Community pertussis outbreak: Systems and processes to maximize efficiency

ISSUE: Our community experienced an increase in cases of Bordetella pertussis between June 24 and September 20, 2004. Increased demand for treatment, prophylaxis, and education caused stress on the healthcare system. Communication, tools, and processes were developed or modified to maximize efficiency and effectiveness. PROJECT: Controls were implemented throughout the system with emphasis on outpatient areas, visitors, pediatrics, obstetrics, and neonatal intensive care. Communication between public health, infection control, employee health, pharmacy, and providers was critical for managing the influx of ill, exposed, and worried well. Very early into the outbreak, treatment and prophylaxis algorithms were distributed to providers. Later, a liaison role was created to facilitate communication between case finders and providers. The treatment protocol was revised based on new knowledge regarding erythromycin drug interactions. Ill employees were furloughed for 5 days. A database efficiently organized case and contact information. All outbreak management tools were ready and available in an “outbreak toolbox” file. RESULTS: Masks were worn during 35% of encounters with 43 pertussis-positive patients. Thirty-one employees were exposed during patient care, 25 ill employees were furloughed, and 5 ill employees exposed 147 patients. There were no hospitalizations or nosocomial cases. Employee referrals and prescription costs totaled over $14,000. LESSONS LEARNED: Based on our experience, we would recommend the following: 1) Form a multidisciplinary coordination team early in the outbreak. 2) Have all outbreak tools (i.e., screening, prophylaxis, and education tools) in a central location and ready to use. 3) Provide treatment and prophylaxis algorithms and information to providers on a timely basis. 4) Utilize a pharmacy to distribute prophylaxis and evaluate drug interactions. 5) Implement respiratory hygiene/cough etiquette to minimize transmission of respiratory pathogens. 6) Implement droplet precautions (mask) when examining or collecting respiratory specimens from undiagnosed, coughing patients. 7) Identify ill employees and expedite employee test results. 8) Regularly meet with local public health officials. 9) Exposed patients should be contacted only by trained health professionals. 10) Inform and educate departments exposed to ill co-workers. 11) Utilize a computer database to manage cases and contacts. 12) Facilitate communication between public health officials.