Rising Number of Measles Cases Creates Numerous Patient Safety Issues
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:
- Developing screening protocol for patients calling in with symptoms of upper respiratory infections and measles. Staff should query the individual regarding exposure to known measles cases, travel abroad, and immunization status.
- Documenting all discussions with patients and parents of minors regarding measles, including the risks and benefits of inoculation. When patients/parents decline measles immunization, consider using an informed refusal form. Patients who contract measles and claim that their physician never discussed inoculation represent a potentially significant liability.
- Providing serologic testing for immunity, when necessary, and documenting all related discussions with patients who are unsure of their immunity status against measles.
- Ensuring that immunization tracking is up to date and well documented in the medical record so that patients remain on schedule.
- Complying with state laws for the provision of vaccines to healthcare workers. Ideally, healthcare workers should demonstrate evidence of immunity to work with patients who are suspected of having measles or patient populations, including infants, who are susceptible to measles themselves.
- Advising those who may have come in contact with an infected individual to contact their physician immediately.
- Ensuring that office staff members are trained to use personal protective equipment and proper isolation techniques when working with an infected individual.
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:
- Minimize the risk of exposure to others by admitting the patient through a separate entrance and isolating him or her in an exam room. If possible, schedule the patient at the end of the day. It is preferable that the exam room not be used until the following day since the virus can live on surfaces for up to two hours. Keep the exam room door closed.
- Place a surgical mask on the patient and ensure that all office staff members wear protective equipment, including gloves, eye protection, masks, or an N-95 particulate respirator (properly fit-tested), if needed.
- Follow standard disinfection and sterilization procedures for exam rooms.
- Obtain specimens for disease testing. Report suspected cases to the local health department.
- Consider making post-exposure prophylaxis available to those who have been exposed. Post-exposure vaccination can be effective in preventing measles in some individuals. As an alternative, Immunoglobulin, if administered within six days, can offer some protection against measles or lessen the manifestation of the disease.
- Contact your local health department for additional guidance.