Health Care Workers Mumps at Fraser Health

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Health Care Workers Mumps at Fraser Health

• Occupational Health Nurses
• In the Trenches
• April 2, 2009
• Tricia Davies RN BSN OHN(C)
  

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Todays Mumps Session will

• Present what transpired at Chilliwack General
  Hospital for the OHN team/MASH tent
• Insight of HCW culture characteristics
• Review three complicated case scenarios
• Share what we have learned and accomplishedso
  far

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Before staff exposures to mumps

• OHN team identified high risk health care units
  at risk for exposure to communicable diseases at
  Fraser Health.
• October 2007 OHNs began updating these high
  risk groups
• August 2008 CMA researched article Two Nova
  Scotia mumps outbreaks in adolescence and young
  adults.
• October 2008 Mumps warnings posted on Public
  Health Agency and BCCDC websites.

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What does an Occupational Health Nurse do when a
confirmed mumps exposure is officially announced
for the first time in 30 years ?
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About Health Care Workers

• Immunizations records are incomplete or
  nonexistent.
• No immunization records of their own to share
  with their employer.
• Travel to other health regions and everywhere
  else in-between.
• Communication strategies with staff prove
  cumbersome, often unsuccessful.
• Unable to be immunized as HCWs are pregnant/
  attempting to conceive.

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Scenario One

• CGH ER admits Epi-linked mumps patient,
  immediately isolated in ER
• Age 19,visted Calgary for two weeks, arrived at
  Abby airport three days previously.
• Epi-link contact with Calgary boyfriend

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Scenario One The Saga continues

• Unmasked mumps patient, removed from isolation in
  ER.
• Diagnosis Acute Appendicitis
• Prepared for OR by lab, x-ray, nursing staff,
  etc
• Unmasked while transported to OR,PAR, medical
  unit patient room and home.

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MASH Tent

• Contact tracings initiated.
• MASH tent clinics were established at MSA, CGH,
  MMH, FCH where the exposures were occurring.
• Distributed letters to staff requiring
  vaccination communicating titres/clinic
  dates/times/locations.

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Scenario Two Stealth

• 19 yr old ER admitted with ? Meningio virus
• On medical unit with IC precautions in effect for
  meningio.
• Precautions lifted, walking in unit, unmask.
• 2 days latter Mumps serology positive,
  determined to be shedding virus, asymptomatic.

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Scenario Three

• Contact tracing HCW identified as exposed
  Epi-linked with prodromal symptoms, no MMR
  records, negative titre levels, buccal swab was
  pending, results 5 days later were negative.
• After exposure, worked in a prison, travels to
  authority hospital outside FH for emergency
  procedure, goes on vacation to Toronto, Montreal
  and then a cruise for two weeks in Florida

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Adverse reactions to MMR vaccine

• Fourteen adverse reaction case reports submitted
  to Public Health for follow-up.
• One pregnancy confirmed 6 weeks after receiving
  one MMR vaccination. Advised by OHN to be
  referred by family physician to specialist for
  follow-up.

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STATUS up to July 2008

• 1,586 health care workers have been assessed in
  Abbotsford, Mission, Chilliwack, Agassiz and Hope
  between Mar 1/08 Jul 11/08
• 1,178 vaccinations (including measles/mumps/rubell
  a tetanus/diphtheria and hepatitis B) have been
  given
• 909 MMR (measles, mumps, rubella) vaccinations
  have been given
• 49 staff immunization clinics were held over 22
  weeks for a total of 165 hours
• 24 staff immunization clinics at CGH / FCH for a
  total of 88.5 hours
• 25 staff immunization clinics at MSA / MMH for a
  total of 77 hours
• Occupational Health Update Report July 10
  2008, by Elayne Preston

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July 2008 update continued

• CGH/FCH
• 50.7 of those assessed required mumps
  vaccination
• MSA/ARH
• 53 of those assessed required mumps vaccination

• 17 HCWs with symptoms of mumps-like illness were
  furloughed from work for a total of 440 work
  hours missed

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Organizational Costs

• Quarantined Staff Hours
• Workplace Health Staff Hours
• Site Managers Hours
• Supplies
• TOTAL COST

• 12,350.00
• 88,821.00
• 4462.00
• 4000.00
• 109,633.00

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We already know...

• Numerous barriers in obtaining old or non
  existing immunization records for heath care
  workers causes delays in completing contact
  tracings.
• Without adequate records, OHNs are further
  challenged in identifying FH staff that meet
  criteria for communicable disease exposure while
  at work.

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Learning..continues

• Credibility of Occupational health nursing in
  terms of meeting highest standards of practice
  and delivery of service for Fraser Health.

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Learningoutcomes

• Continue co-ordinating monthly immunization
  clinics for all new and existing staff at the
  primary FH sites. Intranet website provides
  updated schedule.
• Pilot in centralizing OHN services using a Call
  Centre model approach.
• For all staff to be provided immunization record
  cards for their own records to bring to clinics
  when it needs updated.

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Call Centre January 09

• Gather new employee health history info and
  immunization records.
• Record health history info and immunization
  records into data base
• Facilitate BBF exposure management

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Call Centre Future

• Create systematic inquiry analysis for program
  development
• Triage communicable disease outbreak management
• Co ordinate program delivery to service areas

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Finally..

• Mumps outbreak brought many Fraser Health and
  external resources beyond capacity, prioritizing
  the need to develop a future plan.

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Future CD Goal

• Restructure and redevelop delivery of
  Occupational Health services to include
• Maximizing effectiveness and
  efficiency in management of all aspects of
  communicable disease exposures of staff in health
  care.