Managing the risk of viral haemorrhagic fever transmission in a non-high-level intensive care unit: experiences from a case of Crimean-Congo haemorrhagic fever in Scotland

Abstract

A case of Crimean-Congo haemorrhagic fever (CCHF) was imported into Scotland in 2012. To discuss the public health response to the case, and the control measures taken to prevent secondary transmission. Following confirmation of the case, an incident management team (IMT) was convened to ensure that: (i) all individuals exposed to the case and/or their blood/body fluids were identified, assessed and followed-up appropriately; and (ii) the appropriate disinfection or disposal of equipment was used to manage the patient, laboratory specimens obtained from the case, and their environment. Contact tracing identified 19 individuals who required follow-up and monitoring. No secondary cases occurred. Identification of laboratory specimens obtained prior to diagnosis proved challenging. The majority were traced, temporarily stored in sharps boxes and subsequently incinerated. A small number could not be recovered and consequently would have been disposed of through the routine hospital waste system. Biochemical and haematology analysers were decontaminated according to the manufacturers' instructions and liquid waste was discharged to drains. The patient's mattress, sphygmomanometer and pulse oximeter probe were incinerated. Decontamination of the clinical environment was undertaken following guidance from national experts. While national guidance for the management of cases of viral haemorrhagic fever (VHF) available at the time in the UK informed the approach taken to manage the risk of secondary transmission, a number of practical issues relating to infection control aspects of managing a patient with VHF in a non-high-level isolation unit environment were encountered. Close liaison between national experts and the IMT was key to the expedient response to the emerging issues.