Rising Number of Infectious Disease Cases Creates Patient Safety Issues

Debbie Hill, RN, MBA, LHRM, Patient Safety Risk Manager, The Doctors Company

Physicians are reporting communicable, or infectious, diseases that were thought to have been controlled in the United States. New cases of whooping cough (pertussis) and, most recently, measles (rubeola) are making headlines. During the first half of 2014, there were more than 288 reported cases of measles, the highest number for any one year since the disease was eliminated from the country in 2000.1 In addition, newly classified infectious diseases are emerging, like Middle East Respiratory Syndrome Coronavirus (MERS-CoV), a viral respiratory illness.

Modern travel has been found to impact how far and fast infectious diseases spread.2 Outbreaks often occur when a disease is brought into the United States and spread to people who have not been vaccinated.1

Exposure to infectious diseases in a medical office or facility is a serious patient safety issue. To protect staff and patients, medical offices need to have established protocols that limit the exposure risk from individuals who come into the office with one of these debilitating, if not fatal, conditions. Medical malpractice liability risk may grow as reports of infectious diseases continue.

Unlike hospitals, most medical offices are not equipped with negative pressure isolation units that protect staff and other patients from infectious diseases. Your practice, however, can reduce liability risks and promote patient safety by:

  • Documenting all discussions with patients and parents of minors regarding infectious diseases, including the risks and benefits of inoculation.
  • Documenting all discussions about serologic evaluations with patients who are unsure of their immunity status.
  • Ensuring that all immunization tracking is up to date so that patients remain on a timely immunization schedule.
  • When possible, allowing only staff members who have demonstrated evidence of immunity to work with patients suspected of having a communicable or infectious disease.
  • Complying with state laws for the provision of vaccines to healthcare workers. For more information, go to http://www2a.cdc.gov/vaccines/statevaccsApp/.
  • Notifying those who may have come in contact with an infected individual that they should see a physician.
  • Ensuring that all office staff members are trained in the use of personal protective equipment and on proper isolation techniques when working with patients who present with symptoms of an infectious disease.

Physicians should be prepared to evaluate patients for new and emerging infectious diseases.3 Staying current on the latest signs and symptoms, diagnostic testing, and case definitions, as well as infection control recommendations from the Centers for Disease Control and Prevention, is essential.

Follow these tips if you or your staff suspects a patient has an infectious disease:

  • Minimize risk of exposure by moving the patient from the waiting area and isolating him or her in an exam room.
  • For airborne diseases, 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, if needed.
  • Follow standard disinfection and sterilization procedures for exam rooms.
  • Report suspected cases to the local health department and obtain specimens for disease testing.
  • Consider making post-exposure prophylaxis available to those who have been exposed. Post-exposure vaccination can be effective in preventing infectious disease in some individuals; if the vaccine does not prevent contraction, it will likely lesson the severity of the disease.


1 CDC: Highest number of U.S. measles cases since 2000. CNN Health.
http://www.cnn.com/2014/05/29/health/cdc-measles/. Published May 30, 2014. Accessed June 5, 2014.

2 Measles. Travelers’ Health. Centers for Disease Control and Prevention.
http://wwwnc.cdc.gov/travel/diseases/measles. Published May 9, 2013. Updated December 13, 2013. Accessed June 5, 2014.

3 Middle East Respiratory Syndrome (MERS): Healthcare Provider Preparedness Checklist for MERS-CoV. Center for Disease Control and Prevention.
http://www.cdc.gov/coronavirus/mers/preparedness/checklist-provider-preparedness.html. Published July 15, 2013. Accessed June 5, 2014.

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 considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.


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