New Virus on the Block: Introducing Infection Control Processes for Mpox Patients in the Emergency Department During a Major Outbreak

Background Caring for Mpox cases is complicated due to enhanced isolation precautions and healthcare worker monitoring requirements. Emergency department (ED) healthcare workers (HCW) are at particular risk of exposure if infection prevention measures are not met or symptoms are not immediately identified. In July 2022, the World Health Organization declared a Mpox outbreak and public health emergency of international concern. In our medical center, Hospital Epidemiology was tasked with preparing for this epidemic. Methods Epidemiology developed a comprehensive protocol for Mpox patient care and staff safety and collaborated with the ED, Microbiology, Environmental Services, and Hospital leadership. The protocol established case definitions, infection control measures, patient disposition, clinical management, considerations for lab, medications, procedures, radiology, food and nutrition, cleaning/disinfection, linens, waste management, exposure management, and HCW monitoring. A condensed version was provided to the ED in a checklist format including step-by-step workflows. Additionally, Epidemiology developed an electronic survey for ED HCW to identify those meeting exposure criteria to be contacted for investigation. Lastly, Epidemiology nurses provided in-person/virtual education about Mpox and infection control measures. Results From June – November 2022, the ED evaluated 241 suspected patients, tested 223, and found 108 positive cases. There were eight exposure incidences in the ED with 235 HCW involved; only eight HCW met high-risk exposure criteria and none developed secondary infections. Epidemiology successfully introduced collaborative protocols, checklists, and exposure monitoring to facilitate Mpox patient care in the ED. As public health guidance evolved, Epidemiology rapidly updated the internal documents and enabled the ED to safely deliver crucial medical care. Conclusions Epidemiology played a critical role in supporting the ED during a Mpox outbreak in the community through collaboration with key stakeholders to develop protocols, checklists, and electronic monitoring. These processes allowed the ED to safely care for large numbers of suspect/confirmed Mpox patients. Caring for Mpox cases is complicated due to enhanced isolation precautions and healthcare worker monitoring requirements. Emergency department (ED) healthcare workers (HCW) are at particular risk of exposure if infection prevention measures are not met or symptoms are not immediately identified. In July 2022, the World Health Organization declared a Mpox outbreak and public health emergency of international concern. In our medical center, Hospital Epidemiology was tasked with preparing for this epidemic. Epidemiology developed a comprehensive protocol for Mpox patient care and staff safety and collaborated with the ED, Microbiology, Environmental Services, and Hospital leadership. The protocol established case definitions, infection control measures, patient disposition, clinical management, considerations for lab, medications, procedures, radiology, food and nutrition, cleaning/disinfection, linens, waste management, exposure management, and HCW monitoring. A condensed version was provided to the ED in a checklist format including step-by-step workflows. Additionally, Epidemiology developed an electronic survey for ED HCW to identify those meeting exposure criteria to be contacted for investigation. Lastly, Epidemiology nurses provided in-person/virtual education about Mpox and infection control measures. From June – November 2022, the ED evaluated 241 suspected patients, tested 223, and found 108 positive cases. There were eight exposure incidences in the ED with 235 HCW involved; only eight HCW met high-risk exposure criteria and none developed secondary infections. Epidemiology successfully introduced collaborative protocols, checklists, and exposure monitoring to facilitate Mpox patient care in the ED. As public health guidance evolved, Epidemiology rapidly updated the internal documents and enabled the ED to safely deliver crucial medical care. Epidemiology played a critical role in supporting the ED during a Mpox outbreak in the community through collaboration with key stakeholders to develop protocols, checklists, and electronic monitoring. These processes allowed the ED to safely care for large numbers of suspect/confirmed Mpox patients.