A Surveillance System to Reduce Transmission of Pandemic H1N1 (2009) Influenza in a 2600-Bed Medical Center

Tsui-Ping Chu,Ling-Sai Chang,Chung-Chen Li,Huey-Ling You,Chi-Chen Wei,Hock-Liew Eng,Li-Wen Hsu,Ing-Kit Lee,Lin Wang,Jien-Wei Liu,Kuender D Yang,Daniel G Bausch

doi:10.1371/journal.pone.0032731

Abstract

BackgroundConcerns have been raised about how the transmission of emerging infectious diseases from patients to healthcare workers (HCWs) and vice versa could be recognized and prevented in a timely manner. An effective strategy to block transmission of pandemic H1N1 (2009) influenza in HCWs is important.Methodology/Principal FindingsAn infection control program was implemented to survey and prevent nosocomial outbreaks of H1N1 (2009) influenza at a 2,600-bed, tertiary-care academic hospital. In total, 4,963 employees at Kaohsiung Chang Gung Memorial Hospital recorded their temperature and received online education on control practices for influenza infections. Administration records provided vaccination records and occupational characteristics of all HCWs. Early recognition of a pandemic H1N1 (2009) influenza case was followed by a semi-structured questionnaire to analyze possible routes of patient contact, household contact, or unspecified contact. Surveillance spanned August 1, 2009 to January 31, 2010; 51 HCWs were confirmed to have novel H1N1 (2009) influenza by quantitative real-time reverse transcription polymerase chain reaction. Prevalence of patient contact, household contact, or unspecified contact infection was 13.7% (7/51), 13.7% (7/51), and 72.5% (37/51), respectively. The prevalence of the novel H1N1 infection was significantly lower among vaccinated HCWs than among unvaccinated HCWs (p<0.001). Higher viral loads in throat swabs were found in HCWs with patient and household contact infection than in those with unspecified contact infection (4.15 vs. 3.53 copies/mL, log10, p = 0.035).ConclusionA surveillance system with daily temperature recordings and online education for HCWs is important for a low attack rate of H1N1 (2009) influenza transmission before H1N1 (2009) influenza vaccination is available, and the attack rate is further decreased after mass vaccination. Unspecified contact infection rates were significantly higher than that of patient contact and household contact infection, highlighting the need for public education of influenza transmission in addition to hospital infection control.

Highlights

H1N1 (2009) influenza was another pandemic infection that followed the severe acute respiratory syndrome (SARS) pandemic
Unspecified contact infection was defined as a laboratoryconfirmed case of influenza in a healthcare workers (HCWs) who did not belong to the patient contact or household contact infection groups
The vaccination program was not included in the original infection control strategy, but was introduced on November 1, 2009, according to the

Summary

Introduction

H1N1 (2009) influenza was another pandemic infection that followed the severe acute respiratory syndrome (SARS) pandemic. During the 2003 SARS outbreak, our 2600-bed medical center experienced a serious nosocomial infection that resulted in closure of the facility in a bid to contain the hospital-acquired infection [1]. The first imported case in Taiwan was diagnosed in May 2009 [6] and the virus spread to the community in July the same year [7]. After this development, our infection control team immediately designed a series of strategies to enhance our colleagues’ awareness and prevention of hospital-acquired infections. An effective strategy to block transmission of pandemic H1N1 (2009) influenza in HCWs is important

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