Measles, mumps outbreaks reveal need for hospital control strategies
Responses to recent outbreaks of measles and mumps in the United States demonstrated the need for infection control strategies at heath care facilities, according to research presented at the annual conference of the Association for Professionals in Infection Control and Epidemiology, or APIC.
Between April and August 2017, a community outbreak of measles caused 79 confirmed cases in Minnesota. Most cases were concentrated in the Twin Cities metropolitan area, according to a press release. Twenty-four of the patients were cared for at Park Nicollet Health Services’ Methodist Hospital and more than 20 clinics. The health system is part of a larger system of six hospitals and more than 55 clinics in two states.
Amy Priddy, DNP, RN, CIC, infection prevention senior manager at Park Nicollet Health Services, and colleagues activated a systemwide command center early in the outbreak to coordinate work and communication within the health system. They created patient and visitor messaging in multiple languages, and used health records to support active measles surveillance, symptom-based triage and the initiation of procedures in a timely basis.
“Our integrated response allowed us to share information in real time and adjust prevention strategies in a timely way,” Priddy said in the release. “Every time you have an event like this, there’s an opportunity to apply what you have learned as a system to other situations.”
Researchers measured the effectiveness of the system at the end of the outbreak. They noted inadequate use of infection prevention precautions in three instances of care of confirmed measles cases. No health care-associated cases of measles transmission were reported.
Measles-containing vaccine was administered to 9,731 patients and staff during the outbreak period, which was an 11.8% increase from the same period a year earlier.
Priddy and colleagues identified opportunities for improvement, including maintaining and spreading current information during the outbreak.
Thi Dang, MPH, CHES, CIC, health care-acquired infections epidemiologist for the Texas Department of State Health Services, presented a study involving the largest outbreak of mumps in Texas in more than 20 years. The outbreak took place between November 2016 and June 2017.
“Many of the providers were unfamiliar with mumps because they have never seen it before,” Dang said in the release. “This gap, and others that we identified, provides valuable information for any outbreaks that we might be faced with in the future, as we better understand aspects of symptom monitoring vaccination recommendations, and control measures.”
A public health staff member certified in infection control coordinated the implementation of passive and active control measures in health care facilities. Health advisories, which were used to convey general mumps awareness, and testing guidelines were passive measures, whereas the use of direct phone calls to health care facilities to measure appropriate infection control was considered an active measure.
The researchers found that 67% of the facilities did not have a designated infection prevention representative, with many facilities unfamiliar with testing recommendations for mumps or their lab testing capability.
Documentation of workers’ mumps immunity status was not available at nonacute care facilities.
“Nine ill health care workers were excluded from work until the fifth day after parotitis onset,” the researchers wrote. “Nine additional health care workers were recommended to be excluded from work postexposure per CDC guidelines.”
There was one occurrence of heath care-associated transmission of mumps.
“Infection preventionists play a critical role in the public heath response to outbreak situations by communicating and implementing control measures,” 2018 APIC President Janet Haas, PhD, RN, CIC, FSHEA, FAPIC, said in the release. “These case studies show clearly that comprehensive strategies in the face of outbreak situations go a long way toward preventing further spread of infection and disease.” – by Bruce Thiel
Dang T, et al. I303: Infection control measures in healthcare facilities amidst a community outbreak of mumps. Presented at: APIC; June 13-15, 2018; Minneapolis.
Priddy A, et al. I303: Measles! Responding to a community outbreak as part of an integrated health system. Presented at: APIC; June 13-15, 2018; Minneapolis.
Disclosures: Dang and Priddy report no relevant financial disclosures.