Occupationally Acquired Infections A Timely Reminder

Healthcare workers (HCWs) are known to be at risk for contracting an infection from a patient or from a patient specimen.1 It might be presumed that no one would be more aware of this risk than HCWs themselves; yet, these risks often are minimized or even ignored by HCWs who perhaps through long exposure to such risks have become immune to concern albeit not to infection. It is thus useful for HCWs to be reminded of these risks from time to time, so that we do not become too complacent. The January 2001 issue of Infection Control and Hospital Epidemiology begins the new year, and indeed the new millennium, with a timely reminder that occupationally acquired infections continue to be a very real risk for HCWs. This reminder is in the form of three reports that aptly illustrate the ongoing problems associated with such infections in HCWs. In this editorial, I will comment briefly on each of these reports, discuss the salient points, and suggest an approach that would avoid, or at least curtail, some of these problems in the future. The first report, by Obasanjo et al, is entitled “An Outbreak of Scabies in a Teaching Hospital: Lessons Learned” and describes a large outbreak of scabies in an acute-care urban hospital.2 Overall, 773 HCWs and 204 patients were exposed to an individual (HCW or patient) with scabies and required prophylaxis or treatment. Of these, 113 (15%) of 773 HCWs and 82 (40%) of 204 patients had symptoms or developed a rash consistent with scabies. This outbreak resulted in over $50,000 in direct expenses and almost $20,000 in person-hours lost due to sick leave. The effect of this outbreak on staff morale was far greater than its financial impact. The second report, by D’Agata et al, is entitled “Nosocomial Transmission of Mycobacterium tuberculosis from an Extrapulmonary Site” and describes nosocomial transmission of tuberculosis from a genitourinary site.3 This elderly patient expired after 27 days of hospitalization during which a prostatic abscess was drained and bilateral orchiectomy was done. Disseminated tuberculosis was diagnosed at autopsy. There had been no evidence of active pulmonary tuberculosis during this patient’s hospitalization, including negative acid-fast bacilli stains on bronchial washings done 5 days before his death. A total of 128 HCWs were exposed to this patient during this hospitalization. Of 95 exposed HCWs who previously had nonreactive tuberculin skin tests, 12 (13%) had newly positive tuberculin skin tests. The majority of conversions occurred among nurses, particularly those nurses who packed or irrigated the surgical wounds. Of note, all three autopsy personnel converted. In contrast, only 2 of 17 respiratory therapists exposed to this patient had conversion of their tuberculin skin test, suggesting that the transmission of tuberculosis from this patient did not come from the respiratory tract. The third report is by Rice et al, entitled “An Evaluation of Hospital Special-Ventilation-Room Pressures,” and assesses the magnitude and consistency of positive and negative airflow in hospital special-ventilation rooms.4 A total of 18 rooms were sampled, including 10 standard rooms (with no special ventilation), 4 airborne isolation rooms (with negative pressure), and 4 protective-environment rooms (with positive pressure). The results of this study showed that the pressure stability of these rooms varied by room and over time. Of the 274 pressure readings for airborne isolation rooms, 186 (68%) of the readings showed compliance with the Centers for Disease Control and Prevention recommendations. At times, the positive pressure in protective-environment rooms dropped suddenly and dramatically; one such episode was due to a loose fan belt. The inconsistency of the ventilation control of the specialventilation-room pressures noted in this study suggests that these rooms would not have been reliably capable of achieving their stated purpose.