National Survey on Infection Prevention and Control in United States Emergency Departments

In the emergency care setting, implementation of infection prevention and control (IPC) practices can be challenging due to numerous factors including emergency department (ED) crowding and boarding of patients, high staff-turnover rates, and acuity of patient needs. Understanding how the unique nature of the ED environment impacts IPC implementation is essential to reducing healthcare-associated infections and to improving patient safety. In this study we aimed to assess ED leaders' perceptions of IPC practices to identify areas for potential intervention and inform targeted process improvement initiatives.

Between January-July 2023, ED leaders across the United States were queried about their IPC practices using the National Emergency Department Inventories (NEDI)-USA survey, which is administered annually to all EDs in the US. An expanded survey was administered in a subset of EDs to assess healthcare personnel training for IPC, reported adherence to recommended practices and policies related to disinfection of reusable medical equipment and environment, use of personal protective equipment, hand hygiene practices, patient care space cleaning and disinfection, use of transmission-based precautions signage, risk perceptions of how healthcare personnel practice contributes to healthcare-associated infections and barriers to appropriate room cleaning.

Of the 289 facilities surveyed, 159 (55%) responded, and among responding EDs, 67 (42%) reported seeing ≥ 40,000 patients in the prior year. Regarding healthcare personnel training, 84% (131/156) of ED leaders reported that ≥80% of their ED healthcare personnel were correctly trained in IPC procedures according to their hospital's policies. Perception of healthcare personnel compliance with IPC practices, however, was lower. Although 75% (118/157) of EDs reported > 80% compliance with correct N95 respirator use, compliance with transmission-based precaution signage was identified as a significant gap, with 30% (47/159) of EDs reporting that they never, rarely, or only sometimes posted signs for patients who required them. Further, 69% (61/89) of EDs reported that they never, rarely, or only sometimes posted transmission-based precaution signs for patients in hallways or overflow treatment spaces.

This national survey found that ED leaders perceive that their healthcare personnel have a high level of knowledge of IPC policies and compliance with some, but not all, IPC policies in the ED. The overall high perceptions of compliance stand in contrast to prior published observations of poor IPC practice in ED settings, suggesting complex relationships between perception and practice that may impact patient safety outcomes. These findings can guide future targeted interventions to improve IPC compliance, reduce healthcare-associated infections, and improve patient safety in emergency settings.