title: Health care worker exposures to pertussis: missed opportunities for prevention.
abstract: OBJECTIVE
  Pediatric health care workers (HCWs) are at particular risk for pertussis exposure, infection, and subsequent disease transmission to susceptible patients. This cross-sectional study describes the epidemiology of occupational exposures to pertussis and identifies factors that may inform interventions to promote effective implementation of infection prevention and control (IPC) guidelines.
  
  
  METHODS
  We abstracted data from occupational health (OH) and IPC records for pertussis cases that resulted in an exposure investigation in a large quaternary pediatric care network, January 1, 2002 to July 18, 2011. We calculated the frequency of occupational exposures and measured associated characteristics. To assess the frequency of potential missed exposures, we reviewed electronic health record (EHR) data identifying laboratory-confirmed pertussis cases not documented in OH or IPC records.
  
  
  RESULTS
  A total of 1193 confirmed HCW pertussis exposures were associated with 219 index cases during the study period. Of these, 38.8% were infants <6 months old and 7 were HCWs. Most (77.5%) of exposures occurred in the emergency department or an ambulatory site; 27.0% of exposures occurred after documented initiation of IPC precautions. We identified 450 laboratory-confirmed pertussis cases through EHR review, of which 49.8% (N = 224) had no OH or IPC investigation. The majority of uninvestigated cases (77.2%) were from ambulatory sites.
  
  
  CONCLUSIONS
  Occupational exposures to pertussis occur frequently in pediatric health care settings despite appropriate IPC guidelines. Interventions are needed to ensure consistent implementation of IPC practices and timely identification and reporting of pertussis index cases to prevent HCW exposures and potential transmission to patients.
authors.affiliation: MSHP, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Division of Infectious Diseases, The Children's Hospital of Philadelphia, CHOP North, 3535 Market Street, Room 1511, Philadelphia, PA 19104. feemster@email.chop.edu.
authors.forename: Danica E
authors.initials: DE
authors.lastname: Kuncio
authors.forename: Maria
authors.initials: M
authors.lastname: Middleton
authors.forename: Mary G
authors.initials: MG
authors.lastname: Cooney
authors.forename: Mark
authors.initials: M
authors.lastname: Ramos
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Feemster
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D003430:Cross-Sectional Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006282:Health Personnel; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D009515:New Jersey / Q000453:epidemiology; D016273:Occupational Exposure / Q000517:prevention & control / Q000706:statistics & numerical data*; D015143:Philadelphia / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014917:Whooping Cough / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*
keywords: ambulatory care; health care worker; infection control; occupational exposure; pertussis