OHW 91 - Special Considerations When Investigating Exposures to Patients with Mpox with Prolonged Hospitalizations and Comorbidities in a Large Acute Care Facility

Background: Since July 2022, there have been 21 Mpox cases identified in our 928-bed hospital. Most cases have primarily presented in the emergency room and discharged with the exception of two patients. These cases required special considerations during the exposure investigation due to prolonged hospitalizations, significant comorbidities, and procedures resulting in extensive staff exposures.

Methods: Infection Prevention utilized Centers for Disease Control and Preventions (CDC) guidance and a health department risk assessment tool to identify exposed staff with considerations for two unique inpatient cases.
A male patient with a prolonged hospitalization due to severe immunosuppression, considerable comorbidities, and poor response to treatment led to a re-evaluation of exposure investigations. This patient expired in the hospital. Daily risk assessments of frontline staff, a modified visitation policy to protect patient privacy, strict post-mortem guidance, and communication with public health partners were implemented.
A second case involved a female patient who presented for a labial abscess incision and drainage (I&D). Since she was positive for chlamydia, Mpox was not suspected until her partner tested positive for Mpox the following day. Due to insufficient personal protective equipment (PPE) use during the initial I&D, an exposure investigation was completed before laboratory confirmation of Mpox was finalized to allow for timely post-exposure vaccinations.

Results: The male patient case did not result in any exposures to staff while the female patient case resulted in 16 intermediate-to-high-risk staff exposures with 14 of those individuals receiving post-exposure vaccinations.

Conclusions: Even with CDC and health department guidance, further logistical implementation of recommendations can prove to be challenging with additional barriers from unique patient cases. Through collaboration with frontline staff and public health partners, processes can be adapted to ensure that all staff and visitors are protected and that exposed staff have appropriate and timely follow-up.