MSHP, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Division of Infectious Diseases, The Children's Hospital of Philadelphia, CHOP North, 3535 Market Street, Room 1511, Philadelphia, PA 19104.
Pediatrics. 2014 Jan;133(1):15-21. doi: 10.1542/peds.2013-0745. Epub 2013 Dec 16.
Pediatric health care workers (HCWs) are at particular risk for pertussis exposure, infection, and subsequent disease transmission to susceptible patients. This cross-sectional study describes the epidemiology of occupational exposures to pertussis and identifies factors that may inform interventions to promote effective implementation of infection prevention and control (IPC) guidelines.
We abstracted data from occupational health (OH) and IPC records for pertussis cases that resulted in an exposure investigation in a large quaternary pediatric care network, January 1, 2002 to July 18, 2011. We calculated the frequency of occupational exposures and measured associated characteristics. To assess the frequency of potential missed exposures, we reviewed electronic health record (EHR) data identifying laboratory-confirmed pertussis cases not documented in OH or IPC records.
A total of 1193 confirmed HCW pertussis exposures were associated with 219 index cases during the study period. Of these, 38.8% were infants <6 months old and 7 were HCWs. Most (77.5%) of exposures occurred in the emergency department or an ambulatory site; 27.0% of exposures occurred after documented initiation of IPC precautions. We identified 450 laboratory-confirmed pertussis cases through EHR review, of which 49.8% (N = 224) had no OH or IPC investigation. The majority of uninvestigated cases (77.2%) were from ambulatory sites.
Occupational exposures to pertussis occur frequently in pediatric health care settings despite appropriate IPC guidelines. Interventions are needed to ensure consistent implementation of IPC practices and timely identification and reporting of pertussis index cases to prevent HCW exposures and potential transmission to patients.
儿科医护人员（HCWs）特别容易接触到百日咳，感染并随后将疾病传播给易感患者。本横断面研究描述了职业接触百日咳的流行病学，并确定了可能为促进有效实施感染预防和控制（IPC）指南的干预措施提供信息的因素。
我们从大型四级儿科护理网络的职业健康（OH）和 IPC 记录中提取了因暴露调查而导致的百日咳病例的数据，时间为 2002 年 1 月 1 日至 2011 年 7 月 18 日。我们计算了职业暴露的频率，并测量了相关特征。为了评估潜在的漏诊暴露的频率，我们审查了电子健康记录（EHR）数据，以识别未在 OH 或 IPC 记录中记录的实验室确诊的百日咳病例。
在研究期间，共发生了 1193 例经确认的 HCW 百日咳暴露事件，与 219 例索引病例相关。其中，38.8％为 <6 个月大的婴儿，7 例为 HCWs。大多数（77.5％）暴露发生在急诊部门或门诊场所；27.0％的暴露发生在记录开始 IPC 预防措施之后。我们通过 EHR 审查发现了 450 例实验室确诊的百日咳病例，其中 49.8％（N = 224）无 OH 或 IPC 调查。大多数未调查的病例（77.2％）来自门诊场所。
尽管有适当的 IPC 指南，但在儿科保健环境中仍经常发生职业性百日咳暴露。需要采取干预措施，以确保一致实施 IPC 实践，并及时发现和报告百日咳索引病例，以防止 HCW 暴露和潜在的向患者传播。
