Infection Prevention in Swedish Emergency Departments
We are conducting a short survey to investigate the activities and views of ED
directors regarding healthcare associated infections (HAI) in Swedish emergency
departments. The survey is distributed to the director of every emergency
department in the country. It takes approximately 10 minutes to complete.
The study has been approved by the Institutional Review Board of Brigham
and Women’s Hospital: participation is completely voluntary and confidential.
All of your answers to the survey are important to the study, but you may skip
any questions which you choose not to answer. Only aggregate results will be
reported.
Please complete the survey online, or print the attached PDF document, mark
your responses, scan the document and return it by e-mail to:
lyanagizawa-drott@partners.org
Please also send an e-mail do the above address if you have any questions.
URINARY CATHETERS & CATHETER-ASSOCIATED UTI (CAUTI)
1. Does your ED have a written policy regarding the appropriate indications for placement of urinary catheters?
0 No
1 Yes
2. Is a portable bladder ultrasound scanner routinely used for determining post-void residual bladder volume?
0 No
1Yes
3. Does your ED have a system (e.g. paper checklist or prompt on computer orders) that requires
ordering providers (Medical Doctor/Nurse Practitioner/Physician Assistant) to document an appropriate
indication justifying Foley catheter placement?
0 No
1Yes
2 Partial / In Process
1
a. IF YES, how is the ordering provider prompted?
Paper checklist 2 Prompt in computer orders 3 Other:
4. Do you, or someone in ED leadership, give regular feedback to ED staff on the appropriateness
of urinary catheters placed in your ED?
0 No
1 Yes
5. Do you, or someone in ED leadership, report on your ED’s urinary catheter appropriateness to
hospital leadership?
0 No
1 Chief medical officer
3 Hygiene doctor, or other hospital hygiene unit
Yes: check all that apply 2 CEO/president
4 Payer/regional authorities
5 Other:
6. Are you, or someone in ED leadership, notified about catheter-associated UTIs from catheters
placed in your ED?
0 No
1 Yes
7. Is your ED participating in a project to reduce catheter-associated UTIs? (By “project” we mean a
multidisciplinary group effort that is on a regular meeting agenda)
0 No
1 Quality improvement project run by ED leadership/staff 3 Hospital-run project
Yes: check all that apply 2 External collaborative (regional or national)
8. Is a specific ED staff member the designated “champion” for catheter-associated UTI
prevention (someone responsible for promoting appropriate use of urinary catheters)?
0 No
1 Physician
Yes: check all that apply 2 Nurse 3Other:
HAND HYGIENE - HANDWASHING
9. Is ED staff (MD/PA/RN) compliance with hand hygiene audited?
0 No (SKIP TO QUESTION #15)
1 Yes, by direct observation
2 Yes,
by calculating hand sanitizer used
10. How frequently is ED staff hand hygiene monitored by direct observation?
1 At least monthly
3 Less than quarterly (e.g. annually) 2 At least quarterly (between 1-3 months)
4 Unsure
11. What was the compliance with appropriate hand hygiene for your ED on the most recent audit?
1 0-19% correct hygiene 3 40-59% correct hygiene 5 80% or more correct hygiene
2 20-39% correct hygiene 4 60-79% correct hygiene 6 Unsure
12. Do you, or someone in ED leadership, give regular feedback to ED staff on your ED’s hand
hygiene compliance?
0 No
1 Yes
13. Do you, or someone in ED leadership, report on your ED’s hand hygiene compliance to hospital leadership or
to a unit for hospital hygiene?
0 No
1 Chief medical officer
3 Hygiene doctor, or other hospital hygiene unit
Yes: check all that apply 2 CEO/president
4 Payer/regional authorities
5 Other:
14. Is your ED participating in a project to improve hand hygiene? (By “project” we mean a
multidisciplinary group effort that is on a regular meeting agenda.)
0 No
1 QI project run by ED leadership/staff 3 Hospital-run project
Yes: check all that apply 2 External collaborative (regional or national)
15. Is a specific ED staff member the designated “champion” (or team leader) for improving hand
hygiene?
0 No
1 Physician
Yes: check all that apply 2 Nurse 3 Other:
PRECAUTIONS
16. Does your ED have a policy to place the following patients on contact precautions (gown and
gloves)?
a. All patients with stool incontinence or diarrhea
b. Patients with suspected Clostridium difficile infection
c. All patients with a cutaneous abscess or other purulent skin infection
d. Patients with suspected Methicillin-resistant Staphylococcus aureus (MRSA) Infection
e. Patients with drug resistant gram-negative organisms (e.g. Extended Spectrum BetaLactamases)
17. When a new patient arrives to the ED who requires contact precautions but all the ED rooms
are full, the new patient could be either: placed in a currently occupied room (current occupant
moved to hallway) or temporarily placed in a hallway or overflow space. How often is the new
precautions patient placed in a hallway or overflow treatment space?
1
0-19%
2
20-39% 3 40-59% 4 60-79% 5 ≥80% 0 Not applicable: no private ED rooms
GENERAL INFECTION PREVENTION QUESTIONS
18. Please rate how strongly you agree or disagree with each of the following statements by
checking the appropriate box.
a. Compared to other patient safety issues, hospital-aquired infections (HAIs) are a
significant risk to ED patients.
b. Patients discharged from the ED are at minimal risk from HAIs.
c. The ED does not have a significant impact on my hospital’s rate of HAIs.
d. There is close collaboration between infection prevention/control staff at the hospital or
in the region and the ED.
19. Has your ED participated in projects to address any other HAIs? Check all that apply.
1 MRSA
2 Clostridium Difficile
20. Does your ED have written guidelines for the management and treatment of patient with C.
diff infection?
0No 1Yes 2Unsure
21. Are you aware of patient(s) who visited your ED with C. diff. and subsequently had a
colectomy or died due to C. diff?
0No 1Yes, within the last year 2Yes, more than one year ago
GENERAL EMERGENCY DEPARTMENT QUESTIONS
22. Please indicate the total number of ED beds (exclude hallway)
How many of those are:
Private rooms
Beds separated by curtains
designated hallway beds (if any)
Pre-
23. a.Please indicate the total number of patient visits at your ED for 2011
b. Please indicate the approximate percent that were at least 18 years old
24. Please indicate the approximate percent of all ED visits that led to admission
admitted
25 Please indicate the average (mean) length of stay for all ED patients:
Unsure
26. On a typical day at 6pm:
.
%
hours
a. Are there any ED patients being cared for primarily in the hallway? 0 No 1 Yes
b. Are there any patients that “board” in your ED for >2 hours until an inpatient bed becomes
available?
0 No 1 Yes
27. Please indicate the mean time that a patient waits in the ED for a bed to become available in
the hospital (boarding time):
hours.
28. Are the following available electronically in your ED?
a. Laboratory results reporting
b. Computerized order entry by physicians for medications
IF YES, is there computer notification that the patient is allergic to a medication?
c. Patient tracking information in the ED (e.g., location, admission status)
IF YES, is there a visual “flag” or “warning” that a patient has contact precautions (e.g.
MRSA)?
29. Does your hospital have a training program for interns?
0. No 1. Yes
IF YES, do they spend at least part of their training in the ED?
0. No 1. Yes
30. How would you describe your hospital’s ED capacity?
1.Under capacity
2. Good balance
3. Over Capacity
4. Unsure
31. Have you, as ED director, completed the survey yourself? If not, please indicate the
title (not the name) of the person who filled it out:
1.
Yes 2. No, it was completed (in part or completely) by:
Thank you for completing the survey!
If you have any questions or thoughts regarding infection control measures in the ED, please
contact Lisa Yanagizawa Drott: lyanagizawa-drott@partners.org