Measuring Social Contacts in the Emergency Department

• Type of Material: Article
• Authors: Douglas W Lowery-North, Emory University; Vicki S Hertzberg, Emory University; Lisa Elon, Emory University; George A Cotsonis, Emory University; Sarah Hilton, Emory University; Christopher Vaughns, Emory University; Eric Hill, Emory University; Alok Shrestha, Emory University; Alexandria Jo, Emory University; Nathan Adams, Emory University
• Language: English
• Date: 2013
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2013 Lowery-North et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0070854
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 8
• Issue: 8
• Start Page: e70854
• End Page: e70854
• Grant/Funding Information: This study was funded by the National Institute of Allergy and Infectious Diseases (NIAID) Center of Excellence in Influenza Research and Surveillance at Emory University (contract HHSN266200700006C, Richard Compans and Walter Orenstein, PIs).
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Biology, Biostatistics

Abstract

Background Infectious individuals in an emergency department (ED) bring substantial risks of cross infection. Data about the complex social and spatial structure of interpersonal contacts in the ED will aid construction of biologically plausible transmission risk models that can guide cross infection control. Methods and Findings We sought to determine the number and duration of contacts among patients and staff in a large, busy ED. This prospective study was conducted between 1 July 2009 and 30 June 2010. Two 12-hour shifts per week were randomly selected for study. The study was conducted in the ED of an urban hospital. There were 81 shifts in the planned random sample of 104 (78%) with usable contact data, during which there were 9183 patient encounters. Of these, 6062 (66%) were approached to participate, of which 4732 (78%) agreed. Over the course of the year, 88 staff members participated (84%). A radiofrequency identification (RFID) system was installed and the ED divided into 89 distinct zones structured so copresence of two individuals in any zone implied a very high probability of contact <1 meter apart in space. During study observation periods, patients and staff were given RFID tags to wear. Contact events were recorded. These were further broken down with respect to the nature of the contacts, i.e., patient with patient, patient with staff, and staff with staff. 293,171 contact events were recorded, with a median of 22 contact events and 9 contacts with distinct individuals per participant per shift. Staff-staff interactions were more numerous and longer than patient-patient or patient-staff interactions. Conclusions We used RFID to quantify contacts between patients and staff in a busy ED. These results are useful for studies of the spread of infections. By understanding contact patterns most important in potential transmission, more effective prevention strategies may be implemented.