A Whooping Cough of a Time: An Employee with Pertussis in an Adult Hospital

ISSUE: Infection Control (IC) was notified when a Respiratory Care employee was diagnosed with pertussis. Patients (pts) & employees on the Bone Marrow Transplant (BMT) Unit & an intensive care unit (ICU) were exposed. PROJECT: The Respiratory Care manager was contacted & a list of pts for whom the employee provided care was generated. Occupational Health (OH) contacted the employee for more detailed information on the disease course. The period of communicability was determined after the information was obtained from the employee. The Hospital Epidemiologist was consulted to determine short-term versus prolonged exposure based on CDC recommendations. Prolonged exposure included if a pt received ventilator care, nebulizer treatments, multi-dose inhaler (MDI) treatment or MDI instruction. Exposed ptʹs Physicians were notified by fax & mail. Follow-up phone calls were made to the physician offices the day after faxes were sent. An E-Mail was sent to nurse managers explaining the exposure & providing a pertussis fact sheet. All Respiratory Care employees were queried for symptoms of pertussis. RESULTS: The employee had contact with 62 pts during the period of communicability before exposure was reported. Twenty-three pts received oxygen per nasal cannula (indicating short-term exposure), 28 pts had prolonged exposure, & 11 pts expired with diagnosis not related to the exposure. Two of the 4 exposed pts still in the hospital presented with new respiratory symptoms. These pts were isolated. Two of the 24 discharged pts developed new respiratory symptoms. Three pts were available for nasopharyngeal swabs & were negative for B. pertussis by PCR testing. No sick hospital employees were identified. Infection Control spent approximately 40 hours identifying, notifying & performing surveillance on this one pertussis exposure. LESSONS LEARNED: One ill employee can expose many pts & staff to communicable disease in a hospital setting. It is critical to have more than one method to notify a physiciansʹ office when faced with an exposure to ensure proper notification. IC & OH must collaborate with many disciplines to promptly identify, define & communicate an exposure.