TRIP

Time in ER Sends Infection Back to Nursing Home (CME/CE)

MedPageToday, 2012

An emergency department visit may triple the risk of respiratory and gastrointestinal infections for nursing home residents, researchers found.
The rate of new acute respiratory or GI infections was 5% within a week of an emergency department visit compared with 2% when not leaving the long-term care facility, according to Caroline Quach, MD, of McGill University in Montreal, and colleagues.
After adjustment for other factors, seniors at such facilities were 3.9-fold more likely to acquire an infection following a trip to the emergency department, the group reported online in CMAJ .
Whether patients are picking up pathogens in the waiting room or exam room -- from staff or other patients -- additional precautions may be reasonable for five to seven days after their return from the emergency department, Quach's group recommended.
Action Points   The study found an emergency department visit may triple the risk of respiratory and gastrointestinal infections for nursing home residents.
Note that in the presence of an ongoing outbreak of influenza or other infection at the care facility, a visit to the emergency department had no additional effect on risk.
"If they acquire an infection while in the emergency department, these residents may be the source of an outbreak upon return to their facility," they wrote.
"Prolonged length of stay, limited capacities for diagnosis, and variable infection control programs may allow outbreaks to propagate and persist for many months, underlining the importance of identifying potential sources of infectious agents," they added.
One prior study suggested that an influenza outbreak would kill almost one patient in 100 in a nursing home and incur more than $6,000 in costs over 30 days.
Quach's study examined outcomes at 22 nursing homes in Ontario and Quebec during the months of September 2006 to May 2008 when a trip to the emergency department would most likely result in cold, flu, and gastroenteritis exposure.
Among the 1,269 residents included in the study, 424 visited the emergency department during these periods.