Bridging the Gap: Utilizing Quality Improvement Tools to Refine a Pediatric Varicella Exposure Investigation

• Published in: American journal of infection control 2023-07, Vol.51 (7), p.S13-S13
• Main Authors: Moore, Riley, Bonebrake, Amanda, Davies, Nicole, Marsh, Maeve, McHugh, Matthew P., Patel, Ami, Kociolek, Larry, O'Donnell, Anna
• Format: Article
• Language: English
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2023.04.151

As vaccination rates among pediatric patients decrease, there is increased risk of re-emergence and spread of vaccine preventable diseases. When patients are present for care, crowded emergency department (ED) waiting rooms can further exacerbate the risk of transmission. For primary varicella-zoster virus (VZV) infection, early identification of infectious patients and exposed individuals is critical in the post-exposure management of susceptible patients. The Infection Prevention & Control (IP&C) team at a 368-bed acute care pediatric hospital was notified via laboratory reporting of a case of varicella in an unmasked infant evaluated in the ED. Following confirmation, an investigation was conducted by the IP&C team to identify exposed patients for notification and potential interventions, such as vaccination and/or Varicella Zoster Immune Globulin (VZIG) treatment. A gap analysis, which is an exercise to compare current with desired performance, was completed to refine the process for future investigations. Because of delays in initiating airborne precautions related to unusually high ED volumes, 141 patients were identified as sharing airspace for at least one hour with the index patient; physical proximity of patients in the ED was unable to be determined retrospectively. Of those, 42 (29.8%) were identified as at-risk for VZV infection due to immune status; 4 were eligible for VZIG administration. A gap analysis conducted by the IP&C team identified three opportunities for process improvement: prompt screening and isolation of infectious patients in the ED; informatic support to identify exposed individuals; and written/verbal communication of event with third parties. For communicable diseases such as VZV where post-exposure interventions must be initiated promptly, early identification of infectious patients and exposed individuals is necessary. When processes fail, quality improvement tools like a gap analysis can provide IP&C teams with a framework to review current practices and determine actions to take to improve processes.