An Exposure Silver Lining Playbook

The topic of communicable disease exposures has increasingly been discussed in healthcare and infection prevention and control (IPC). As we’ve seen over 1022 cases of measles in the United States in 2019, Ebola has spread into Uganda, and the threat of multidrug-resistant infections like Candida auris grows, the challenge of responding to outbreaks and exposures increases. Not to mention that in the United States, there are over 36 million hospital admissions annually and roughly 18 million health care workers, which means that there is a lot of potential for infectious disease exposure and transmission.

In a recent article on Contagion®, the burden of such exposures was discussed—in terms of the IPC team, but also for nursing. The article noted that 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 preventionists and staff nurses when an exposure to a communicable disease occurs.

From the IPC perspective, responding to an exposure is usually a rapid, challenging, and stressful situation. Depending on the organism and volume of exposed individuals, there might be little time to get prophylaxis to exposed staff and patients, and there could be hundreds of people involved in the exposure. The rapid response of these situations is currently being discussed during the Association for Professionals in Infection Control and Epidemiology (APIC 2019) annual conference. Speakers from the Children’s Hospital of Philadelphia discussed not only their efforts to respond to such events, but also the risk assessments and response plans they put in place. Discussing 10 exposures within their pediatric medical network between 2015 and 2018, they noted that these events included exposures to tuberculosis, Middle Eastern Respiratory Syndrome (MERS), measles, and more.

The exposure events that required IPC intervention were defined as requiring a large number of patients and/or staff, presented safety concerns for staff and/or families, resulted in emotional trauma, or involved a poorly understood organism. Learning from these events and the challenges in addressing exposures among staff and patients, the IPC team developed resources to help reduce the burden of exposures in the future.

In my own experiences, these efforts are critical to helping shave off time in when an exposure occurs. These include anything from developing exposure-response algorithms to designating communication materials to families/staff, and creating even stronger processes for communicating the exposure between IPC, staff, and occupational health. Even something as simple as identifying those exposed can be exceedingly complex, which means that spending a bit of time on the front end can save you a world of headaches should an exposure occur.

The IPC team from the Children’s Hospital of Philadelphia created an exposure playbook that team members could access via SharePoint, which included a checklist for tracking response along with templates for line lists and epidemic curves. Notification templates and specific information sheets for designated diseases, as well as screening algorithms and family notification letter templates, were also created. They also made sure that quick links to policies and procedures were incorporated, to ensure that staff had the access they needed. Since this playbook was developed it has been used twice in exposures and has been successful.

What the Children’s Hospital of Philadelphia IPC team has shown is that not only do these exposures occur but that preparing the necessary resources ahead of time can exponentially make the process more efficient and effective. For the infection preventionist, every minute spent on a word document is 1 not spent on the hospital units doing education and training to help remedy the situation real-time. An ounce of prevention is truly worth a pound of cure.

The presentation, “An Infection Prevention and Control Exposure Playbook: Preparing for Rapid Response,” was given on Friday, June 14, 2019, at APIC 2019 in Philadelphia, Pennsylvania.