458. Healthcare Worker Pertussis Exposure and Potential Transmission to Vulnerable Patients: Missed Opportunities for Prevention
Session: Poster Abstract Session: Occupational Health
Thursday, October 18, 2012
Room: SDCC Poster Hall F-H
Background: The incidence of pertussis is steadily increasing and adult caregivers with unrecognized disease are a significant reservoir of infection.  In pediatric healthcare settings, healthcare workers (HCWs) are at particular risk for pertussis exposure and subsequent transmission to susceptible patients. This study describes the epidemiology of occupational exposures to pertussis in a large pediatric healthcare network.

Methods: We conducted a cross-sectional study of reported HCW pertussis exposures at a large quaternary pediatric care network from January 1st, 2002 – July 18th, 2011.  Data were abstracted from occupational health (OH) and infection control (IC) records.   We calculated the frequency of potential and confirmed exposures and measured the following characteristics associated with each exposure: location, index case age, HCW role, use of IC precautions at time of exposure, and subsequent OH interventions.  We also reviewed electronic health record (EHR) data to identify any laboratory-confirmed pertussis cases that were not documented in OH or IC records to measure the frequency of potential missed pertussis exposures.

Results: There were 1,193 confirmed HCW pertussis exposures from 219 index cases during the study period. The majority (39%) of index cases were infants <6 months old, however, the proportion of index cases >7 years old increased from 16% (2002-07) to 34% (2008 – 11).  Seven index cases were HCWs.  Most (77%) of exposures occurred in the emergency department or an ambulatory site and 27% of exposures occurred after documented initiation of appropriate IC precautions. EHR review identified 448 cases of laboratory-confirmed pertussis of which 224 (50%) were not documented in OH or IC records. The majority (77%) of apparently uninvestigated cases were from ambulatory sites.

Conclusion: Occupational exposures to pertussis occur frequently in pediatric health care settings, even when appropriate infection control precautions are initiated.  Current reporting mechanisms may underestimate the true magnitude of exposures, potentially resulting in infected HCWs who may be a source of infection for vulnerable patients.  Interventions are needed to ensure consistent implementation of IC practices and timely recognition and reporting of pertussis cases.

Danica Kuncio, M.P.H., Yale University School of Public Health, New Haven, CT, Maria Middleton, M.P.H., Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, Mary Cooney, R.N., B.S.N., Occupational Health, The Children's Hospital of Philadelphia, Philadelphia, PA, Mark Ramos, Center for Biomedical Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, Susan Coffin, MD, MPH, The Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania, Philadelphia, PA and Kristen Feemster, MD, MPH, MSHP, Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA

Disclosures:

D. Kuncio, None

M. Middleton, None

M. Cooney, None

M. Ramos, None

S. Coffin, None

K. Feemster, None

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