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Quality Standard for Assurance of Measles Immunity Among Health Care Workers

Published online by Cambridge University Press:  02 January 2015

Peter J. Krause ,
Peter A. Gross ,
Trisha L. Barrett ,
E. Patchen Dellinger ,
William J. Martone ,
John E. McGowan Jr ,
Richard L. Sweet  and
Richard P. Wenzel
Peter J. Krause*
Affiliation:
Hartford Hospital, Hartford, and the University of Connecticut School of Medicine, Farmington, Connecticut
Peter A. Gross
Affiliation:
Hackensack Medical Center, Hackensack, and New Jersey Medical School, Newark, New Jersey
Trisha L. Barrett
Affiliation:
Alta Bates Medical Center, Berkeley, California
E. Patchen Dellinger
Affiliation:
University of Washington Medical Center, Seattle, Washington
William J. Martone
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
John E. McGowan Jr
Affiliation:
Emory University School of Medicine, Atlanta, Georgia
Richard L. Sweet
Affiliation:
Magee Women's Hospital and, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Richard P. Wenzel
Affiliation:
University of Iowa Hospitals and Clinics, Iowa City, Iowa
*
Department of Pediatrics, Hartford Hospital, Hartford, CT 06115
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Abstract

Objective:

The objective of this quality standard is to prevent nosocomial transmission of measles by assuring universal measles-mumps-rubella (MMR) vaccination of all healthcare workers who lack immunity to measles. Although the primary emphasis is on healthcare workers in hospitals, those at other sites, such as clinics, nursing homes, and schools, are also included. It will be the responsibility of designated individuals at these institutions to implement the standard.

Options:

We considered advocating the use of measles vaccine rather than MMR but chose the latter because it also protects against mumps and rubella and because it is more readily available.

Outcomes:

The desired outcome is a reduction in the nosocomial transmission of measles.

Evidence:

Although direct comparative studies are lacking, nosocomial outbreaks of measles have been reported (as recently as 1992) in institutions where measles immunization of nonimmune healthcare workers is not universal, whereas such outbreaks have not been reported in institutions with universal immunization.

Values and Validation:

We consulted more than 50 infectious-disease experts in epidemiology, government, medicine, nursing, obstetrics and gynecology pediatrics, and surgery. In light of disagreement regarding the implementation of the standard, we used group discussions to reach a consensus.

Benefits, Harms, and Cost:

The consequences of the transmission of measles (and of mumps and rubella) in a healthcare institution include not only the morbidity and mortality attributable to the disease, but also the significant cost of evaluating and containing an outbreak and the serious disruption of regular hospital routines when control measures are instituted. The potential harm to healthcare workers after the implementation of the standard consists of untoward effects of MMR vaccine, although the reactions of vaccines should be minimal with adherence to recommended vaccination procedures. Implementation of the standard should entail no expense to healthcare workers; the precise cost to institutions is unknown, but the expense would be mitigated by prevention of measles outbreaks.

Recommendations:

We recommend MMR vaccination of all healthcare workers who lack immunity to measles.

Sponsors:

The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Diseases Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. The standard is endorsed by the IDSA.

Type
Consensus Paper
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 3 , March 1994 , pp. 193 - 199
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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