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Occupationally related outbreak of chickenpox in an intensive care unit
Nasser Yehia A Aly1, Ina'am Al Obaid, Noura Al-Qulooshi
1Department of Tropical Medicine and Hygiene, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. nasseryehia@gmail.com
Insights
An intensive care unit (ICU) experienced a chickenpox outbreak among unvaccinated staff. Implementing strict isolation, staff education, and vaccination can prevent such healthcare-associated infections.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Occupational Health
Background:
- Healthcare-associated infections pose a significant risk in intensive care units (ICUs).
- Chickenpox (varicella) outbreaks can occur in healthcare settings, particularly among susceptible staff.
- Preventing nosocomial transmission is crucial for patient and staff safety.
Observation:
- An index case of chickenpox encephalitis in a pediatric patient led to an outbreak in an ICU.
- Three unvaccinated ICU nurses contracted chickenpox 16-21 days post-exposure.
- The outbreak occurred despite the index patient being placed in an isolation room.
Findings:
- The outbreak was linked to occupational exposure to the index chickenpox case.
- Lack of vaccination and inadequate adherence to infection control protocols contributed to the secondary transmission.
- All affected staff nurses were treated without complications.
Implications:
- Adherence to isolation precautions is critical in preventing varicella zoster virus (VZV) transmission.
- Pre-employment screening for VZV immunity and robust staff vaccination programs are essential.
- Excluding susceptible healthcare workers from patient care and comprehensive staff education are vital preventive measures.
Objective:
To report occupationally related outbreak of chickenpox in intensive care unit (ICU).
Case Presentation And Intervention:
The index patient was a 4-year-old child who presented with a 3-day history of fever and rash and was clinically diagnosed as chickenpox encephalitis. She was admitted to an isolation room in ICU, kept on oxygen mask and given intravenous fluids, anticonvulsant, antipyretic and acyclovir. Twelve hours later, the patient was transferred to Infectious Diseases Hospital. Secondary cases were three unvaccinated ICU staff nurses who developed chickenpox 16-21 days following exposure. They were also transferred to Infectious Diseases Hospital. The affected nurses were interviewed and filled out a questionnaire. Individual immune status was verified by reviewing previous varicella zoster-IgG screening data for all ICU staff. The chickenpox case was defined according to the CDC case classification. All were treated with no complications.
Conclusion:
This report shows that adherence to isolation precautions, exclusion of susceptible staff from attending the affected patient, education, pre-employment anti-VZV-IgG screening and vaccine coverage of staff could have prevented the occurrence of this outbreak.
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