title: A healthy degree of suspicion: A discussion of the implementation of transmission based precautions in the emergency department.
abstract: BACKGROUND
  Emergency department (ED) presentations have increased significantly domestically and internationally. Swift identification and implementation of transmission based precautions (TBP) for patients known or suspected of having an epidemiologically important pathogen is important. ED staff, particularly triage nurses, are pivotal in detecting and preventing infection, including healthcare associated infections (HAI).
  
  
  METHODS
  MEDLINE, CINAHL, PubMed and Ovid were searched for articles published between 2004 and 2015 using key search terms: infection control/prevention and emergency department(s), triage, and transmission based precautions and emergency department(s), and triage, to identify common themes for discussion. Systematic review/meta-analysis was not in the scope of this exploration.
  
  
  RESULTS
  Themes were identified relating to HAI and ED practices and grouped into: assisted detection of conditions for which TBP is required, ED and TBP, mass-causality event/bioterrorism/pandemic/epidemic, infection control not TBP and multi-resistant organisms not TBP. The literature is heavily influenced by worldwide epidemic/pandemics and bioterrorist risks resulting in increased awareness of the importance of swift identification of syndromes that require TBP, but only in these situations.
  
  
  CONCLUSIONS
  Implementation of appropriate TBP, changing triage practices, training and measures to assist decision-making could assist in preventing HAI in the ED context. A systematic quantitative review of the literature is recommended to guide practice change research.
authors.affiliation: School of Nursing and Midwifery, Griffith University, Australia; Gold Coast Hospital and Health Service, Australia. Electronic address: p.zimmerman@griffith.edu.au.
authors.forename: Peta-Anne
authors.initials: PA
authors.lastname: Zimmerman
authors.affiliation: School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Australia.
authors.forename: Matt
authors.initials: M
authors.lastname: Mason
authors.affiliation: School of Nursing and Midwifery, Griffith University, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Elder
mesh_terms: D003428:Cross Infection / Q000451:nursing / Q000517:prevention & control* / Q000635:transmission; D016529:Emergency Nursing / Q000379:methods; D004636:Emergency Service, Hospital; D006801:Humans; D017053:Infection Control / Q000379:methods*; D011364:Professional Practice; D014218:Triage / Q000379:methods
keywords: Emergency department; Healthcare associated infections; Infection control; Transmission based precautions; Triage practices