Failure to report has life-threatening result

HCW left with permanent disability

Lack of reporting of infectious disease exposures may also result in a lack of treatment. And that can have serious, even deadly, consequences.

On Dec. 3, 2009, respiratory technician Suheil “Sam” Saliba helped intubate a patient who had been discovered unconscious in his home. Meningitis was suspected, and by the next day, lab tests on spinal fluid suggested that’s what it was.

By Sunday, Dec. 6, the case was confirmed, but Alta Bates Summit Medical Center in Oakland waited until Monday, more than 24 hours later, to report the case to the local health department, according to the California Department of Industrial Relations Occupational Safety and Health Division (Cal-OSHA). The hospital never notified the Oakland police department or fire department, and it didn’t conduct an exposure analysis until Saliba and a police officer were admitted to the emergency department of a different hospital with meningitis.

Both men recovered, but are on permanent disability. Saliba told local reporters that he has permanent hearing loss, joint damage, memory loss and cognitive impairment from neurological damage related to the illness. “I’ve been through a lot,” Saliba said.

Cal-OSHA uncovered three other cases of delayed reporting of meningitis and active tuberculosis and two other cases without timely exposure analysis.

“There was a lack of urgency — there needs to be a sense of urgency,” says Deborah Gold, CIH, MPH, deputy chief of health and engineering services for Cal-OSHA in Oakland.

Gold notes that the state’s Aerosol Transmissible Disease Standard, the only one of its kind in the country, requires exposure investigations to begin within 72 hours. Meningitis also is a reportable disease to the health department. The federal Ryan White HIV/AIDS Treatment Extension Act of 2009 requires reporting of certain life-threatening diseases to emergency responders.

“We’ve been trying to use this as an instructional moment to reach out to people in other hospitals and health care systems to make sure they understand the importance of this reporting system,” she says.

“Without that initial reporting and notification, you’re not going to take the other important actions to prevent disease, particularly with meningitis where the incubation period is short and the effects of getting the disease are significant,” she says. “It’s a disease that needs to be taken seriously.”

New focus on other diseases

Traditionally, infection control and employee health departments have focused on tuberculosis and bloodborne pathogens as the major infectious disease risks to health care workers. It’s time to pay more attention to diseases spread by aerosols and droplets, says Katherine West, MSEd, CIC, BSN, who specializes in working with first responders as a infection control consultant in Manassas, VA.

“We’re at a historic low for TB cases in this country. I don’t see that as a [major] issue,” she says. “It’s time to move beyond TB and bloodborne pathogens and make sure we’re covering the airborne and droplet diseases. Some of them reported in higher numbers than bloodborne pathogens.”

It’s critical for hospitals to alert first responders to potential exposures, as well as employees, she says. “I realize facilities are overworked right now with data collection and their responsibility to bring down [the rate of] hospital-acquired infections, but they’ve got to include all members of the health care team [in reporting and exposure analysis],” she says. “That includes fire rescue and law enforcement as well.”

In addition to reporting problems, West sees problems with inadequate training of health care workers related to infection control. “It’s like everybody’s looking for the quick fix,” she says. “Well, that will come back to haunt you most times.”

The U.S. Occupational Safety and Health Administration has announced its intention to create an infectious disease rule, although the agency has yet to issue a draft version of the rule. It is likely to be patterned after California’s Aerosol Transmissible Disease Standard.

In comments to OSHA, Cal-OSHA urged the federal agency to provide additional protections to health care workers related to infectious diseases:

“All employers are faced with decisions regarding the prioritization of resources,” noted then-Cal-OSHA chief Len Welsh. “We have been told by employers that the existence of the ATD regulation has been used to require sites where outbreaks have occurred to conduct exposure investigations that the local management would otherwise have declined to do...”

The failure to provide prompt reporting and exposure analysis demonstrates the need for regulation, Welsh said. “Although the state mandates reporting of infectious diseases, until the passage of this standard there was no easily available civil enforcement mechanism.”