Our health center successfully met the challenges posed by the 2009 H1N1 outbreak. The intent in sharing the details of our planning and experience is to allow others to determine which elements of this planning might be adapted for managing a surge of patients in their setting.
WHAT'S KNOWN ON THIS SUBJECT: The incidence of pertussis has significantly increased, and infection can result in severe disease among young children. This highly contagious disease may frequently be transmitted in pediatric health care settings, necessitating effective infection control practices to reduce exposure risk.WHAT THIS STUDY ADDS: Despite institutional guidelines, pediatric health care workers (HCWs) are frequently exposed to pertussis because of delayed or incomplete adherence to infection control practices. Inconsistent reporting may also result in missed HCW exposures, increasing the risk of subsequent transmission to patients. abstract OBJECTIVE: Pediatric health care workers (HCWs) are at particular risk for pertussis exposure, infection, and subsequent disease transmission to susceptible patients. This cross-sectional study describes the epidemiology of occupational exposures to pertussis and identifies factors that may inform interventions to promote effective implementation of infection prevention and control (IPC) guidelines. METHODS:We abstracted data from occupational health (OH) and IPC records for pertussis cases that resulted in an exposure investigation in a large quaternary pediatric care network, January 1, 2002 to July 18, 2011. We calculated the frequency of occupational exposures and measured associated characteristics. To assess the frequency of potential missed exposures, we reviewed electronic health record (EHR) data identifying laboratory-confirmed pertussis cases not documented in OH or IPC records.RESULTS: A total of 1193 confirmed HCW pertussis exposures were associated with 219 index cases during the study period. Of these, 38.8% were infants ,6 months old and 7 were HCWs. Most (77.5%) of exposures occurred in the emergency department or an ambulatory site; 27.0% of exposures occurred after documented initiation of IPC precautions. We identified 450 laboratory-confirmed pertussis cases through EHR review, of which 49.8% (N = 224) had no OH or IPC investigation. The majority of uninvestigated cases (77.2%) were from ambulatory sites. Ms Kuncio contributed to study design, performed data collection and analyses, and produced the first draft of and reviewed and revised the manuscript; Ms Middleton aided in data cleaning and analyses and reviewed and revised the manuscript; Ms Cooney contributed to study design and implementation and reviewed and revised the manuscript; Mr Ramos contributed to data collection and study execution and reviewed and revised the manuscript; Dr Coffin contributed to study design, actively directed data analyses, and reviewed and revised the manuscript; Dr Feemster conceptualized the study design, supervised data analyses and study implementation, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted. CONCLUSIONS:www.pediatrics.org/cgi
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