Burden of Disease Exposures—Reasons to Invest in Hospital Response

Communicable disease exposures are a massive burden, whether you’re in public health or a patient-facing role. In the world of health care, they represent a huge strain on both the nursing staff and infection preventionists. Whether it be something like norovirus, a multidrug-resistant infection, or an airborne disease like measles, responding to such an event in a health care facility is extremely taxing.

For most patients admitted to a hospital, the number of health care workers and ancillary staff coming into the room represents a pretty significant volume. In a situation involving a communicable disease, each additional health worker and staff member that enters the patient room represents an increased risk of disease transmission. From the perspective of this infection preventionist, an exposure can act as a massive disrupter to daily patient safety efforts. From pertussis to measles, I’ve seen such events not only eat up time for the infection prevention and occupational health programs, but also represent a significant financial burden for the health care facility.

The time spent responding to an exposure means less time for patient care and infection prevention, but can also result in health care workers having to stay home if they’re exposed and immuno-naïve. A new survey sought to understand the impact for infection preventionist and staff nurses when an exposure to a communicable disease occurs. Investigators wrote in the American Journal of Infection Control (AJIC) regarding this very issue and surveyed staff nurses in a New York hospital network and infection preventionists at the 2018 Association for Professionals in Infection Control and Epidemiology annual conference, as well as members of the Association for Professionals in Infection Control and Epidemiology chapters.

A total of 150 nurses and 228 infection preventionists responded with some insight into just how time-consuming these exposures are. Data regarding workload increase for each exposure was captured in 2 questions asking participants to rank the overall increase in daily workload for each of these exposures (0-3 scale, with 0 meaning not applicable and 3 meaning a dramatic increase in workload of more than 60 minutes), and to explain the 3 most time-consuming activities for outbreak and exposure activities. Infection preventionists reported the most time-consuming outbreaks/exposures resulted from mumps/measles, tuberculosis, gastrointestinal viruses, and multidrug-resistant organisms. For an exposure to Clostridioides difficile, lice or scabies, and influenza, there was a more than 60-minute workload increase for nurses.

Participants were also asked to list the 3 most time-consuming activities out of 8 options—“(1) additional isolation precautions, which slow down patient care; (2) additional documentation in the electronic health record; (3) educating patients and families on outbreak or exposure precautions; (4) staffing changes because of either absent staff or cohorting patients; (5) requirement to take prophylactic medication (eg, azithromycin for pertussis); (6) visits to the workforce health and safety or occupational health department; (7) meeting or training with IPs; and (8) taking mandatory time off.” Investigators determined that the top 3 activities reported by nurses were additional isolation precautions that slow down patient care, educating patients and families on outbreak and exposure precautions, and staffing changes owing to absent staff or patient cohorting.

Infection preventionists were also asked to select the 3 most time-consuming activities related to an outbreak or exposure from a list of 10—“(1) case detection, (2) chart review, (3) ward rounding, (4) exposure list compilation, (5) staff and visitor notification, (6) family and patient education, (7) preventive measures for exposures, (8) documentation in the electronic health record, (9) reporting to regulatory authorities, and (10) reports to hospital supervisors.” Overall, the research team found that the top 3 activities reported by infection preventionists were chart review, exposure list compiling, and preventive measures for exposures.

These findings not only capture the considerable burden of communicable disease outbreaks or exposures within a health care facility, but also the impact on nursing efforts. Time away from patients to work on exposures is not time well spent and, as the investigators highlight, these findings suggest that administrators need to carefully allocate resources and plan in the event of an exposure or outbreak. Ultimately, it behooves us to invest in better prevention efforts through training and education on rapid isolation precautions and stronger infection prevention.