Lack of communication and inadequate infection control practices probably contributed to the meningitis infection of healthcare worker and police officer last December in California.
“Occupational Transmission of Neisseria meningitides–2009”  in Morbidity and Mortality Weekly Report (MMWR) November 19, 2010, examines the occupational transmission of N. meningitis and measures to control and prevent secondary transmission of it. “Breaches in infection control, notification delays, and lack of worker exposure assessment and postexposure chemoprophylaxis (PEP) likely contributed to secondary cases, according to the report.
The case-fatality rate for meningococcal disease is 10%–14%; survivors can experience brain damage, hearing loss, limb loss, and learning disabilities, according to the CDC.
The case involves police and fire emergency responders and hospital workers responding to a 36-year old man found unconscious at home , who was eventually treated in the emergency department and admitted to an ICU with the probable diagnosis of meningococcal disease, 2009 pandemic influenza A (H1N1), or community-acquired pneumonia.
A few days after the man was diagnosed with N. meningitis, a police officer who was part of the original response team and a respiratory therapist who was “present during airway suctioning and assisted with endotracheal tube placement in the ED at hospital,” also tested positive for N. meningitis, says the report. The police officer was hospitalized for five days; the respiratory therapist was hospitalized for 11 days.
In all 23 workers, including police officers, firefighters, paramedics, and healthcare workers were involved in the case with 10 workers having been within 3 feet of the patient when providing care. Among these 10 care providers, the policeman wore only gloves, and while two fire fighters and two paramedics donned N95 respirators, the respiratory therapist in the emergency department did not, according to the report.
“Lack of PPE availability in the field and lack of knowledge regarding where respirators and surgical masks were located in the ED were cited as two reasons why appropriate PPE was not worn by healthcare workers,” states MMWR.
The report concludes by recommending that healthcare facilities should:
- Review local health authority reporting procedures to ensure timely reporting of notifiable diseases, such as N. meningitis
- Provide infection-control training and PPE to potentially exposed workers.
- Conduct timely and thorough investigations to identify and evaluate workers potentially exposed to a patient suspected to have meningococcal disease.