Closely tracking occupational infections among health care workers helps Vanderbilt University Medical Center in Nashville detect clusters and prevent further transmission.
Tuberculosis remains the primary infectious disease threat to health care workers, with exposures occurring from delays in diagnosis, according to a Vanderbilt analysis. From 2006 to 2011, 1,844 employees were exposed in 62 events, resulting in nine new latent TB infections, the analysis showed. The tracking of specific exposures was possible because of Vanderbilt’s homegrown occupational health surveillance system.
The occupational health software links with the human resources database, so employee health professionals can determine who was working in a particular unit. If there is a conversion on a TB skin test, they can check to see if any other conversions occurred on the same unit.
Twice, Vanderbilt has detected increased conversions and provided additional training and personal protective equipment, says Mary Yarbrough, MD, MPH, FACOEM, associate professor of clinical medicine and executive director of Vanderbilt’s health and wellness program.
On a quarterly basis, employee health works with infection control to review cases of TB conversions and other exposure events, Yarbrough says.
“We’re so focused on prevention, which is good, but we’ve also got to look and see where the prevention didn’t work,” she says. “Where did we have our exposures? What diseases resulted from that and what can we do [to prevent the exposures]?”
The surveillance software makes it easy to look for connections. “If someone comes in and converts on a TB test, we can go back and see if they had any exposures. Were there any other people on that unit that had conversions or exposures?”
For example, when an increase in conversions was detected in the emergency department, occupational health investigated and found that employees were not always closing the door of isolation rooms and some employees were not wearing the respirators. After re-training and a switch to bi-annual TB testing, no conversions occurred the following year, says Yarbrough, who recently presented her results at the annual stakeholder meeting of the National Personal Protective Technology Laboratory of the National Institute for Occupational Safety and Health (NIOSH) in Pittsburgh.