345. Using Electronic Documentation for a Contact Investigation in a High Risk Oncologic Setting
Session: Poster Abstract Session: HAI: Outbreaks
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • 345_IDWPOSTER_Upload.pdf (532.6 kB)
  • Background:

    Transmission of Tuberculosis from a healthcare worker (HCW) to a patient has been described infrequently. Contact investigations are labor intensive and pose challenges to the infection preventionist. Our goal is to describe a contact investigation following diagnosis of cavitary, smear positive pulmonary Tuberculosis in a HCW with direct patient contact on a high risk oncologic unit.

    Methods:

    Contact tracing was performed by querying electronic medical records for all patients admitted to the unit during the infectious period.  All assessments, administration of medications, educational moments, and events where the HCW provided care for patients were reviewed. Estimates of daily and cumulative exposures were derived from these records. Electronic employee schedules were used to identify HCWs with shared time on the unit. The concentric circle approach was developed based on this data.

    Results:

    There were 137 patients with 5,900 interactions with the index case.  Administrative and Nursing leadership provided time estimates for each type of interaction. Sixty- three of 137 patients and 146 employees were identified to be at high risk and constituted our “first tier” of the concentric circle for testing. Fifty of the 63 patients and all 146 employees received post exposure testing:

    # of patients

    Post Exposure Testing

    Result

    42

    TST

    Negative

    4

    QuantiFERON Gold-TB In-Tube

    Negative

    3

    Known LTBI, CXR only

    Negative

    1

    Know HIV pos, CXR only

    Negative*

    * Patient offered prophylaxis but refused

    # of employees

    Post Exposure Testing

    Result

    123

    TST

    Negative

    17

    QuantiFERON Gold-TB In-Tube

    Negative

    6

    Known LTBI, Assessed for Active TB

    Negative Symptom Screening

    Conclusion:

    Electronic medical records and employee scheduling systems are useful resources to conduct otherwise labor intensive contact investigations.  The widespread implementation of these systems should be routinely utilized for epidemiologic investigations. We estimate that this had a time savings impact of over 1,000 person-hours.  Despite the high risk features of our index case, a highly vulnerable immunocompromised patient population and extended proximity with co-workers, we did not find any evidence of transmission of active or latent TB among exposed individuals.

    Shauna C. Usiak, MPH, CIC1, Janice Kaplan, RN, CIC1, Violet Fitzpatrick, RN, COHN2, Patrice Schwegman, BS3, Ann Martin, BS3, Mary Ann Connor, MS, RN4, Janet Eagan, RN, MPH, CIC1, Arthur E. Brown, MD, FIDSA, FSHEA2 and Mini Kamboj, MD1, (1)Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, (2)Employee Health & Wellness Services, Memorial Sloan Kettering Cancer Center, New York, NY, (3)Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY, (4)Hospital Administration, Memorial Sloan Kettering Cancer Center, New York, NY

    Disclosures:

    S. C. Usiak, None

    J. Kaplan, None

    V. Fitzpatrick, None

    P. Schwegman, None

    A. Martin, None

    M. A. Connor, None

    J. Eagan, None

    A. E. Brown, None

    M. Kamboj, None

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