水痘(水痘)在美国的医疗机构中很少见,但可以从带状疱疹患者那里传播给医护人员(HCWs),反过来,可能会将其进一步传播给未接种疫苗,免疫抑制,有风险,脆弱的病人。由于在推荐的儿童免疫接种计划中包括水痘疫苗接种以及在雇用期间筛查HCW的水痘免疫,因此这种情况并不常见。我们提供了一例医院获得性水痘的病例报告,该患者在长期住院期间通过HCW感染了水痘,该患者在暴露于患者的室友带状疱疹后感染了水痘。室友之间没有身体接触,但两名患者都有一个共同的HCW作为照顾者。带状疱疹患者立即被置于空中预防措施中,但是HCW继续工作,并与我们的患者有身体接触。HCW最初在接触带状疱疹患者18天后出现水痘,我们的患者在HCW后17天出现水痘。时间表和两个潜伏期,在我们的病人出现水痘之前,表明水痘在HCW中的传播是由于接触带状疱疹患者以及随后的患者。该病例强调了水痘(水痘)从接触带状疱疹患者到未免疫的HCWs的医院传播的可能性,并进一步传播给未免疫的患者。在就业时验证医务人员的免疫状况,强制豁免权,接触带状疱疹后,未接种疫苗的工作人员休假,接种疫苗或水痘带状疱疹免疫球蛋白(Varizig)的暴露后预防将最大程度地减少在医疗机构中传播水痘等传染病的风险。此外,建立患者免疫力,提高住院患者对带状疱疹的警惕和早期识别,并立即启动适当的感染控制将进一步预防此类事件并提高患者安全性。
这是一例31岁未接种水痘的患者,在住院80天期间出现水痘。在长期住院期间,他有不同的室友,但与他们没有身体接触,也没有访客。在大多数日子里,同样的HCW给他和他的室友提供了照顾。患者的一名室友被发现患有带状疱疹,并立即被转移到另一个房间,并采取适当的感染预防措施。HCW可能未接种水痘,并且在常规患者护理期间持续大量接触带状疱疹患者,其中涉及大量的身体接触。HCW没有休假,评估免疫力,或给予暴露后预防(PEP)。作为常规护理的一部分,HCW继续与我们的患者接触。在第18天,接触带状疱疹患者后,HCW患了水痘.此后17天,我们的病人出现了水痘.在接触带状疱疹患者后一个潜伏期后,HCW中水痘感染的时间间隔,然后在另一个潜伏期后,我们的患者中水痘感染的时间间隔表明水痘带状疱疹病毒(VZV)从带状疱疹患者传播到HCW,再从HCW传播到我们的患者。评估工作时医护人员对水痘的免疫力,确保只有具有免疫力的医护人员才能照顾带状疱疹和水痘患者,休假未免疫暴露的HCW,提供PEP,入院时记录患者对水痘的免疫力可能有助于预防VZV在医院环境中的传播。由于其具有很高的教育价值和相关的学习要点,因此这是一种尝试。
Chickenpox (varicella) is a rare occurrence in healthcare settings in the USA, but can be transmitted to healthcare workers (HCWs) from patients with herpes zoster who, in turn, can potentially transmit it further to unimmunized, immunosuppressed, at-risk, vulnerable patients. It is uncommon due to the inclusion of varicella vaccination in the recommended immunization schedule for children and screening for varicella immunity in HCWs during employment. We present a
case report of hospital-acquired chickenpox in a patient who developed the infection during his prolonged hospital stay through a HCW who had contracted chickenpox after exposure to our patient\'s roommate with herpes zoster. There was no physical contact between the roommates, but both patients had a common HCW as caregiver. The herpes zoster patient was placed in airborne precautions immediately, but the HCW continued to work and have physical contact with our patient. The HCW initially developed chickenpox 18 days after exposure to the patient with herpes zoster, and our patient developed chickenpox 17 days after the HCW. The timeline and two incubation periods, prior to our patient developing chickenpox, indicate transmission of chickenpox in the HCW from exposure to the herpes zoster patient and subsequently to our patient. The
case highlights the potential for nosocomial transmission of chickenpox (varicella) to unimmunized HCWs from exposure to patients with herpes zoster and further transmission to unimmunized patients. Verification of the immunization status of HCWs at the time of employment, mandating immunity, furloughing unimmunized staff after exposure to herpes zoster, and postexposure prophylaxis with vaccination or varicella zoster immunoglobulin (Varizig) will minimize the risk of transmission of communicable diseases like chickenpox in healthcare settings. Additionally, establishing patients\' immunity, heightened vigilance and early identification of herpes zoster in hospitalized patients, and initiation of appropriate infection control immediately will further prevent such occurrences and improve patient safety.
This is a
case report of a varicella-unimmunized 31-year-old patient who developed chickenpox during his 80-day-long hospitalization. He had different roommates during his long hospital stay but had no physical contact with them and neither had visitors. On most days, the same HCW rendered care to him and his roommates. One of the patient’s roommates was found to have herpes zoster and was immediately moved to a different room with appropriate infection prevention measures. The HCW is presumably unimmunized to varicella and sustained significant exposure to the patient with herpes zoster during routine patient care which involved significant physical contact. The HCW was not furloughed, assessed for immunity, or given postexposure prophylaxis (PEP). The HCW had continued contact with our patient as part of routine care. On day 18, after exposure to the patient with herpes zoster, the HCW developed chickenpox. 17 days thereafter, our patient developed chickenpox. The time interval of chickenpox infection in the HCW after one incubation period after exposure to the patient with herpes zoster followed by a similar infection of chickenpox in our patient after another incubation period suggests the spread of varicella zoster virus (VZV) from the herpes zoster patient to the HCW and further from the HCW to our patient. Assessing the immunity of HCWs to varicella at the time of employment, ensuring only HCWs with immunity take care of herpes zoster and varicella patients, furloughing unimmunized exposed HCWs, offering PEP, and documentation of patients’ immunity to varicella at the time of hospital admission could help prevent VZV transmission in hospital settings. This is an attempt to publish this novel
case due to its high educational value and relevant learning points.