Anyone who turns on the evening news has likely seen reports of measles outbreaks cropping up across pockets of the United States. The country is currently experiencing the largest outbreak of measles since 1992 and since the Centers for Disease Control and Prevention (CDC) declared the virus eliminated in 2000. As of July 25, the CDC had reported 1,164 cases in 30 states, and that number is continuing to rise.
A measles outbreak is of concern to healthcare facilities large and small in urban or rural areas. There are a number of factors that make measles a particularly difficult virus to protect patients, staff and visitors from contracting.
First, it is a highly contagious and airborne virus, transmitted by respiratory droplets from the nose, mouth, or throat of an infected person. They usually spread through a cough or sneeze. Small particle aerosols from someone with measles can remain suspended in the air for long periods of time after the person has left the area. Additionally, the virus can live on surfaces for up to two hours. Complicating matters further is the fact that the virus is contagious up to four days before the tell-tale rash, so people may be infected and spreading the virus without knowing it.
While healthcare facilities can’t necessarily prevent the possibility of exposure to measles, they can prepare themselves for a potential outbreak. Having the right infection prevention program and personal protective equipment (PPE) in place to minimize the potential spread of the virus is critical. Considerations include:
Knowing local risk factors: Knowing your local risk factors can allow health care facilities to prepare for the possibility of a fast-spreading outbreak. According to CDC data, 88 percent of all recent measles cases have happened in tight-knit communities where people share the same values, beliefs and interact often. The more informed a health care facility is about the local community surrounding it, the better it can prepare for a potential outbreak. Factors that elevate the risk level significantly include patient populations or pockets of the community that a significant number of people who regularly opt-out of vaccinations for religious or other reasons and communities that are frequently exposed to international travelers.
A 2018 analysis published in PLOS Medicine states that dozens of counties across the U.S. had nonmedical vaccine exemption rates that were between 5.1 and 30 percent in 2016-17.
Having a plan: If a patient brings measles into your facility, having the right PPE and making sure staff is trained on how to use it is critical to ensuring safety and minimizing the spread of the virus. Facilities should follow airborne protocols and make sure they have enough respirators, such as N95s, in stock. During a measles outbreak, the number of staff who need respirators can increase by 10 or 20 times per day. Calculate the appropriate amount of PPE you may need, remembering to factor in special populations such as health care workers who don’t typically use face masks or other PPE, visitors and pediatric patients who require special sizes of PPE.
OSHA also recommends stockpiling items such as soap, tissue, hand sanitizer and PPE including gloves, goggles, face shields, surgical masks and N95 respirators as a way to remain properly prepared for an unexpected outbreak scenario. The CDC recommends that the stockpile be enough for an 8-week supply. This advice applies to hospitals and larger healthcare facilities, as well as smaller private practices and urgent care clinics, which may not keep a broad range of PPE on hand.
Following protocol for PPE: Simply having the stock on hand isn’t enough. OSHA requires that healthcare facilities fit test staff who will wear certain PPE, such as N95 respirators, to ensure the device fully protects the individual wearing it. OSHA also requires that fit testing take place annually. By building in a program and someone to oversee it on an ongoing basis, health care facilities can ensure they meet this requirement. Also make sure you train any staff who will be using PPE, especially if it’s a group who doesn’t typically wear it, on proper donning and doffing.
Knowing your stock: Different outbreaks require different PPE bundles and have different protocols, so preparing for one scenario will not necessarily prepare you for all. In the case of measles, the appropriate PPE bundle includes:
• Respirator masks (such as N95)
PPE also has a shelf life, so be sure to regularly take inventory and check expiration dates. Just because you stockpiled for an event that you consider to be recent, such as the Ebola outbreak in 2014, know that your stock may have since expired.
It is common for inventory audits to find that a facility’s idea of what they have in stock does not match what is actually in stock. There is also the chance that the PPE stockpiled won’t match the protocol for an alternate scenario. To avoid this, carry a broad stockpile and check it regularly to see if you need to resupply. It is recommended that healthcare facilities should be prepared for 2-4 outbreak scenarios. If costs are a concern, ask your supplier if certain PPE, such as respirators, can work for multiple outbreak scenarios rather than carrying multiple products.
Creating strong partnerships: To ensure you’re prepared, make sure purchasing, materials management and infection prevention staff work closely together on what PPE to stockpile, how much to carry on site and what the plan is should you need to ramp up your supply of certain PPE if an outbreak occurs.
Asking about your vendor’s supply chain: With certain highly contagious pathogens such as measles, time is of the essence during an outbreak. Having a supplier who can expedite the delivery of the necessary PPE from what can be 8-20 weeks to 8 days is critical and ultimately protects staff and patients who will potentially be in contact with infected patients.
Carrying enough of the appropriate PPE and having a supplier who can quickly respond to a pressing need before an infectious disease outbreak, will protect your clinical staff and arm them with the confidence needed to perform at their highest levels and prevent further spread of the virus.
Jason Burnham, BSME LSSBB MBA, is the Associate Director – Outbreak Readiness for O&M Halyard.