Because I’m always on the lookout for more reasons to despise contact precautions, I immediately seized on this last finding. As Mike and his colleagues pointed out in a study published in March of this year, difficulty in finding beds for patients requiring contact precautions is one factor that exacerbates ED overcrowding. At Mike’s hospital, patients who required contact precautions waited in the ED for an hour longer than those who did not. Active detection and isolation programs make this problem even worse, as pointed out in this Irish study—patients colonized or infected with MRSA waited 2.5 hours longer in the ED than did those who were not identified as being at high-risk for MRSA.
In other words, not only does ED overcrowding lead to poorer HH and increased risk of pathogen transmission, but the patient population in many EDs may be “enriched” with MDRO carriers (who stay in EDs longer while awaiting a bed)!