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Avoid a 4th of July emergency room trip – KRISTV.com | Continuous … – KRIS Corpus Christi News

CORPUS CHRISTI –

For many Americans, the 4th of July is a day of patriotism, family celebration, barbecue, and, of course, fireworks. However, each year the fun ends with a trip to the emergency room for those who aren’t careful.

Last year fireworks accidents sent more than 11,000 Americans to emergency rooms.

The 4thof July holiday has earned a reputation as the most dangerous holiday in the U.S. Jennifer Carr, theTrauma Program Managerat the Corpus Christi Medical Center says 4th of July related activities and fireworks bring a lot of people into the ER.

It is actually more common than you think. We see a lot of injuries with adults, and we also see injuries with children. We see injuries due to fireworks. We see burns to faces, hands, and eyes due to fireworks,said Corpus Christi Medical Center Trauma Program Manager Jennifer Carr.

According to the Consumer Product Safety Commission (CPSC). The injuries skyrocket around this time of year. More than 230 people on average end up in the ER with fireworks-related injuries every day in the month around July 4th.

If somebody gets injured from a firework, you definitely want to get them to the closest emergency department. Call 911, especially if it is an injury to the face or eye. Typically a burn such as a sunburn is a first-degree burn. Anything that is more than a first-degree burn needs to beevaluated by a physician. Anything that causes the skin to open up or not stay intact anymore needs to be evaluated. Burns can scar and require lots of treatments infollow-up phases, said Carr.

Even with seemingly harmless sparklers, parents should use great caution and think twice before handing them to children.

Take it seriously. Realize that fireworks can cause injuries, and always have adult supervision even with sparklers. Children need to be supervised. Sparklers can reach a temperature of 2000 degrees, and so we see lots of injuries of children with fireworks. A lot of those is because of lack of adult supervision, said Carr.

Before use:

During use:

After use:

While following these tips will help, sometime injuries happen. The most common areas of the body that are injured tend to be the hands, fingers, eyes, head and face, mostly with burns. If your child gets inured, considering the following:

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Who pays when someone without insurance shows up in the ER? – USA TODAY

Right now, GOP senators are trying to gather enough votes to pass their Obamacare replacement plan, but even fellow Republicans are having a time a hard time accepting the health care bill. USA TODAY

An ambulance arrives at a hospital emergency room.(Photo: PhotoDisc)

WASHINGTON If an uninsured patient shows up in the emergency room, who pays? The hospital? Taxpayers? The patient? Other patients?

The question is important as Republicans debate health care legislation that could result in more than 20 million fewer Americans having health insurance in ten years.If that happens, some people will go without care. Others will show up at hospitals, but wont be able to pay their bills.

The year the Affordable Care Act passed, hospitals provided about $40 billion in “uncompensated care” that is, care they were not paid for.That was nearly 6% of their total 2010 expenses.

A 1985 federal law requires emergency departments to stabilize and treat anyone entering their doors, regardless of their ability to pay.

But that doesnt mean the uninsured can get treated for any ailment.

Theres lots of medical care we want to consume thats not an emergency, said health care economist Craig Garthwaite, an associate professor and director of the health care program at Northwestern University’s Kellogg School of Management.

It also doesnt mean that hospitals wont try to bill someone without insurance. And the bill they send will be higher than for an insured patient because theres no carrier to negotiate lower prices.

As a result, the uninsured are more likely to be contacted by collection agencies, as they face problems paying both medical and non-medical bills. One study, published in 2016 by the National Bureau of Economic Research, found that someone who goes into the hospital without insurance doubles her chances of filing for bankruptcy over the next four years.

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McConnell: Senate will stick with working on health care bill

Poll: Only 12% of Americans support the Senate health care plan

Heres why its so hard to write health care legislation that will pass

Senate health care bill: Here’s how it would affect you

For the bills that go unpaid, hospitals can try to compensate by charging other patients more. But that doesnt happen as much as many people including policymakers — think.

The authors of the ACA believed thatincreasing insurance coverage through Medicaid and subsidies for private insurance would lessen the cost-shifting that leads to higher insurance premiums. Supreme Court Justice John Roberts also mentioned that benefit in the 2011 decision he authored upholding the laws constitutionality. But researchers havent been ableto document much of a cost shift.

Studying the effects of expanding Medicaid in Michigan where more than 600,000 gained coverage researchers at the University of Michigan havefound no evidence that the expansion affected insurance premiums. They did, however, document that hospitals uncompensated care costs dropped dramatically by nearly 50%.

Conversely, when Tennessee and Missouri had large-scale Medicaid cuts in 2005, the amount of care hospitals provided for free suddenly increased. In a 2015 study published by the National Bureau of Economic Research, Garthwaite and his co-authors estimated every uninsured person costs local hospitals $900 in uncompensated care costs each year.

This is not a trivial thing for a hospital to deal with, Garthwaite said. While hospitals average 7% profit margins, uncompensated care costs can be more than 5% of revenue.

Hospitals do get help with the unpaid bills from taxpayers.

The majority of hospitals are non-profits and are exempt from federal, state and local taxes if they provide a community benefit, such as charitable care. Hospitals also receive federal funding to offset some of the costs of treating the poor.

The ACA scaled back those payments in anticipation that hospitals’ uncompensated care costs would go down. The GOP proposals to overhaul the ACA would reinstate the payments, while making changes to Medicaid and private insurance subsidies that the nonpartisan Congressional Budget Office estimates would result in more than 20 million fewer people having insurance by 2026.

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The return of extra federal payments to hospitals for uncompensatedcare wouldnt be enough to offset the unpaid bills, according to an analysis by the Commonwealth Fund. The study examined the Medicaid changes included in the bill that passed the House in May, and co-author Melinda Abrams said the effects of the Senates pending proposal would be at least as great.

Hospitals operating margins in all states would decline. And hospitals in most of the 31 states which expanded Medicaid under the ACA would have negative operating margins by 2026, according to the analysis.

Ultimately, you have to cut services, fire people, or both, Abrams said. It is shifting the burden of the cost. What is currently shared between the federal government and state governments will be shifted largely to the states. And the burden will be felt by the providers, the patients, the community and the taxpayer.

Pressure from hospitals was often a factor in states decisions to expand Medicaid under the ACA. In some states, such as Indiana, hospitals even agreed to a pay new taxes in exchange for the additional federal revenue from Medicaid patients. Most of the recent decline in hospitals uncompensated care costs has been in states which expanded Medicaid.

And hospitals are among those fighting hard against GOP efforts to phase out the expansion and cap overall Medicaid payments to states.

If these proposed cuts take place, devastation would occur for local rural economies due to hospitals closing and patients incurring huge amounts of debt, Trampas Hutches, CEO of Melissa Memorial Hospital in Holyoke, Colo., said at one of the many events organized by the American Hospital Association and other health care providers in opposition to the GOP bills.

One reason Medicaid has been harder to cut than other safety-net programs such as welfare cash payments is that a large part of the spending is a transfer to health care providers, Garthwaite argues. Thats particularly true for hospitals which are essentially insurers of last resort when there are large coverage gaps.

When policymakers decide not to provide health insurance for a portion of the population that otherwise could not afford insurance,” Garthwaite and his colleagues wrote in their 2015 analysis, “hospitals ultimately bear the cost of that decision,

As President Donald Trump continues to push his agenda of repealing and replacing Obamacare, Americans are not on his side about this. Susana Victoria Perez (@susana_vp) has more. Buzz60

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Hospital Ends Agreement to Have Off-Duty Police in Emergency Room – KARK

LITTLE ROCK, Ark. – A footprint in town, means you have history to share.

CHI St. Vincent’s history dates back more than a century to 1888.

“We’re here to protect and take care of people,” says an emergency room staffer.

The Emergency Room employee, who asked we hide their identify, knows things change over time.

“Something’s got to be done to keep it safe. It could be anybody that something happens too,” the employee says.

The staffer says about two months ago, the hospital ended its agreement to keep an off-duty police officer in the Emergency Room.

“If something starts going down–we have to get to the appropriate phones, call 911 and wait for back up to get there,” the worker says.

St. Vincent officials say they have a full-time security team and the off-duty police officers were only working ‘a few hours overnight each night’.

The staffer says overnights are primetime for problems.

“A patient has charged an area of the desk where they could’ve gotten to the staff and they were said to be quite threatening and very abusive and even threatening to hurt staff,” the employee says.

St. Vincent Hospital officials provided a prepared statement:

“Our Environment of Care and Workplace Safety committees are made up of coworkers from multiple divisions, including Nursing and Security. Those committees are involved in re-evaluating our security protocols in order to maintain the highest level of safety possible and ensure we are allocating resources where needed most.

As part of an ongoing evaluation, we determined it would be more beneficial at this time to focus resources on how to improve security throughout the hospital. The off-duty police officers who were previously contracted by us were only located in the Emergency Department and only for a few hours overnight each night. So, we are in the process of implementing additional security measures for all of our departments on all of our campuses.

We continue to have an excellent relationship with law enforcement in every community we serve. Those partnerships, in addition to an active, full-time security team, help us ensure the safety of patients and coworkers.”

“Just keeping an eye out for what’s going on, who’s going where,” the staffer says.

While CHI St. Vincent has a full-time security team, the Emergency Room employee says the guards are not armed.

A Little Rock Police spokesperson says off-duty officers provide armed security in the Emergency Room at Baptist Health and Children’s Hospital. UAMS has its own separate police force.

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Newman Regional Health emergency room expansion begins – Emporia Gazette

One turn of a shovel and it was official.

Ground was broken at Newman Regional Health Wednesday, signifying the beginning of its $14.4 million emergency room expansion project.

I want to thank you all for coming out today for the groundbreaking, Bob Wright, Newman Regional Health chief operating officer said. I was looking at the statistics today and, since 2013, our emergency room volume is up 22 percent, which helps explain why this project is so important to our community. We are doubling the number of rooms in our ER and tripling the square footage. We are co-locating express care and our critical decision unit on the same floor of the ER for better access to patients to our diagnostic equipment and their caregivers.

The expansion will increase the size of the emergency room tremendously. The current ER consists of 5,000 square feet with the expansion providing an additional 10,000 square feet. Wright said the expansion will benefit hospital staff and patients.

Just the space is a huge benefit, Wright said. The current rooms are so small we cant get the staff we need in a room. Sometimes you need three staff members in a room and they are too small for three people.

The emergency room will have a centralized nursing station and 19 total rooms the current ER has 10 small rooms. The 19 rooms include three trauma rooms, four fast track rooms and 12 regular examination rooms. The rooms are arranged around the central nursing station, which provides a clear line of sight to all patient rooms, which increases patient and staff safety.

Harold Blits, vice president of facilities at Newman Regional Health, said the emergency room expansion will benefit the community.

Its not so much how its going to benefit the staff. The big benefit is to the community, Blits said. If you have ever been a patient in the ER you know how tight it is, how loud it is, the lack of privacy.

The expansion will also include a waiting room, three exam rooms and a procedure room for express care. As patients enter they will self-determine if they need to be seen in express care or the emergency room. If they begin treatment in express care but the severity level is too high, they will be transferred to the emergency room.

A room for pre- and post-patients using the cath lab is included as well as room for an infusion station for those patients who come to the hospital for IV medications. Two safety rooms, observation rooms, a sexual assault nurse exam room and office space are also included. Staff will have access to a break room, staff bathrooms and locker rooms.

With Wednesdays groundbreaking, Bilts and Wright anticipate the expanded emergency room to open in December of 2019.

We anticipate being open 18 months from today, Bilts said.

I believe the next 18 months will go very quickly and we will be here soon cutting a ribbon, Wright said.

How patients benefit

^ Decrease in wait time

Wait times are expected to decrease with the additional space.

The space allows the ability to turn the patients quicker, Wright said. Waiting times will go down because we can get them in a room quicker. We can lose 20 minutes to an hour while people are in the waiting room and we havent even got them in a room yet.

^ Increased safety

Safety is always a top priority for patients and staff. The new emergency room is designed with safety in mind.

This space is designed for safety, Bilts said. Good line of sight to all patient rooms and a central nursing station.

^ Privacy

Each room in the new emergency room has a private bathroom to increase patient privacy.

Now we have two little bathrooms in the middle of a hallway and you are wandering out there exposed, Bilts said. Every room will have a restroom and there is just so much more privacy.

^ Space for family

The larger room sizes not only accommodate medical equipment and staff but also allow space for family to remain in the room with the patient. Each room will have a sleeper sofa for family members to rest while waiting.

Currently there is no room for family in our ER right now, Bilts said. If the doctor and nurse have to come in, the family member has to stand in the corner and basically hope they dont take up a spot more than 18 inches by 18 inches. Now the rooms will be plenty big enough for family to be there with the patient.

***************** Second Info Box *******************

By the numbers

^ $14.4 million is budgeted for the emergency room expansion

^ 19 total rooms in the emergency room three trauma rooms, four fast track rooms, 12 regular exam rooms

^ 15,000 square feet in the new emergency room

^ 7-percent increase in the number of patients using the emergency room in 2017 over 2016

^ 22 years since the last emergency room renovation was completed in 1995

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IC in Care Series The Emergency Department – Infection Control Today

By Kelly M. Pyrek

Competing priorities, life-and-death situations and a vast quantity of unknown variables are the hallmarks of the emergency department (ED), and compliance with infection prevention and control (IPC) principles and practices can be challenging. Katherine West, BSN, MSEd, CIC, points to the directive from the Occupational Health and Safety Administration (OSHA) — CPL 02-02.069 — that indicates that the delivery of healthcare should not be delayed. “Trauma response is more important than infection control compliance, and even OSHA recognizes that fact,” West says. “We have a duty to meet the patient care needs.”

That being said, abdication of IPC is not acceptable, and infection preventionists and ED personnel must work toward a manageable compromise that can still protect patients and healthcare professionals to a reasonable degree. Researchers are currently endeavoring to study the IPC needs of the ED and determine best practices for better outcomes, as well as determine standardized methods and definitions of compliance monitoring in order to be able to compare results across settings.

In their review, Carter, et al. (2014) examined published literature addressing adherence rates among ED personnel to selected infection control practices, including hand hygiene and aseptic technique during the placement of central venous catheters and urinary catheters, as well as rates of ED equipment contamination. Suitable studies revealed that hand hygiene compliance ranged from 7.7 percent to 89.7 percent, while other studies indicated that aseptic technique practices during urinary catheterization was lacking, and equipment contamination in the ED was persistent.

As Carter, et al. (2014) summarize, “The emergency department is an essential component of the healthcare system, and its potential impact continues to grow as more individuals seek care and are admitted to the hospital through the ED. Invasive procedures such as central lines are placed with increased frequency in certain EDs, but adherence to best practices (e.g., maximum barrier precautions) varies. ED clinicians also face numerous workflow challenges that may foster the spread of infections including crowding, frequent interruptions to care delivery, use of nontraditional care areas such as hallways and conference rooms, and close proximity of patients, who are often separated only by curtains. Given that many of these barriers have been identified as infection prevention threats, it is critical to understand the infection prevention practices of ED providers and their potential role in the risk of HAIs.”

West points to a number of factors that complicate IPC in the emergency department. “The ED is a very challenging area for infection control because it is often a contracted services and staff miss many of the laws and procedures that are important. For example, many are not aware of the HIV testing laws in their state or that HIPAA does not prevent the release of source patient test results to the exposed employee. Rapid patient turnover may impede cleaning compliance. So, compliance monitoring is important. In many facilities, staff is temp staff and that adds to the issues.”

She also emphasizes the need to balance healthcare personnel safety with the need to protect patients. “There is a need to protect patients from infection as well as staff,” West says. “For too long the duty to the patient has often been forgotten. With the new healthcare law, patient protection from infection becomes more important. Patient who develop infection two days after admission, that will be termed healthcare-associated and there may be no government reimbursement for the cost of extended stay and treatment. Staff training needs to focus on proper IV site prep, etc. Training is often not in accordance with requirements for infection control. Attendance at training is important and often not deemed as important.”

Additionally, West emphasizes that “Infection preventionists often do not have enough time to do training in person, which is ideal, so there is time for questions to be answered and items clarified. Paperwork seems to take up so much time. Making rounds and observing care rendered in the ED is very important. Compliance monitoring is key to risk and liability reduction and will also identify training needs. Rounds and training are the best way to interact with ED staff and identify problems.” Let’s take a closer look at several key IPC areas in the ED.

Hand hygiene Carter, et al. (2014) found that hand hygiene was the most commonly observed infection prevention practice in the studies they reviewed, and adherence rates varied widely. For example, several studies examined hand hygiene practices before and after interventions; Haas and Larson used WHO guidelines to assess the impact of a wearable alcohol hand sanitizer dispenser among ED personnel in a New York hospital. The researchers observed 757 hand hygiene opportunities; the adherence rate improved from 43 percent to 62 percent during the first intervention month of the study but was not sustained, with a 51 percent adherence rate after the second quarter.

Scheithauer, et al. (2013) acknowledges that the ED “represents an environment with a high density of invasive and thus infection-prone procedures,” and sought to define the number of hand-rubs needed for an individual patient care at the ED and to optimize hand hygiene compliance without increasing workload. In this prospective tri-phase (6-week observation phases interrupted by two six-week interventions) before after study to determine opportunities for and compliance with hand hygiene per WHO protocol, the researchers evaluated 378 patient cases with 5674 opportunities for hand-rubs (HR) and 1664 HR performed. They found that compliance significantly increased from 21 percent (545/2,603) to 29 percent (467/1,607), and finally 45 percent (652/1,464) in phases 1, 2 and 3, respectively. The number of HR needed for one patient care significantly decreased from 22 to 13 for the non-surgical and from 13 to 7 for the surgical patients due to improved workflow practices after implementing standard operating procedures (SOPs). In parallel, the number of HR performed increased from 3 to 5 for non-surgical and from 2 to 3 for surgical patients. Avoidable opportunities as well as glove usage instead of HR decreased by 70 percent and 73 percent, respectively.

Venkatesh, et al. (2011) conducted an observational study to identify predictors of hand hygiene in the ED. Compliance was 89.7 percent over 5,865 opportunities. The researchers found that observation unit, hallway or high-visibility location, glove use, and worker type predicted worse hand hygiene compliance. Hallway location was the strongest predictor (relative risk, 88.9 percent).

In their study at two university hospital centers, Martel, et al. (2014) found that 53 percent of nurses washed their hands after seeing the patient, and only 40 percent applied recommendation before. However, the researchers note, “given a great turnover of patients, nurses may have just washed their hands after the last patient assessment and be already decontaminated for the next. Some handwashing may have been missed because nurses often left our site of observation immediately before and after seeing the patient.”

Aseptic technique during catheterization In their review, Carter, et al. (2014) identified one study that observed aseptic technique during urinary catheterization. In this study, medical students used standardized observation tools to observe aseptic technique in one ED in the UK and another ED in New Zealand. Procedures observed included urinary catheterization, wound examination or closure, injections or intravascular cannulation, lumbar puncture, and pleural aspiration. Overall, 27 percent (UK) and 58 percent (New Zealand) of invasive procedures were performed using aseptic technique. Adherence to aseptic technique was reported in aggregate and not categorized by procedure type.

Regarding aseptic technique during central venous catheter insertion, Carter, et al. (2014) identified seven studies that examined central venous catheters inserted in the ED or by emergency medicine residents. One study examined the effect of a video review on the sterile technique practices of surgical and emergency medicine residents during the placement of central lines. Compliance to aseptic technique was higher among those who received the video-based online training than those who received paper-based training or no training (74 percent vs 33 percent, respectively). In a separate evaluation, the same research team also assessed maximum barrier precautions among primary and secondary operators through a video recording. Among elective central lines, maximum barrier precautions were used by 88 percent (99/113) of primary operators and 69 percent (31/45) of secondary operators or senior medical staff.

Contact precautions Researchers have found variability of contact precaution policies in U.S. emergency departments. A study published in Infection Control and Hospital Epidemiology in 2014, Daniel J. Pallin, MD, MPH, and Jeremiah D. Schuur, MD, MS, both from Brigham and Women’s Hospital, surveyed a random sample of U.S. EDs confirmed substantial variation in the adoption of policies relating to contact precautions. While most EDs have policies relating to contact precautions when specific organisms are suspected, a minority have such policies for the symptoms often caused by those organisms. This indicated that institutional policies do not mirror consensus recommendations by the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA) and other national bodies. The authors write, “The variation in policy that we observed leads us to recommend that emergency medicine organizations, such as the American College of Emergency Physicians, should enact policies addressing contact precautions in the ED.”

Respiratory hygiene As Rothman, et al. (2006) remind us, “The participation of emergency physicians and nurses is critical for effective responsiveness to respiratory threats in hospitals. ED personnel represent a critical link in the chain of communication and response, along the continuum from the community to the inpatient unit. Policies should anticipate responses to the complex spectrum of possible respiratory illnesses, from highly transmissible and unexpected emerging global diseases such as SARS to yearly influenza epidemics.” They add, “Concerns about the potential spread of respiratory pathogens begin at the point of entry into the healthcare system and continue to the inpatient setting. Emergency personnel need to be aware of the potential for infection, illness, and transmissibility in a variety of potentially high-risk environments, including (1) emergency medical services (EMS) and triage settings (in which historical and clinical information may be limited and risk underestimated), (2) during performance of high-risk invasive airway procedures, and (3) during patient transport to the various inpatient units throughout the hospital.”

Fusco and Puro (2012) observe that “The role of emergency departments in disease transmission dramatically emerged during the outbreak of severe acute respiratory syndrome (SARS). Subsequently, the 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. 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 healthcare 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.”

Martel, et al. (2014) sought to determine the compliance with respiratory hygiene of triage nurses at two university hospital centers and to identify factors influencing compliance to the respiratory hygiene principles of emergency healthcare workers. An anonymous observation of compliance with respiratory hygiene by triage emergency nurses was performed, and a self-administered, voluntary questionnaire on attitudes, perceptions, and knowledge of respiratory hygiene guidelines was distributed to the healthcare workers in the ED. The researchers found the average compliance with respiratory hygiene measures of triage nurses was 22 percent; compliance of healthcare workers was 68 percent. Overall, 91.9 percent of respondents believed that a mask was an effective preventive measure. The main barriers to mask use by healthcare workers were tendency to forget (37.8 percent) and discomfort (35.1 percent). Despite clearly visible respiratory hygiene posters in both hospital sites, necessary materials such as masks and tissues were missing in 9.6 percent of the cases. Patient isolation and decontamination measures were rarely or never applied.

As Martel, et al. (2014) observe, “The emergency department is the point of entry into the hospital for many patients and as such constitutes a prime location for the propagation of respiratory infections. These communicable diseases can then be further spread into the hospital as well as back into the community, creating a significant societal burden.” Martel, et al. (2014) found that nurses frequently asked about fever and cough (82 percent), which could be explained by the fact that the emergency room evaluation sheet included an inquiry regarding cough and fever, but they rarely informed the patient of the need to wear a mask (18 percent). The researchers say this could be explained by a lack of knowledge regarding the increased transmission risk in the presence of fever and cough. However, despite the fact that the self-applied questionnaire was not completed by the same healthcare workers, 94.1 percent of them reported that they would recommend mask wearing to a patient with fever and cough. Even though hygiene equipment (such as masks) was present 94.4 percent of the time, only 18.3% of patients had applied the mask recommendations prior to triage.

Martel, et al. (2014) also point out that in spite of CDC recommendations, patient handwashing measures were never met. The absence of posters focusing on this measure, in contrast to the importance of wearing a mask by patient, may result in the slightly higher adherence to the mask precaution (18% vs 0%, respectively). The researchers note, “Several factors could explain that only 9% of nurses informed patients about proper mask technique. Some nurses were seen to request isolation precautions instead. Also, when masks were well positioned, nurses did not further address proper application. Moreover, some nurses may have overestimated patient knowledge regarding the need for mask to cover both nose and mouth and be changed when wet. Despite evidence that spatial separation can reduce droplet spread of infection, we showed a very low compliance to patient isolation (12%).We know that implementation of these measures in many crowded waiting rooms remains particularly difficult. However, both hospitals sites had well-identified areas for this purpose.”

Martel, et al. (2014) recommend the following measures to standardize adequate practices: 1. Visual tools specifically designed for the emergency waiting room displayed prominently (e.g., on the door of the room), encouraging the following basic steps: disinfection of hands and wearing of mask by patient with fever and cough. 2. Modification of present visual tools in waiting rooms to mention real indications for mask wearing: coughing, sneezing, and runny nose and not only fever and cough because they are common. 3. Modification of the emergency department sheet, reminding nurses of the association between fever and cough and the need for patients to wear a mask. 4. Positive reinforcement of respiratory hygiene compliance by supervisors and training on respiratory hygiene/respiratory etiquette of emergency personnel with creation of measures such as online courses aimed at facilitating learning and improving accessibility and flexibility as well as reducing costs.

Equipment contamination In their review, Carter, et al. (2014) identified four papers described equipment contamination in the ED: “Of primary focus was contamination with methicillin-resistant Staphylococcus aureus (MRSA). In one large ED from a United States tertiary care hospital, 7 percent (5/69) of environmental surfaces (chairs, keyboards, telephones, and others) were positive for MRSA compared with no positive sites (0/63) in an outpatient clinic. Another research team took 63 samples of computer mice in an ED in over a one-year period and found only normal skin flora, with no MRSA. In a United States ED, Frazee et al took surveillance cultures of ultrasonographic probes used in the ED; approximately two thirds (111/164) were contaminated with skin or environmental flora, eight samples had heavy growth of skin or environmental flora, and 3.7 percent (6/164) grew organisms including methicillin-sensitive S aureus, Aspergillus, Acinetobacter spp, and mixed Gram-negative rods. Finally, a researcher cultured the stethoscopes of ED nurses and physicians in three Canadian EDs. Of the 100 stethoscopes samples, 70 percent were contaminated. A majority of specimens grew coagulase-negative staphylococci (54/100).”

References:

Carter EJ, Pouch SM and Larson EL. Common infection control practices in the emergency department: A literature review. Am J Infect Control. 42 (2014) 957-62.

Fusco FM and Puro V. Infection control in the emergency department. CMAJ. 184(9):1065. Jun 12, 2012.

Martel J, Bui-Xuan EF, Carreau AM, Carrier JD, Larkin E, Vlachos-Mayer H and Dumas ME. Respiratory hygiene in emergency departments: Compliance, beliefs and perceptions. American Journal of Infection Control 42 (2014) 957-62.

Rothman RE, Irvin CB, Moran GJ, et al. Respiratory hygiene in the emergency department. Ann Emerg Med 2006;48:57082

Scheithauer S, Kamerseder V, Petersen P, Brokmann JC, Lopez-Gonzalez LA, Mach C, Schulze-Rbbecke R and Lemmen SW. Improving hand hygiene compliance in the emergency department: getting to the point. BMC Infectious Diseases 2013, 13:367.

Venkatesh AK, Pallin DJ, Kayden S and Schuur JD. Predictors of Hand Hygiene in the Emergency Department. Infect Control Hosp Epidemiol. 2011 Nov;32(11):1120-3.

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7 of the Most Bizarre Reasons People End up in the Emergency Room – The Cheat Sheet

Emergency room staff see some crazy stuff, but you may be surprised to hear its not always the drama-filled scenes you see on TV. Theres a reason shows like Nurse Jackie and ER have such a loyal fan base, after all. A pill-popping ER nurse, fighting her own addiction, and a string of dramatic trauma cases are far more entertaining than patients with headaches and sprained fingers.

But the truth is emergency rooms tend to be a bit more low-key on a day-to-day basis they may even be weirder than you would think. Here are seven of the the most bizarre reasons people end up in the emergency room.

There are some fairly unusual reasons people visit the emergency room. Just take a look at this graph compiled by FlowingData, for instance.The data, which was collected in 2014 by the Consumer Product Safety Commission, shows just how random ER injuries can be. One worth mentioning has to do with ruining an otherwise perfect day of fun in the sun: Emergency rooms across the U.S. saw 1,231 beach chair-related injuries in June alone. Talk about spoiling a day at the beach.

Having any sort of reaction appear on your skin can be cause for concern. But theres no need to take it upon yourself to diagnose it as a much more serious disease, at least not before youve actually heard a doctors opinion.

One Reddit user said, I have patients who develop a rash, look it up on WebMD, and come to me screaming that they must have Stevens-Johnson Syndrome. Fast forward to the exam part of an ER visit, and the most common diagnosis is contact dermatitis from laundry soap. Reddit does go on to say, however, that although Stevens-Johnson syndrome is very rare, you should see a doctor immediately if you develop a rash after taking a new medication.

If that skin rash is due to contact dermatitis, theres no reason to panic. In most cases its not necessarily all that serious, and could even go away on its own. In fact, according to the American Academy of Dermatology, Almost everyone gets this type of eczema at least once. We get contact dermatitis when something that our skin touches causes a rash. Some rashes happen immediately. Most take time to appear. Irritants can include bleach, nickel, and latex gloves.

Foreign objects are a big one, and theres a wide range of them that can cause enough harm where an ER visit is in order. One Reddit usersayshe sees a lot of this one. Ear wax is NOT your enemy. It protects your ears it has antibacterial and antifungal properties, and is absorbent. Not a week goes by without a consultant for blood in the ear due to a Q-tip, or a ruptured drum from puncturing it with a foreign object, or a thermal injury from ear candling. It is NOT DIRT. So, you might want toease up on your cotton swabusage.

If youre cringing right now thinking about getting hooked, or hooking your friend in a not so pleasant place, know it is very possible. According to the American Academy of Family Physicians, fishhooks are right up there with splinters and glass. Most fishhook injuries occur in the hand, face or scalp, upper extremity, or foot, the organization says. Fishhooks in the eyelid or eye require immediate ophthalmologic referral. Just thinking about a hook in the eye is enough to send a person to the ER.

In the same vein, actually ingesting foreign objects can cause a well-deserved trip to the ER. While this may sound pretty ludicrous, it does happen.Vice polled a few medical professionals about some of the bizarre things ER docs see. In one response, the physician mentioned how those with mental health problems often engage in self-harming behavior. Unfortunately, it seems some emergency rooms are no strangers to people who consistently swallow harmful objects; knives, in particular.

Onehealthcare professional told Vice there are lots of well-known people who swallow knives, moving around from one hospital to the next. And interestingly enough, trying to remove such objects can be more dangerous than leaving them. The surgeons wont really operate on them unless theyve perforated some part of their gastrointestinal track, Vice explains. Sometimes they wont even operate on them anyways because theyre just going to do it again. So we just manage their symptoms. Ouch.

You dont often worry about grill tools being cause for concern, but the bristles on wire grill brushes have been known to get stuck on grills, resulting in transfer towhatever you happen to be cooking at the moment. While the numbers arent staggering, it does happen. Using data projections from the Consumer Product Safety Commissions National Electronic Injury Surveillance System, researchers estimate more than 1,600 ER visitswere a result of ingesting wire bristle grill brushes between2002 to 2014. Again, not staggering, but something to keep in mind.

BBQ-goers and chefs alike should be well-educated on the products theyre using. And according to Fox News, there are some precautions you can take to make sure you dont end up in the ER thanks to a bristle-loaded burger.

For instance, only use quality tools, thoroughly clean your grill and tools, and prepare the meat properly. And probably most importantly, make sure youre paying attention. Its easy to throw meat on the grill and walk away to socialize, but keeping a watchful eye on your meal can makea big difference.

Similar to our first point, this one also comes from FlowingDatas visual, which includes injury data collected by the Consumer Product Safety Commission. Injuries relatedbeds or bed frames comes in at No. 3 on the list. (If youre wondering what took the No. 1 and No. 2 spots, it was stairs/steps at 1,135,343 ER visits in 2014 and floors/flooring materials at 1,131,428 ER visits in 2014. But those two seemed a little less unusual, seeing as falling down stairs, or even tumbles due to slippery floors are quite common.)

Beds and bed frames accounted for 620,302 ER visits in 2014,which seems remarkablyhigh. It seemslike more of a user error issue, if you really think about it.

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7 of the Most Bizarre Reasons People End up in the Emergency Room – The Cheat Sheet

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