Hospital with more than 100 mpox cases develops protocol to simplify response
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Key takeaways:
- A multidisciplinary team created a guideline and checklist to simplify the mpox response in an emergency department that saw more than 100 cases.
- The process may be adaptable to future emerging pathogens.
ORLANDO — Staff at a hospital that saw more than 100 cases of mpox in its emergency department collaborated to design an infection control protocol to simplify the response, safely care for patients and prevent further transmission.
Speaking at the annual meeting of the Association for Professionals in Infection Control and Epidemiology, Corinne Belandres, BSN, RN, CIC, PHN, a nurse epidemiologist at Cedars-Sinai Medical Center in Los Angeles, said the processes could be used to respond to future emerging pathogens.
The 2022 mpox outbreak spread to more than 100 countries, most of which had not historically reported the disease. More than 30,000 of the approximately 88,000 cases reported globally occurred in the United States, according to the CDC.
“Dozens of people flocked to our emergency room seeking mpox testing, with the majority allowed to return home and advised to quarantine,” Belandres said during a presentation.
According to Belandres and colleagues, hospital epidemiology staff were tasked with preparing Cedars-Sinai for cases. They began putting together a draft guideline for diagnosing and treating patients after receiving a health advisory on May 20, and eventually condensed it into a checklist for the emergency department by late June, when it had started identifying patients with mpox.
The full protocol included establishing case definitions, infection control measures and processes for collecting and testing specimens. Microbiology, environmental services and hospital leadership collaborated on the effort.
Belandres said the team created a kit for collecting specimens — effectively, a large resealable plastic bag with all the items and documents that are needed for collection.
The epidemiology department also created a workflow to manage the reporting of cases, which evolved into the use of clinical surveillance software. The hospital’s microbiology department helped create an in-house testing solution, which lessened the time needed for results from days to a few hours.
Out of 241 suspected cases, the emergency department tested 223 people and confirmed 108 mpox infections. There were eight exposure incidents in the emergency department involving 235 health care workers, eight of whom met high-risk exposure criteria. None of the health care workers developed secondary mpox infections, and there were no other secondary infections recorded at the facility, Belandres and colleagues reported.
“Our hospital was one of the first to care for and treat mpox patients in a very vulnerable community,” Belandres said. “We were able to implement a multidisciplinary team to support the influx of patients arriving to our hospital.”
Making the documentation and guidelines easily accessible — including creating a website for easier access — and keeping information up to date allowed the hospital to handle the mpox outbreak more smoothly, Belandres said.
“Our epidemiology nurses presented mpox education to their assigned departments and units as an opportunity to share common sense, symptoms and how to care for mpox patients,” she said. “This boots-on-the-ground, just-in-time education helped answer questions, clarified misconceptions and overall built our staff’s trust.”
Belandres said the method of multidisciplinary teamwork that the hospital marshalled at the beginning of the mpox outbreak “can be used for future emerging pathogen preparedness by taking current resources on hand and adapting them to whatever the new pathogen may be.”
“This demonstrated one of the many successful collaborative efforts between our local public health department and hospital epidemiology through a multisystem approach to leverage resource availability, slow mpox cases from rising and improve community outreach efforts,” she said.
Reference:
- Belandres C, et al. New virus on the block: Introducing infection control processes for mpox patients in the emergency department during a major outbreak. Presented at: APIC 2023; June 26-28, 2023; Orlando.
- CDC. 2022 mpox outbreak global map. https://www.cdc.gov/poxvirus/mpox/response/2022/world-map.html. Updated June 21, 2023. Accessed July 3, 2023.
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Belandres C, et al. New virus on the block: Introducing infection control processes for mpox patients in the emergency department during a major outbreak. Presented at: APIC 2023; June 26-28, 2023; Orlando.
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