Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Melinda Pettigrew

Abstract

Background

Infection control policies have a significant impact on the risk for disease transmission in healthcare settings, and adherence to guidelines dictates their effectiveness. Healthcare worker (HCW) exposure to communicable diseases can occur when guidelines have not been consistently implemented, placing the HCW at risk for infection with subsequent transmission to patients and co-workers. Respiratory pathogens are a common source of healthcare-associated infection, especially in pediatric settings and pertussis has emerged as a particularly important agent that is associated with an increasing number of both community and healthcare-associated outbreaks despite the availability of an effective vaccine. Adults, including HCWs, are at high risk to be key reservoirs for transmission. We therefore aimed to describe the epidemiology and prevalence of HCW exposures to pertussis and related infection control measures in place for their prevention.

Methods

Data were collected as part of a retrospective cross-sectional study of occupational exposures of HCWs to four pathogens (pertussis, tuberculosis, meningococcus and varicella) at a large quaternary pediatric care network from January 1st, 2002 to July 18th, 2011. We reviewed occupational health and infection control records for all reported cases of pertussis to measure the frequency of potential and confirmed exposures, the associated index case and HCW characteristics, and subsequent occupational health interventions. We reviewed electronic health record data to identify all laboratory-confirmed pertussis cases during the study period and measure the frequency of potential missed exposures to pertussis.

Results

During the study period, there were 219 index cases of pertussis identified from occupational health records associated with 1193 confirmed employee exposures. 322 exposures (27%) occurred despite documentation of infection control precautions being in place for the patient. Of the 448 laboratory-confirm pertussis cases identified through the EHR, 50%(N=224) were not investigated, indicating potential missed HCW exposures. The majority of uninvestigated cases were patients from ambulatory sites.

Conclusions

Pertussis results in a significant number of occupational exposures among HCWs. The true magnitude of exposures may be even greater than measured and thus many exposed HCWs may not receive appropriate interventions to prevent infection and subsequent transmission to co-workers and vulnerable patients. Interventions are needed to improve identification and reporting of pertussis as well as consistent implementation of infection control practices to prevent exposure.

Comments

This is an Open Access Thesis.

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