3 things to do immediately if measles is a possibility

Make policies 'very specific and very strict'

When a Swiss tourist came to a Tucson, AZ, ED with pneumonia, none of the ED nurses suspected that measles was the underlying cause. As a result, the patient wasn't isolated, and patients and health care workers in the ED were needlessly exposed.

Also, because there was inadequate documentation of the measles-immune status of health care workers, the hospital needed to conduct a massive immunization.

"Although rare, cases of measles do still occur in the U.S., emergency room nurses should maintain a high index of suspicion for measles in patients who present with fever and rash, especially if they have a history of foreign travel," says Kathleen Gallagher, DSc, MPH, team leader for the Center for Disease Control and Prevention's Measles, Mumps, Rubella, and Polio Team. To reduce the risk of disease transmission, Gallagher recommends:

  • All ED nurses should ensure that they are immune to measles.
  • If you suspect measles, immediately isolate the patient in a negative pressure room.
  • Ensure that appropriate infection control precautions are taken with the patient.
  • Alert the hospital's infection control practitioner, who should notify local public health authorities.

The University of California-Davis Medical Center has "very specific and very strict policies" for measles and German measles cases, says Ann Bennett, RN, MSN, nurse educator for the ED. "In essence, all employees who have direct patient contact or whose work requires them to be in patient care areas must be immune to rubella and rubeola," she says. "Immunity is obligatory and a condition of employment."

If a case of measles is suspected, Bennett says these immediate steps would be taken:

  1. A mask is placed on the patient.
  2. The patient is isolated in a negative pressure room, or a private room with the door closed.
  3. Rooms are wiped down with disinfectant and not used for at least two hours after a suspected measles patient has left the room.

The ED recently was alerted by the California Department of Public Health that recent cases of measles have occurred, so nurses have a high index of suspicion for this diagnosis if a patient presents with fever and rash and has a history of international travel within the previous three weeks or had had contact with international visitors.

"Luckily, we have not had any cases," says Bennett. "However, if we did, we would treat it as we would treat any infectious, contagious disease. Since all our patient care staff are immunized, any staff could care for the patient."