Monday, December 18, 2017

OCMA Blog

Rising Number of Measles Cases Creates Numerous Patient Safety Issues

As more measles cases are diagnosed, physicians should implement effective screening protocols, infection control techniques, and patient education to reduce liability risks and promote patient safety. Since initial presenting symptoms of measles are similar to those of upper respiratory infections, measles may be misdiagnosed before a patient presents with the familiar red rash.


Exposure to measles in a medical office or facility is a serious patient safety issue because of the potential for complications from the disease, including death. The disease is airborne and extremely contagious. An infected individual is considered contagious from four days before to four days after the rash appears. The rash usually appears 14 days after a person is exposed; however, the incubation period ranges from 7 to 21 days.

Your practice can reduce liability risks and promote patient safety by:

  • Developing screening protocol for patients calling in with symptoms of upper respiratory infections and measles. Staff should query the individual regarding exposure to known measles cases, travel abroad, and immunization status.
  • Documenting all discussions with patients and parents of minors regarding measles, including the risks and benefits of inoculation. When patients/parents decline measles immunization, consider using an informed refusal form: www.thedoctors.com/ecm/groups/public/@tdc/@web/@kc/@patientsafety/documents/form/con_id_001221.pdf. Patients who contract measles and claim that their physician never discussed inoculation represent a potentially significant liability.
  • Providing serologic testing for immunity, when necessary, and documenting all related discussions with patients who are unsure of their immunity status against measles.
  • Ensuring that immunization tracking is up to date and well documented in the medical record.
  • Complying with state laws for the provision of vaccines to healthcare workers. For more information, go to www2a.cdc.gov/nip/statevaccapp/statevaccsapp/default.asp.
  • Advising those who may have come in contact with an infected individual to contact their physician immediately.
  • Ensuring that office staff members are trained to use personal protective equipment and proper isolation techniques.

Follow these tips if you or your staff suspects a patient has measles symptoms:

  • Minimize the risk of exposure to others by admitting the patient through a separate entrance and isolating him or her in an exam room. If possible, schedule the patient at the end of the day. The exam room should not be used until the following day since the virus can live on surfaces for up to two hours. Keep the exam room door closed.
  • Place a surgical mask on the patient and ensure that all office staff members wear protective equipment.
  • Follow standard disinfection and sterilization procedures for exam rooms.
  • Report suspected cases to the local health department.
  • Consider making post-exposure prophylaxis available to those who have been exposed. Post-exposure vaccination can be effective in preventing measles in some individuals. As an alternative, Immunoglobulin, if administered within six days, can offer some protection.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety


Measles Outbreak Update February 2015

Measles Outbreak Update
February 17, 2015


Measles cases have continued to occur in Orange County with 35 cases confirmed this year. In California, as of February 13, 2015, 113 cases have been confirmed since December 2014; 20% of those with known hospitalization status have been hospitalized. Of those with known vaccination status, the majority are unvaccinated, with most of these because of personal belief exemptions.

Orange County Cases
Of the 35 Orange County cases, 14 are children, 13 of whom were not vaccinated.
Thirteen of our cases spent time at the Disneyland Parks since mid-December, 2014. Sixteen cases had no known source, signaling ongoing transmission in the community. The most recent cases were contacts to previously known cases.

Vaccination is Key to Prevention
Although some of the confirmed cases occurred in people with a history of vaccination, their illness is generally milder and typically not as infectious. Vaccination is critical to prevent the ongoing spread of disease.

  • Although the overall risk of getting measles in Orange County remains low, residents who have not received any measles-containing vaccine and do not have any other evidence of immunity should get a dose of MMR vaccine.
  • Two doses of measles-containing vaccine (MMR vaccine) are more than 99% effective in preventing measles. The first dose is routinely given at 12-15 months of age, with the second dose usually at age 4-6 years. The second dose may be given any time ≥28 days after the first dose.
  • All healthcare workers (HCW), including those born before 1957, should have two documented doses of MMR or serologic evidence of measles immunity. HCW who are exposed to a case of measles may be excluded from work until they provide evidence of immunity.
  • If exposed to measles, all, children and school/child care staff without documented immunity will be removed from work/school/child care from day 7 after the first exposure to day 21 after the last exposure.

Report any suspect case of measles to the Orange County Health Care Agency immediately at 714-834-8180 (714-628-7008 after hours).

For more information on measles, see www.ochealthinfo.com/measles. Information on vaccination recommendations by age group is available in the previous advisory dated 1/26/2015 and guidance on clinical presentation, infection control, reporting, and testing is in the 1/21/2015 advisory.

click here to download this measles outbreak update.


Measles Outbreak Update

Measles has now been confirmed in 22 Orange County (OC) residents, signaling ongoing transmission in the community and at the Disneyland Parks. Thirteen of these cases spent time at the Disneyland Parks since mid-December, 2014. In California, as of today, 59 cases of measles have been confirmed since the end of December; 42 of these had an exposure in December at Disneyland or California Adventure Park. Additional cases have been identified that were at the park while infectious in January, including within the last week. Nine of the OC cases have no Disney or other known measles exposure. Additional cases are expected in Orange County.
 

Of the 22 Orange County cases, five are children, of whom four were not vaccinated and two were hospitalized. Although some of the confirmed cases occurred in people with a history of vaccination, their illness is generally milder and typically not as infectious. Vaccination is critical to prevent the ongoing spread of disease.

  • Although the overall risk of getting measles in Orange County remains low, residents who have not received any measles-containing vaccine should get a dose of MMR vaccine.
  • Two doses of measles-containing vaccine (MMR vaccine) are more than 99% effective in preventing measles. The first dose is routinely given at 12-15 months of age, with the second dose usually at age 4-6 years. The second dose may be given any time ≥28 days after the first dose.
  • All healthcare workers (HCW) should have two documented doses of MMR or serologic evidence of measles immunity. HCW who are exposed to a case of measles may be excluded from work until they provide evidence of immunity.
  • If exposed to measles, all, children and school/child care staff without documented immunity will be removed from work/school/child care from day 7 after the first exposure to day 21 after the last exposure.

Measles is highly contagious and people can be exposed by just being in the same room as a measles case during their infectious period (4 days before onset of rash until 4 days after). Several of the cases have potentially exposed patients in healthcare facilities, resulting in large contact investigations and persons needing immune globulin administration, post-exposure vaccination, or serologic testing for immunity.

  • Any patient suspected of having measles should be masked immediately and promptly moved to a negative pressure room when available. Providers seeing patients in an office or clinic setting should consider options such as arranging to see suspect measles cases after all other patients have left the office, or assessing patients outside of the building to avoid having a potentially infectious patient enter the office.
  • Notify Orange County Public Health Epidemiology immediately at 714-834-8180 (or 714-628-7008 after hours) about any suspect cases. Do not wait for laboratory confirmation before reporting a suspect case. Do NOT refer patients to Public Health without first discussing with one of our staff.
  • DO NOT send potentially infectious suspect measles patients to a reference laboratory for specimen collection.

For more information on measles, see www.ochealthinfo.com/measles.


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