Waning pertussis immunity and spread of pertussis by asymptomatic adults contributes to increased pertussis exposures of vulnerable children. The Santa Clara Valley Medical Center had 49 pertussis exposures between July 1, 1989, and June 30, 1997, which originated in pediatric units or clinics and had an impact on the Employee Health Service (EHS) and Emergency Department (ED). We have developed a standardized protocol for management of employees and patients exposed to pertussis. The protocol includes a checklist for infection control staff; memoranda to exposed units conveying exposure information, instructions for employees to report to EHS or ED, and disease symptom information; written guidelines for physician management of patient exposures (prophylaxis and isolation) and EHS or ED management of employee exposures; and prophylaxis recommendations. We allow exposed employees to work while wearing a mask (worn until 5 days of prophylaxis are completed or for the entire potential contagious period if prophylaxis was refused). Employees who develop pertussis are restricted from work. Our protocol and standardized forms provide consistent management of pertussis exposures in both patients and employees.
Waning pertussis immunity and spread of pertussis by asymptomatic adults contributes to increased pertussis exposures of vulnerable children. The Santa Clara Valley Medical Center had 49 pertussis exposures between July 1, 1989, and June 30, 1997, which originated in pediatric units or clinics and had an impact on the Employee Health Service (EHS) and Emergency Department (ED). We have developed a standardized protocol for management of employees and patients exposed to pertussis. The protocol includes a checklist for infection control staff; memoranda to exposed units conveying exposure information, instructions for employees to report to EHS or ED, and disease symptom information; written guidelines for physician management of patient exposures (prophylaxis and isolation) and EHS or ED management of employee exposures; and prophylaxis recommendations. We allow exposed employees to work while wearing a mask (worn until 5 days of prophylaxis are completed or for the entire potential contagious period if prophylaxis was refused). Employees who develop pertussis are restricted from work. Our protocol and standardized forms provide consistent management of pertussis exposures in both patients and employees.
Varicella exposures from patients, visitors, and staff continue to occur in healthcare facilities. In a recent report from the National Surveillance System for Health Care Workers, 9 participating hospitals reported 72 varicella exposures from 1996 to 1999, involving 1,111 health-care workers. Depending on the patient and employee demographics for any particular healthcare institution, the number of these exposures can vary. Many healthcare facilities follow the guidelines of the Hospital Infection Control Practices Advisory Committee for non-immune employees exposed to varicella. These guidelines recommend that such employees be excluded from duty from 8 to 21 days after exposure to varicella. There is no standard definition of what constitutes exposure to varicella, which can result in employees' being excluded from duty on one or more occasions without having contracted chickenpox. We previously reported our experience of allowing non-immune employees exposed to varicella to work while wearing masks, checking daily for prodromal symptoms, and excluding these employees from duty only if such symptoms occurred. Since our original report from 1994, we have continued this practice without adverse consequences.
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