Infection Control & Hospital Epidemiology
duration of sick leave. Currently, oseltamivir prophylaxis is aimed at preventing influenza infection in unvaccinated or high-risk populations or to prevent secondary transmission in long-term care facilities in the context of an outbreak.4,5 We could not demonstrate that expanding oseltamivir PEP to all exposed HCWs was associated with a decrease in absenteeism, but this is a single-center experience in a setting with high HCW vaccination rates. However, both 2016–2017 and 2017–2018 influenza seasons were similar in Iowa, with a predominance of A (H3N2) influenza viruses and an overall vaccine effectiveness of only 40%.6–8 Absenteeism rates may have been similar due to HCWs pre- senting to work regardless of symptoms (ie, presenteeism). Expanded PEP may have been effective in those who took osel- tamivir, but we could not analyze absenteeism stratified by PEP uptake. Expanding oseltamivir prophylaxis indications needs to be carefully assessed because it could contribute to the develop- ment of oseltamivir-resistant strains.9 In conclusion, we were unable to demonstrate reduced absenteeism by providing oseltamivir PEP to all exposed HCWs regardless of their vaccination status. Larger prospective studies may clarify the role of expanded PEP, especially during seasons with low vaccination effectiveness. Other preparedness strategies might be needed to achieve the right balance of minimizing sick leave by preventing HCW influenza acquisition while also mini- mizing presenteeism.
Acknowledgments. None. Financial support. No financial support was provided for this analysis.
261
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
References
1. Rule AM, Apau O, Ahrenholz SH, et al. Healthcare personnel exposure in an emergency department during influenza season. PLoS One 2018;13: e0203223.
2. Saxen H, Virtanen M. Randomized, placebo-controlled double blind study on the efficacy of influenza immunization on absenteeism of health care workers. Pediatr Infect Dis J 1999;18:779–783.
3. Recommended vaccines for healthcare workers. Centers for Disease Control and Prevention website.
https://www.cdc.gov/vaccines/adults/rec- vac/
hcw.html. Accessed October 16, 2018.
4. Influenza antiviral medications: summary for clinicians. Centers for Disease Control and Prevention website.
https://www.cdc.gov/flu/professionals/ antivirals/
summary-clinicians.htm. Accessed October 16, 2018.
5. Booy R, Lindley RI, Dwyer DE, et al. Treating and preventing influenza in aged care facilities: a cluster randomised controlled trial. PLoS One 2012;7:e46509.
6. Seasonal influenza vaccine effectiveness, 2004–2018. Centers for Disease Control and Prevention website.
https://www.cdc.gov/flu/professionals/ vaccination/
effectiveness-studies.htm. Accessed October 16, 2018.
7. Summary of the 2017–2018 influenza season. Centers for Disease Control and Prevention website.
https://www.cdc.gov/flu/about/season/flu-season- 2017-2018.htm. Accessed October 16, 2018.
8. Summary of the 2016–2017 influenza season. Centers for Disease Control and Prevention website.
https://www.cdc.gov/flu/about/season/flu-season- 2016-2017.htm. Accessed October 16, 2018.
9. Graitcer SB, Gubareva L, Kamimoto L, et al. Characteristics of patients with oseltamivir-resistant pandemic (H1N1) 2009, United States. Emerg Infect Dis 2011;17:255–257.
Establishing a mass prophylaxis clinic during a hospital scabies outbreak
Caitlin M. Adams Barker MSN, RN, CIC1, M. James Alexander BS2 and Antonia L. Altomare DO, MPH1,3 1Collaborative Healthcare-Associated Infection Prevention Program, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, 2Emergency Management
Program, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire and 3Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, US
To the Editor—An immunocompromised hospital inpatient with Norwegian (crusted) scabies went undiagnosed for 6 weeks without isolation or treatment. A literature review revealed little guidance on the logistics of providing mass prophylaxis to exposed individuals. We used a hospital-based incident command system to establish a mass prophylaxis clinic. A patient with a history of gynecological malignancy undergoing chemotherapy was admitted to a 33-bed hema- tology-oncology, bone marrow transplant unit at our academic medical center in northern New England. The patient had skin
Author for correspondence: Caitlin M. Adams Barker MSN, RN, CIC, 1 Medical
Center Drive, Lebanon, NH 03756. E-mail:
Caitlin.m.adams.barker@
hitchcock.org PREVIOUS PRESENTATION: These data were previously reported as a poster pre- sentation at the 2015 SHEA Annual Conference on May 15, 2015, in Orlando, Florida. Cite this article: Adams Barker CM, et al. (2019). Establishing a mass prophylaxis
clinic during a hospital scabies outbreak. Infection Control & Hospital Epidemiology 2019, 40, 261–263. doi: 10.1017/ice.2018.322
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
plaques and rash of unknown etiology, which went undiag- nosed for 43 days due to the absence of pain or itching. Dermatology was consulted, and an exam revealed diffuse crusted hyperkeratotic scaly macules and papules including plaques in the webbing of the fingers. Skin scraping with mineral oil preparation revealed at least 5 scabies mites. The patient was diagnosed with crusted scabies, placed on contact precautions, and treated with oral ivermectin and topical permethrin. Upon notification, the infection prevention (IP) program
reviewed guidance from the Centers for Disease Control and Prevention and additional literature to assess recommendations for providing prophylaxis in the setting of a prolonged period of undiagnosed crusted scabies in a healthcare facility. Modified institution-wide prophylaxis for patients, staff, visitors, and household contacts was deemed necessary to prevent an outbreak of scabies within the facility. The literature lacked guidance on
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