Medicosnext
Dr. Samjhana Basnet
She is a life saver and an associate professor in the Department of General Practice and Emergency Medicine at Kathmandu University School of Medical Sciences/Dhulikhel Hospital. She is a program lead for Dhulikhel Hospital- One-Stop Crisis Management Center and Basic Life Support training course. She is an active clinician, educator, and researcher with a strong commitment to improving pre-hospital, trauma and emergency care in Nepal while advocating for women’s empowerment and equitable healthcare worldwide.
One of the ways to reduce the spread of infection in the ED is to implement dedicated, segregated rooms to safely manage patients requiring isolation and specialized care.
The dedicated space allows healthcare providers to assess, monitor and treat the suspected or confirmed infectious disease while minimizing the risk of disease transmission within the department and the community.
Early identification and isolation are critical and fundamental steps in preventing the spread of infections within healthcare settings, including the emergency department.
Segregated space should have a system that controls airflow, either negative or positive, to ensure the air is safe to breathe in.
The negative pressure maintains low pressure inside the room and allows air to enter the designated room, which is safely filtered before being exhausted, preventing contaminated particles from getting into the hallways or other treatment areas.
This is essential for managing diseases like pulmonary tuberculosis, influenza, measles, chickenpox, COVID-19, meningococcal meningitis. Without this, emergency departments will be like agents for the spread of infections and put patients, staff, and visitors at risk.
Worldwide, infection takes away millions of lives every year, accounting for 1 in 7 deaths globally. WHO estimates that 50% annual death and up to third of a disability case can be prevented with appropriate emergency care in the low- and middle-income country. Antimicrobial resistance is increasing, resulting in 1.27 million global deaths in 2019 and 4.95 million in 2022. In Nepal, 22% of all annual deaths are related to infectious diseases, and among them, respiratory tract infection and airborne infections are the top most leading cause of death.
The Emergency Department (ED) is a vanguard of the modern healthcare system, serving as the primary point of access for millions of patients worldwide for both life-threatening illnesses or injuries. The ED serves as the frontline of healthcare, providing immediate assessment, stabilization, and treatment for patients with a wide range of medical and surgical emergencies. It is one of the busiest areas of any hospital where ED staffs have direct contact with multidisciplinary health care providers of the hospitals as well as community members, including patients and their visitors. On top of that, ED receives patients with diverse health conditions, including infectious diseases that may pose a risk to treating healthcare providers, other nearby patients, and their visitors.
Segregated Room: The segregated room in the emergency department helps enhance patient safety by improving infection prevention and control, which facilitates uninterrupted delivery of high-quality emergency care for all. This helps to reduce the risk of infection spreading from person to person and also protects those individuals who are immunocompromised or those who are recovering from organ transplant. The designated space provides a controlled environment where infected patients can receive timely medical attention while maintaining appropriate infection prevention measures.
Importance of a dedicated segregated ED room
Infection prevention and control
Negative pressure and isolated rooms play a vital role in airborne pathogens. It enhances infection prevention and control, protects patients, visitors, and health care workers, and strengthens departments’ preparedness for managing infectious disease outbreaks. The implementation of an isolated ED room further reflects that commitment to provide safe, high-quality emergency care while maintaining a secure environment for both patients, visitors, and staff.
Protection of high-risk vulnerable patients
Patients who have a weak immune system, such as those who are under treatment for cancer or those who are recovering from an organ transplant or burns, might suddenly visit the ED to seek lifesaving care. Without dedicated, segregated positive-pressure space, these patients might contract an infection, and their bodies may not be able to fight against it. Positive pressure rooms are specialized rooms where pressure inside the room is kept higher than the surrounding corridors or space so that it prevents dust, microorganisms, or airborne contaminants from entering the room.
High patient Turnover
The ED has a huge turnover of patients. It’s the most common gateway to admission to the wards, intensive care units, or high dependency units. The majority of the patients do get discharged from the emergency department to the community. Without a segregated room in the emergency, the infection rapidly spread within the hospital as well as the community because patients, staff, and visitors are all likely to interact in the same shared vulnerable space. A segregated room reduces the infection by limiting people’s interaction with each other
Supporting infection prevention and control and protecting health care workers:
Infection prevention and control is a fundamental aspect of safe and quality healthcare delivery in a clinical environment. Physically separating suspected or confirmed infected patients from the general ED population can significantly reduce the risk of cross-contamination and healthcare-associated infections. Health care workers can able to effectively utilize infection prevention protocol, personal protective equipment, hand hygiene, environmental cleaning procedures and safe waste disposal methods while taking care of suspected or confirmed infectious illness.
Enhancing Patient Safety and improving workflow and efficiency
Patient safety remains a top priority of emergency care. Health care workers can safely don and doff personal protective equipment. The isolated room can provide privacy, comfort, and focused medical attention. In addition to supporting infection control, the segregated room contributes to improved workflow in the emergency department by streamlining patient management and movement with timely clinical decision making.
Commitment to Quality Emergency Care
The introduction of the segregation room demonstrates dedication to excellence in emergency care and commitment to providing safe, patient-centered, and high-quality emergency health care services in the ED. Continuous improvement in infrastructure and clinical processes is essential for meeting the needs of communities and patients.
Preparedness for infectious disease outbreaks and public health emergencies
Preparedness saves lives in emergencies and disaster events. True readiness for public health emergencies or infectious disease outbreaks is never built during crises; it requires long-term, structural investments and commitment in the health system.
The majority of EDs in developed countries are equipped with isolated segregated space for infectious diseases assessment and management. They prepare for daily emergency response and care as well as event for another pandemic or outbreak. However, in a developing country like ours, we have limited space and safety protocols for managing hazardous exposure, and we see patients in the open ED, which needs to be improved ethically and structurally.
During the COVID-19 pandemic, many of the tertiary care hospital or academic institute started to operate isolated cubicle in the ED for the COVID-19 patient segregation and management. They also installed high-efficiency particulate air (HEPA) filters for removing particles from the air. However, after the resolution of the COVID-19 pandemic, the segregated space in the ED for the infectious diseases has gradually disappeared in all major hospitals of Nepal except for a few health institutes like Birat Medical College teaching hospital, where segregated room in the ED are still in practice.
We can have another outbreak of infectious diseases at any time. We also need to protect our healthcare staff, patients and visitor from infectious diseases every day. Therefore, it is high time to replicate this practice of implementing segregated room in the ED across all health institutes of Nepal. We require a resilient emergency health care system that is capable of rapidly identifying and responding health threats at the ED.
Conclusion
The emergency health care system should be committed to fostering a safe environment where all patients in the ED receive timely, compassionate, and evidence-based care. The practical addition of a segregated room in the ED setting is a hospital’s dedication to safeguarding the health of individuals, protecting patients and healthcare workers, enhancing preparedness for future challenges and ultimately delivering exceptional emergency care.
