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1610. Implementation of Clinical Care Pathway Reduces Measles Exposures During Outbreak in New York
BACKGROUND: The United States is currently experiencing the largest measles outbreak since 1994. The New York outbreak started in October 2018 in several communities with low immunization rates for measles. Our institution is a referral center for the Hudson Valley and New York City. Failure to imme...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808800/ http://dx.doi.org/10.1093/ofid/ofz360.1474 |
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author | Daniel, Jency Patel, Darshan Sussner, Rita M Mack, Lynda Chen, Donald S Margaret. Nolan, Sheila |
author_facet | Daniel, Jency Patel, Darshan Sussner, Rita M Mack, Lynda Chen, Donald S Margaret. Nolan, Sheila |
author_sort | Daniel, Jency |
collection | PubMed |
description | BACKGROUND: The United States is currently experiencing the largest measles outbreak since 1994. The New York outbreak started in October 2018 in several communities with low immunization rates for measles. Our institution is a referral center for the Hudson Valley and New York City. Failure to immediately recognize the disease early in the outbreak resulted in several exposure investigations and significant expenditure of time and resources. With evidence of ongoing transmission in local communities, we initiated a multi-pronged approach to recognize and limit potential measles exposures. METHODS: We developed a clinical pathway to alert Emergency Department (ED) staff and local Emergency Medical Service (EMS) agencies to the signs and symptoms of measles and provided steps for isolation, care, and testing for patients with possible measles. The ED staff and EMS personnel were educated in meetings and by posters, emails, and huddles. Reports of cases were made to infection control in real time, and local Departments of Health (DOH) were subsequently notified of suspected cases and exposures. We describe data pre and post-intervention. Chi-square was used to compare the number of patients requiring contact investigations for staff and patient exposures pre- and post-pathway implementation. RESULTS: From October 2018 through April 2019, 31 patients were evaluated for measles. Measles was diagnosed in 15 patients (1 adult, 14 children). Eight patients were admitted to the hospital, 3 required Pediatric ICU care. Pre-pathway implementation, 2 out of 9 (22%) evaluated patients resulted in exposure investigations; post implementation, 1 out of 22 (4.5%) evaluated patients required an exposure investigation (P = 0.18). The investigations conducted by our infection control department included 153 patients, 141 pre-implementation vs. 12 post-implementation. Nine patients required prophylaxis with immunoglobulin, and 10 patients received MMR vaccine as prophylaxis. No exposures resulted in clinical cases of measles. CONCLUSION: Implementation of a clinical pathway to recognize and isolate suspected measles patients with ED staff and EMS personnel resulted in reduced exposures and improvement in communication with Infection Control and local DOH. DISCLOSURES: All authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-6808800 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68088002019-10-28 1610. Implementation of Clinical Care Pathway Reduces Measles Exposures During Outbreak in New York Daniel, Jency Patel, Darshan Sussner, Rita M Mack, Lynda Chen, Donald S Margaret. Nolan, Sheila Open Forum Infect Dis Abstracts BACKGROUND: The United States is currently experiencing the largest measles outbreak since 1994. The New York outbreak started in October 2018 in several communities with low immunization rates for measles. Our institution is a referral center for the Hudson Valley and New York City. Failure to immediately recognize the disease early in the outbreak resulted in several exposure investigations and significant expenditure of time and resources. With evidence of ongoing transmission in local communities, we initiated a multi-pronged approach to recognize and limit potential measles exposures. METHODS: We developed a clinical pathway to alert Emergency Department (ED) staff and local Emergency Medical Service (EMS) agencies to the signs and symptoms of measles and provided steps for isolation, care, and testing for patients with possible measles. The ED staff and EMS personnel were educated in meetings and by posters, emails, and huddles. Reports of cases were made to infection control in real time, and local Departments of Health (DOH) were subsequently notified of suspected cases and exposures. We describe data pre and post-intervention. Chi-square was used to compare the number of patients requiring contact investigations for staff and patient exposures pre- and post-pathway implementation. RESULTS: From October 2018 through April 2019, 31 patients were evaluated for measles. Measles was diagnosed in 15 patients (1 adult, 14 children). Eight patients were admitted to the hospital, 3 required Pediatric ICU care. Pre-pathway implementation, 2 out of 9 (22%) evaluated patients resulted in exposure investigations; post implementation, 1 out of 22 (4.5%) evaluated patients required an exposure investigation (P = 0.18). The investigations conducted by our infection control department included 153 patients, 141 pre-implementation vs. 12 post-implementation. Nine patients required prophylaxis with immunoglobulin, and 10 patients received MMR vaccine as prophylaxis. No exposures resulted in clinical cases of measles. CONCLUSION: Implementation of a clinical pathway to recognize and isolate suspected measles patients with ED staff and EMS personnel resulted in reduced exposures and improvement in communication with Infection Control and local DOH. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6808800/ http://dx.doi.org/10.1093/ofid/ofz360.1474 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Daniel, Jency Patel, Darshan Sussner, Rita M Mack, Lynda Chen, Donald S Margaret. Nolan, Sheila 1610. Implementation of Clinical Care Pathway Reduces Measles Exposures During Outbreak in New York |
title | 1610. Implementation of Clinical Care Pathway Reduces Measles Exposures During Outbreak in New York |
title_full | 1610. Implementation of Clinical Care Pathway Reduces Measles Exposures During Outbreak in New York |
title_fullStr | 1610. Implementation of Clinical Care Pathway Reduces Measles Exposures During Outbreak in New York |
title_full_unstemmed | 1610. Implementation of Clinical Care Pathway Reduces Measles Exposures During Outbreak in New York |
title_short | 1610. Implementation of Clinical Care Pathway Reduces Measles Exposures During Outbreak in New York |
title_sort | 1610. implementation of clinical care pathway reduces measles exposures during outbreak in new york |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808800/ http://dx.doi.org/10.1093/ofid/ofz360.1474 |
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