Use of the hospital emergency incident command system (HEICS) for investigation and treatment of persons exposed to three healthcare workers with pertussis

ISSUE: Pertussis exposures in healthcare facilities pose a significant risk of transmission to vulnerable patient populations and employees. Surveillance for and a rapid response to pertussis cases significantly reduces associated morbidity and mortality. Use of our facility's HEICS process enabled us to respond to such an event in a rapid, organized manner. PROJECT: On July 25, 2004 an emergency department (ED) physician was diagnosed with laboratory-confirmed pertussis. The 37-week pregnant physician experienced respiratory difficulty and was admitted to the ante partum unit. The physician's attending obstetrician and a physician assistant (PA) from the same office met the clinical case definition for pertussis. All three pertussis cases had contact with patients and staff during the communicable periods of illness. On July 26, a multidisciplinary HEICS team was convened to formulate a plan of action for identification and notification of contacts and chemoprophylaxis for exposed patients and staff. A call center was established for patient/employee notification, exposure assessment, and reporting of laboratory results. A clinic was set up in the hospital to evaluate, treat, and obtain laboratory specimens from symptomatic patients, visitors, and employees. The HEICS team met twice each day to distribute new information, problem-solve, and formulate communication for facility administration and the public. By August 11, follow-up was complete and an all clear was called. RESULTS: Of 283 patients and visitors who were contacted, 223 met exposure criteria and were seen in the clinic for evaluation. Exposure criteria were met in 380 of 595 employees and physicians contacted, who were also referred for clinic evaluation. We provided 591 prescriptions of prophylactic antibiotics. Two of 216 laboratory specimens obtained were PCR positive for pertussis, the index case and one ED patient. Approximately 226 employees supported the HEICS effort. Estimated aggregated costs of the event exceeded $150,000. LESSONS LEARNED: Use of the HEICS model for this event provided the support and structure needed to successfully manage the situation and prevent potential morbidity in our patient population, including the most vulnerable, our newborns. Cost benefit analysis of the scope of the response to this type of event needs to be measured.