New cases of measles (rubeola) are once again making national headlines. In 2014, there were 644 reported cases of measles across 27 states with 23 reported outbreaks. That was the highest number of annual cases for any year since the disease was declared to have been eliminated from the United States in 2000.1 As more measles cases are diagnosed in 2015, physicians should implement effective screening protocols, infection control techniques, and patient education to reduce liability risks and promote patient safety.
Measles outbreaks most often occur in the United States when an unvaccinated traveler gets the disease while traveling in other countries and then spreads it to individuals who have not been vaccinated.2 In addition, the anti-vaccine movement has contributed to the recent spread of measles by creating pockets of unvaccinated people. Given the disease was essentially eliminated from the United States, some physicians may not be familiar with the clinical manifestation of the disease and may not consider measles as a potential diagnosis. Since initial presenting symptoms of measles are similar to those of upper respiratory infections, measles may be misdiagnosed before a patient presents with the familiar red rash.
Exposure to measles in a medical office or facility is a serious patient safety issue because of the potential for complications from the disease, including death. The disease is airborne and extremely contagious; 90 percent of unimmunized individuals who are exposed to the disease could be infected.3 An infected individual is considered contagious from four days before to four days after the rash appears. The rash usually appears 14 days after a person is exposed; however, the incubation period ranges from 7 to 21 days. To protect staff and patients, medical offices should establish screening protocols that limit exposure risk from infected individuals.
Unlike hospitals, most medical offices are not equipped with negative pressure isolation units that offer better protection from airborne diseases. Your practice, however, can reduce liability risks and promote patient safety by:
Physicians who are not familiar with diagnosing measles should obtain additional training. It is essential to be knowledgeable about signs and symptoms, potential complications, diagnostic testing, and infection control recommendations from the Centers for Disease Control and Prevention.
Follow these tips if you or your staff suspects a patient has measles symptoms:
By Debbie Hill, RN, MBA, LHRM, CPHRM, Patient Safety Risk Manager, The Doctors Company
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.