Guidelines should also be in place for management of healthcare workers exposed to certain infectious diseases at work, including tuberculosis, blood-borne pathogens, varicella, and others.
Triage policies
Physicians and clinic managers should consider implementing triage policies to separate infectious patients from others when they arrive at the facility. If respiratory hygiene measures are followed, asking those with common respiratory infections sit in common waiting areas and using common exam rooms is acceptable practice.
Patients with rash and fever present a different problem. Diseases with this presentation include measles, rubella, and varicella—all highly contagious and with potentially serious effects, especially in the immune compromised. Smallpox and monkeypox can also present with these symptoms, although the likelihood is remote. Consider triaging rash and fever patients immediately to a “rash room” and keeping them confined there until the clinical diagnosis is clarified. The best practice is to have a separate entrance and exit location for such patients.
Should one of the more serious diseases remain a possibility after evaluation, further measures might be necessary including avoidance of use of the rash room until disinfected and consultation with the local health department about recommendations for post exposure measures for staff and patients.
Correspondence
1825 E. Roosevelt, Phoenix, AZ 85006. E-mail: dougcampos@mail.maricopa.gov