Mrs Allison Hodge1, Mrs Sue Flockhart1, Ms Catrice Grahame1
1Ballarat Health Services, Ballarat, Australia
43 year old female presented to the emergency department (ED) with a rash, fever, photophobia, headache on the background of recent travel to Cambodia and Vietnam. The rash was noted “red and purpely” on the triage notes but at no time was this examined in the ED. The patient was in the busy ED waiting room for four hours prior to being seen by an ED doctor. The patient was admitted to the ward (into a 4-bed bay) with a provisional diagnosis of illness in a returned traveller.
Infectious diseases (ID) and Infection Control (IC) were only notified 30 hours post admission when it was thought the patient may have measles but this could not be confirmed, as the treating team had never seen a measles rash before.
Priorities were to confirm measles diagnosis, isolate the patient appropriately into airborne precautions, and begin contact tracing. By that afternoon we had confirmation that the patient was PCR and IgM positive.
65 staff members and 43 patient contacts required follow-up, this was in the form of phone calls, pathology, immunisation and the administration of immunoglobulin.
The late diagnosis of measles placed other patients and staff at risk of infection. Despite measles being highly focused in the media leading up to this presentation, the diagnosis was still missed. The introduction of an Infection Control Alert Screening Tool will hopefully guide ED staff not to miss similar presentations.
Allison has been working in the area of Infection Prevention and Control for 8 years. She has a Graduate Certificate in Infection Control from Griffith University, Queensland and an accredited Nurse Immuniser, and a HIV/Hep C counsellor.