Actors feigning a fever and a cough walked unannounced into 73 health care facilities across New York, New Jersey and the U.S. Virgin Islands this year, and just 60 percent of the facilities managed to both mask and isolate them, according to a federal study published on Thursday in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
The drills ran from January through June. Most of the sites were in New York City (52), with 15 elsewhere in New York State, three in New Jersey and three in the Virgin Islands, which federal officials treat as part of the same health region. Forty-two were emergency departments, 19 were hospital outpatient clinics and 12 were urgent care centers. Every facility had agreed to take part. None knew when the actors would show up, and the actors wore makeup and faked their symptoms, according to Ars Technica’s account of the study.
The results were rough. About 55 percent of emergency departments both masked and isolated the mock patients, against 68 percent of outpatient clinics and 67 percent of urgent care centers. Eighteen percent of facilities never offered a mask to a coughing patient who said they had a fever.
Speed was the other problem. Among the facilities that did mask and isolate, only 43 percent got a mask on the patient within the one-minute goal, and only 48 percent reached an isolation room inside the 10-minute goal. The median time to mask was 2 minutes. The median trip to an isolation room took 11, and outpatient clinics had a median isolation time of 20 minutes, with at least one clinic taking nearly an hour.
Staff at 93 percent of the facilities screened the actors for symptoms. But the actors came with a story built to point at bird flu — it involved a dead duck — and staff at only seven of the 73 asked any questions specific to bird flu exposure.
Protective equipment was just as spotty. Only 25 percent of clinicians who dealt with the actors wore all the recommended gear (gloves, mask, gown and eye protection), while 6 percent wore none at all and 19 percent skipped a mask or respirator. Staff at 40 of the 73 facilities, or 55 percent, notified or planned to notify their infection prevention and control teams, as recommended.
“Health care facility waiting areas can be high-risk settings for transmission of respiratory viruses if appropriate IPC measures are not implemented,” the study’s authors wrote.
The true picture may be worse. Not every facility invited to join the drills agreed, the authors said, and those that declined may have scored lower. And though the visits were unannounced, some facilities may have gotten word ahead of time, which could have lifted their numbers.