Standardized Management of Patients and Employees Exposed to Pertussis

Abstract

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.

2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings

“…Understanding the scientific rationale for the precautions will allow HCWs to apply procedures correctly, as well as to safely modify precautions based on changing requirements, resources, or health care settings. 14,654,[680][681][682][683][684][685][686][687] One study found that the likelihood of HCWs developing SARS was strongly associated with less than 2 hours of infection control training and poor understanding of infection control procedures. 688 Education regarding the important role of vaccines (eg, influenza, measles, varicella, pertussis, pneumococcal) in protecting HCWs, their patients, and family members can help improve vaccination rates.…”

“…35,610,689,[876][877][878] Transmission of B pertussis in health care facilities has been associated with large and costly outbreaks that include both HCWs and patients. 17,36,41,100,682,826,879,880 HCWs in close contact with infants with pertussis are at particularly high risk because of waning immunity and, until 2005, the absence of a vaccine appropriate for adults. But 2 acellular pertussis vaccines were licensed in the United States in 2005, 1 for use in individuals age 11 to 18 years and the other for use in those age 10 to 64 years.…”

“…Education and training on the principles and rationale for recommended practices are critical elements of Standard Precautions because they facilitate appropriate decision-making and promote adherence when HCWs are faced with new circumstances. 654,[680][681][682][683][684][685] An example of the importance of the use of Standard Precautions is intubation, especially under emergency circumstances when infectious agents may not be suspected, but later are identified (eg, SARS-CoV, N meningitides). The application of Standard Precautions is described below and summarized in Table 4.…”

Pertussis Infection in a Baccalaureate Nursing Program: Clinical Implications, Emerging Issues, and Recommendations

“…Several outbreaks involving health care facilities have been reported in the past few decades, which is relevant to clinical health care education settings (Broome et al, 1981; Christie et al, 2001; Haiduven, Hench, Simpkins, & Stevens, 1998; Kurt, Yeager, Guenette, & Dunlop, 1972; Linnemann, Ramundo, Perlstein, Minton, & Englender, 1975; Swinker, 1997; Weber & Rutala, 1994; Wright, Edwards, Decker, & Lamberth, 1994). These outbreaks occurred for three main reasons: (1) failure to adequately recognize and isolate infants and children with pertussis infection; (2) failure to recognize and treat disease spread in adults, particularly health care providers; and (3) lack of control measures in place.…”