Title : Containment of an outbreak in Critical Care (ICU): An incident report of a multispecialty hospital in developing world
Abstract:
Introduction:
Varicella-zoster virus (VZV) infection in healthcare organisations, especially in ICUs, is of serious concern, primarily having admitted critical and immunocompromised patients.
Methodology and Results:
The report defines the transmission and infection control measures undertaken to curtail spread of VZV infection in Trauma ICU of a multispecialty hospital of North India.
At the infection outset, a HCW posted in ICU was quarantined after clinically diagnosed to have varicella. At that time, there were 12 critical patients in ICU. And, 54 HCWs were posted (24X7) to manage them.
After VZV outbreak confirmation all susceptible patients as well as HCW were isolated for microbiological assessments and post-exposure vaccinations. Antiviral chemoprophylaxis was initiated in critically ill patients, as evidenced by VZV seronegative IgG levels.
Fresh intake of patients were restricted. Out of total 54 HCW, 14 (25.92%) were found susceptible (protective VZV IgG titres) and were vaccinated. Out of the 12 patients admitted none of the patient got infected. Seven patients were discharged, four patients expired due to their critical illness, while one patient remained till incubation period was over. Epidemiologically, line listing for index case reporting was done.
The efficacy of control measures was re-evaluated to strengthen existing infection control practices and general measures viz. strict hand washing, adherence to aseptic protocols and intensification of environmental cleaning.
Conclusion
Established varicella surveillance measures ensure VZV outbreaks are identified in a timely manner and control measures implemented. Vaccination policy is utmost requirement despite having huge financial implications.
