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Mystery Patient Drills Reveal Gaps in Infection Control Practices in NYC Hospitals

In all, 74 (78%) of the hospitals passed the drills, and no significant differences were found between masking for MERS vs measles patients. However, 19 (39%) of the hospitals “failed at least 1 drill,” which is concerning given the highly infectious nature of these diseases, and high transmissibility of these diseases in ED waiting areas. The researchers note that “masking and isolation occurred significantly more frequently in situations where a travel history had been elicited. [This] suggests that routinely inquiring about recent travel could prevent exposures to infectious patients at critical entry points to the health care system.”

Aside from the masking and isolation procedures, evaluators also recorded adherence to “key infection control practices,” and found that many EDs needed to make changes in this area. In total, 36% of the hospitals practiced appropriate hand hygiene, 74% practiced appropriate PPE use, and 70% practiced appropriate posting of isolation signage. These results indicate that all hospitals could potentially benefit from “routing competency-based infection-control training programs,” according to the report.

Two limitations of the drills highlighted in the report include the fact that, “exercise evaluation was limited to items that were under direct control of the staff members who participated in the drill, the controller, and the evaluator,” and that “controllers were not able to objectively present all signs of illness (eg, fever, chills), and the moulage used to simulate a measles rash might have been misleading or unconvincing, although this information was not captured in the drill reports.”

As a result of this report, researchers have created a toolkit which can be used in other jurisdictions “to support health care facilities and health departments conduct similar drills to identify areas for improvement and enhance readiness at a critical point of entry into the health care system.” The toolkit is available at
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