Electronic Tracking and Management of Staff Exposed to Communicable Infectious Diseases

Background: Infection prevention and control is vital to the safety of workers in the healthcare setting. Prevention measures include isolation precautions to prevent exposure to infectious agents and immunization for vaccine preventable diseases. Despite these measures, occupational exposures still occur and post-exposure evaluations are necessary. The exposure management process is both time and labor intensive. In order to prevent transmissions, exposed healthcare workers (HCWs) must comply with the post-exposure process. However, HCWs do not always comply making the work-up more burdensome and increasing the risk of secondary exposures. New electronic technology makes it possible to streamline the process and track exposures, thus increasing compliance. In response to an exposure event at a large urban academic medical center in 2006 involving 339 individuals (325 HCWs and 14 close contacts), at least 12 departments, and an estimated $262,788 in costs, a multidisciplinary team (MDT) convened to design and implement an electronic system to serve as an infectious diseases exposure event tracking system and a central data repository for employee health information.

Objective: Improve the process of identifying, managing and tracking HCWs exposed to communicable infectious diseases and streamline the time and resources involved.

Methods: Employee vaccination records were manually transferred from paper charts to a secure, web-based electronic system. In the event of an exposure, the system identifies HCWs considered susceptible to the infectious disease while excluding HCWs recognized as being immune based on a customized set of rules developed by the MDT. Managers of departments involved in the exposure receive immediate electronic notification of susceptible employees and then determine which HCWs meet the exposure criteria established by the Infection Control and Prevention Department (IC). Only HCWs who are susceptible and exposed require medical evaluation. Post-exposure evaluation dispositions are available electronically and in real-time. Follow-up and management of delinquent HCWs are tracked and managed electronically.

Results: Compared with the 24 months prior to the implementation of an electronic system, employee compliance with post-exposure evaluation has increased as follows: varicella from 30% to 100%, baseline Mycobacterium tuberculosis (MTB) from 50% to 100%, 10 week MTB follow-up from 5% to 30%. Time needed by IC to track and manage communicable infectious disease exposure events was reduced by an estimated 50%.

Conclusions: Appropriate management of HCWs exposed to infectious agents is critical for an organization. The use of an electronic system expedites recognition of exposed HCWs, facilitates post-exposure evaluation and targets prevention of further transmissions. These electronic systems improve time and resource utilization.