanced with the requirement to treat patients urgently and transfer quickly to an acute hospital bed. We assessed, in a busy and overcrowded ED, the contribution made to a patient's stay by previous MRSA risk group identification and by selective rescreening of those patients who were previously documented in the research hospital as being MRSA positive. Patients with a previous diagnosis of MRSA colonisation were flagged automatically as 'risk group' (RG) on their arrival in the ED and were compared with 'non-risk group' (NRG), i.e. not previously demonstrated in the research hospital to be infected or colonised with MRSA. Over an 18 month period, there were 16 456 admissions via the ED, of which 985 (6%) were RG patients. The expected median times to be admitted following a request for a ward bed for NRG and RG patients were 10.4 and 12.9h, respectively. Female sex, age >65 years, and RG status all independently predicted a statistically significantly longer stay in the ED following a request for a hospital bed. We consider that national and local policies for MRSA need to balance the welfare of patients in the ED with the need to comply with best practice, when there are inadequate ED and inpatient isolation facilities. Patients with MRSA requiring emergency admission must have a bed available for them.
Gilligan
P
P
Emergency Department, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. hegartydeirdre@ireland.com
Quirke
M
M
Winder
S
S
Humphreys
H
H
D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000175:diagnosis* / Q000382:microbiology; D003955:Diagnostic Tests, Routine; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007494:Ireland; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology
Clin Infect Dis. 2007 Apr 15;44(8):1101-7
17366459
J Hosp Infect. 2008 Jul;69(3):249-57
18550214
J Hosp Infect. 2003 Aug;54(4):316-8
12919764
J Infect Dis. 1995 Mar;171(3):614-24
7876608
Bull Acad Natl Med. 2003;187(5):905-18; discussion 918-20
14979056
J Hosp Infect. 2008 Aug;69(4):315-20
18602183
Postgrad Med J. 2002 Jul;78(921):385-92
12151652
J Hosp Infect. 2005 Nov;61(3):189-93
16153745
Infect Control Hosp Epidemiol. 2007 Mar;28(3):249-60
17326014
Emerg Med Clin North Am. 2008 May;26(2):431-55, ix
18406982
JAMA. 2008 Mar 12;299(10):1149-57
18334690
J Hosp Infect. 2007 May;66(1):15-21
17376560
Clin Infect Dis. 2003 Jan 1;36(1):53-9
12491202
Emerg Med J. 2008 May;25(5):265-9
18434458
J Infect Dis. 2006 Jan 15;193(2):172-9
16362880
J Hosp Infect. 2006 May;63 Suppl 1:S1-44
16581155
N Engl J Med. 2006 Aug 17;355(7):666-74
16914702
Clin Infect Dis. 2004 Sep 15;39(6):776-82
15472807
Infect Control Hosp Epidemiol. 2003 May;24(5):362-86
12785411
Infect Control Hosp Epidemiol. 2003 May;24(5):351-5
12785409
J Hosp Infect. 2008 Jul;69(3):230-48
18550218
Clin Microbiol Infect. 2007 Sep;13(9):846-53
17608744
Am J Epidemiol. 1996 Mar 1;143(5):496-504
8610665
Ann Intern Med. 2008 Mar 18;148(6):409-18
18347349