An Outbreak of Parainfluenza 3 (Para 3) in an Outpatient Adult Bone Marrow Transplant (ABMT) Clinic

Abstract

ISSUE: The ABMT program performs over 200 transplants per year. The clinic provides chemotherapy to 60% allogeneic and 40% autologous transplant patients (pts) daily. Between 6/05 – 12/05 there was an outbreak of Para 3 that involved 27 culture-positive pts. Infection Control (IC) measures controlled the outbreak but sporadic activity continues to occur. The clinic area, an open, “U” shaped unit, provides pts with recliners while they are receiving treatment. There are few hand-washing sinks for staff. The pts receive infusions for 6-8 hrs. Five private rooms are used for the pts with the most morbidity. PROJECT: In the year preceding this outbreak 06/04 – 07/04 there were 6 patients with respiratory cultures positive for Para 3. There was a 55% increase in infected pts 2005, warranting more stringent measures. ABMT nursing leadership consulted IC to identify interventions to improve infection rates. IC measures instituted included: 1) Mandatory hand hygiene 2) Respiratory etiquette and precautions signs 3) Symptomatic pts wore masks 4) Scales were cleaned after each use 5) Symptomatic pts were placed in private rooms on contact/respiratory precautions. At the end of 6 weeks, no new cases were identified. Additional interventions included providing hand sanitizer and education to patients and their families regarding hand hygiene and respiratory etiquette; and separating infected and symptomatic patients from non-infected patients during transportation to and from the clinic, in the waiting room, bathrooms and exam areas. Since 7/05, there have been 8 cases of Para 3. RESULTS: Although, stringent IC measures were enforced, the current outpatient facility is in need of renovation to address several infection control concerns. LESSONS LEARNED: It is important to routinely access the treatment modality and status of the pts when evaluating the IC plan. Most importantly, more stringent IC precautions and separation should be considered in both inpatient and outpatient settings. Separate cubicles with barriers, more hand washing sinks, and more bathrooms are needed to prevent transmission of infections in an open common unit such as ABMT.