Surveillance Systems for Tracking Patients and Employees during Epidemics and Disasters

Background: Hospitals are expected to have systems in place to track patients (pts) and health care workers (HCW) exposed to epidemics, bioterrorism events or natural disasters.

Objective: Develop surveillance systems that promptly identify pts and/or HCWs affected by an epidemic or disaster in order to establish staffing needs and facilitate patient placement and prophylaxis or treatment of these individuals.

Methods: We developed a paper-based system that requires managers to fax to the Infection Control (IC) office each day during an outbreak a list of hospitalized pts who meet established criteria for the disease of concern (e.g., influenza-like-illness [ILI]) and a similar list of employees meeting the criteria. IC personnel then review pt charts and interview staff to estimate daily disease burden in the hospital. Our electronic pt tracking system allows emergency department physicians, IC and admitting personnel, or physicians caring for patients already admitted, to place an order into the hospital’s computerized physician order entry system for the disease (or disaster) of interest (Figure). The pt tracking flag appears in the pt’s electronic medical record, and permits IC personnel and administrators to print a line list of affected patients and their location. To detect HCWs who may report to work during an outbreak with symptoms of an infectious illness, we designed a relational database containing information from employees (names, badge numbers and departments), volunteers and independent physicians which has been linked to a table permitting daily entry of body temperature and symptoms (e.g., criteria for ILI).  Records of HCWs can be accessed by using a bar code reader to scan employee badge bar codes or by entering the individual’s name.

Results: The paper-based reporting system and the pt tracking system were pilot-tested during norovirus outbreaks in 2007 and 2008. Since 10/18/09,  we have used the paper-based and electronic pt tracking systems in tandem for surveillance of pts and HCWs with ILI suspected or proven to be due to 2009 H1N1 influenza. Data from these systems have been presented at weekly meetings of a multidisciplinary committee responsible for management of the 2009 H1N1 outbreak.  To date, 66 employees who met criteria for ILI and 42 pts with suspected or proven 2009 H1N1 influenza have been reported to the multidisciplinary committee.

Conclusions: Our prospective paper-based reporting system and electronic pt tracking system have facilitated surveillance of pts and HCWs with presumed or proven 2009 H1N1 influenza, and have assisted us with disease management and prevention. The system designed to screen employees for contagious illness when they report for work has not been put into effect, but remains ready for implementation should the need arise during a pandemic or bioterrorism event.