Literature Review
December 1, 1999 2 minutes read
Literature Review
Gehanno J, Pestel-Caron M, Nouvellon M, et al. Nosocomial pertussis in healthcare workers from a pediatric emergency unit in France. Infect Control Hosp Epidemiol 1999; 20:549-552.
In cases of pertussis in health care workers, all medical staff in the unit who have had unprotected and intensive contact with the worker should be given macrolide treatment to stop any subsequent transmission, the authors advise.
Pertussis was diagnosed in a 55-year-old pediatric emergency unit nurse who had a respiratory illness and paroxysmal cough for five weeks. An epidemiological investigation was initiated to determine if any of 61 other health care workers from the same unit also had pertussis. The authors identified nine additional cases (four confirmed and five probable). To prevent transmission, all workers with cough were treated for 14 days with erythromycin, and those having acute cough were given a five-day sick leave. Despite these measures, a new acute pertussis case was identified in another nurse, who had a positive culture from nasopharyngeal aspirates. All workers in the unit were prescribed spiramycin for 10 days to prevent any further spread of pertussis. No cases of nosocomial pertussis were evident among the pediatric patients who may have been exposed to the health care workers. To prevent similar outbreaks, the authors recommend that infection control professionals consider the following measures:
• Isolate suspected or known pertussis-infected patients using droplet precautions. Health care workers should wear a mask for close contacts (i.e., intubation, bronchoscopy, or suctioning) with a patient having a clinical syndrome highly suggestive of pertussis.
• All workers who’ve had close contact with a pertussis patient should be given postexposure prophylaxis. New macrolides (e.g., azithromycin or clarithromycin) could be chosen, as they appear as effective as erythromycin and are better tolerated.
• Health care workers in whom pertussis is suspected should be furloughed for five days. Diag nosis of pertussis in workers should be made on the basis of clinical signs, confirmed by early culture of nasopharyngeal aspirates, or by PCR.
• If a documented pertussis case occurs in a health care worker, the only effective way to stop the spread of the disease to other workers is to provide prophylaxis for those who have been in close contact with the infected worker.
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