Adherence to infection prevention and control best practices in emergency units at a tertiary care hospital, Riyadh

Emergency department presents a distinctive challenge for implementation infection prevention and control (IPC), due to their complex and dynamic environment, diverse patient population, and unknown carrier status. The objective was to assess the compliance with a number of IPC practices among a group of healthcare workers (HCWs) working in the emergency department.

An observational cross-sectional study was conducted at a large emergency department at a tertiary care hospital between 2018 and 2023. Data were gathered during observation sessions using a standardized IPC observation form. Observers were either experienced IPC professionals or trained medical students.

Out of 123,947 HCW-specific practices observed, 85,542 (69.0%) were compliant and out of 41,650 unit-specific practices observed, 38,355 (92.1%) were compliant. The compliance was highest in the competence of acute respiratory infection procedures (97.3%), followed by isolation precautions (97.0%), housekeeping (96.8%), disposal of sharps (96.8%), waste management (94.5%), donning and doffing of personal protective equipment (PPE, 72.9%), use of PPE (72.3%), hand hygiene (67.2%), patient sitters (64.1%), and disinfection of medical equipment (61.2%). Nurses across all units had much better compliance than other professions. There were > 10% differences in the compliance across the units, with higher compliance in mainly pediatric compared with adult units. The compliance was highest during the COVID-19 pandemic years.

There is considerable variability in implementation of IPC at the emergency department, by practice, profession, unit, and pandemic time. The findings underscore the importance of strategies to improve disinfection of medical equipment, hand hygiene, and adherence of patient sitters.