The prevalence of methicillin-resistant Staphylococcus aureus colonization in emergency department fast track patients

BACKGROUND:Over the past two decades,methicillin-resistant Staphylococcus aureus(MRSA) has evolved from a hospital-associated infection to a significant public health threat in the community,causing outbreaks of soft tissue infections in otherwise healthy individuals.The goal of this study was to determine the prevalence of nasal MRSA colonization in low acuity Emergency Department(ED) Fast Track patients in order to better characterize the epidemiology of this pathogen.METHODS:We conducted a cross-sectional study of a convenience sample of adult patients from our ED Fast Track.Nasal swabs were analyzed for MRSA using a polymerase chain reaction assay.Study participants completed a survey assessing traditional risk factors for CA-MRSA colonization.RESULTS:A total of 106 ED Fast Track patients were tested.Four(3.8%,95%CI 1.5%-9.3%)were MRSA positive.Three traditional CA-MRSA risk factors(personal history of abscess,family history of abscess,and participation in contact sports) were examined.In patients with a positive MRSA nasal swab,only a personal prior history of abscess retained significance(OR 33,95%C11.7-676,P=0.02).CONCLUSION:This study found a higher prevalence of nasal MRSA colonization in low acuity ED Fast Track patients compared with historical community surveillance studies.A personal history of prior abscess was a significant risk for CA-MRSA carriage.

Emergency medicine residencies structure of trainees'administrative experience:A cross-sectional survey

BACKGROUND:While the Accreditation Council for Graduate Medical Education(ACGME)mandates that emergency medicine residencies provide an educational curriculum that includes administrative seminars and morbidity and mortality conference,there is significant variation as to how administrative topics are implemented into training programs.We seek to determine the prevalence of dedicated administrative rotations and details about the components of the curriculum.METHODS:In this descriptive study,a 12-question survey was distributed via the CORD listserv;each member program was asked questions concerning the presence of an administrative rotation and details about its components.These responses were then analyzed with simple descriptive statistics.RESULTS:A total of 114 of the 168 programs responded,leading to a 68%response rate.Of responders,73%have a dedicated administrative rotation(95%CI 64.0 to 80.4).The content areas covered by the majority of programs with a dedicated program include performance improvement(n=68),patient safety(n=64),ED operations(n=58),patient satisfaction(n=54),billing and coding(n=47),and inter-professional collaboration(n=43).Experiential learning activities include review of patient safety reports(n=66)and addressing patient complaints(n=45).Most of the teaching on the rotation is either in-person(n=65)and/or self-directed reading assignments(n=48).The most commonly attended meetings during the rotation include performance improvement(n=60),ED operations(n=59),and ED faculty(n=44).CONCLUSION:This paper provides an overview of the most commonly covered resident administrative experiences that can be a guide as we work to develop an ideal administrative curriculum for EM residents.