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Preparedness Holds Key to Management of Infectious Diseases Offshore

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International SOS has led medical services operations on offshore installations globally and has managed clinical cases in which patients presented with signs and symptoms of known infectious illnesses. In a recent example, three cases of mumps were identified among the work force on an operating oil and gas rig offshore Guyana. The complete paper describes the recommended steps that were followed in the management of the cases. The authors consider these steps to be best practices in infectious disease management on offshore installations.

Disease Overview

Mumps is a viral infection best known for the swelling of the cheeks and jaw seen in patients, a result of infection of the salivary glands. When mumps affects adults, it can lead to complications such as meningitis (inflammation of the lining of the brain and spinal cord) and orchitis (inflammation of the testicles). Initial symptoms include headache, muscle pain, low-grade fever, and malaise. Soon after, painful swelling of the glands in the cheeks and jaw occurs. There is no specific treatment for mumps. It is generally a mild, self-limiting disease that requires only symptomatic management.

Transmission. Mumps is spread by airborne transmission or by direct contact. It spreads mainly through close contact with a person who is sick with the disease; however, people who are asymptomatic also can be contagious. Saliva and droplets coughed or sneezed by an infected person are contaminated with the virus and can infect others by contact with a person’s nose or mouth or contaminated droplets or saliva settling on objects in the environment.

Some people, even those who are fully vaccinated, have an increased risk of contraction. These groups include

  • People who have had close contact with someone who has mumps
  • People in outbreak settings, particularly in universities and other close-knit communities
  • During an outbreak, people who have received fewer than two doses of virus-containing vaccine or have unknown vaccination status

Incubation Period. Incubation period is defined as the time between initial exposure to the disease and development of symptoms. For mumps, the incubation period is between 12 and 25 days (usually 16 to 18 days), specifically 2 to 7 days before and 5 to 9 days after the onset of swelling of the salivary glands. Up to 20% of people who contract mumps have very mild or no symptoms and therefore do not know that they have been infected.

Two doses of vaccine are usually recommended to achieve immunity, while those who have been infected are generally considered immune for life. No specific treatment for mumps exists; it is a viral infection that will not respond to antibiotics.

Offshore Mumps Incident Management

Preparedness is key in managing an outbreak of a disease such as mumps; this includes pre-event, during-event, and post-event procedures. While medical literature establishes the clinical practice guidelines to treat infectious disease cases, an observed deficiency exists in resources that help in the integration of the medical knowledge into an industrial environment—as in an operating offshore drilling rig—for establishing good practices that can be followed in similar scenarios. These recommended practices are outlined in the following subsections.

Simulation Drills. Offshore installation management should allocate time and resources for both desktop and hands-on practical simulation exercise or drills. These can include scenarios of infectious diseases affecting one or multiple onsite employees. The objective is to challenge the healthcare system and procedure onsite in order to uncover gaps.

Monitoring and Surveillance Resources. Identification of a reliable and authentic source of information about world news on potential outbreaks globally and in the region is critical for timely response and preparedness for managing possible infectious disease incidents onsite. In most cases, those incidents will require supplies and resource allocation onsite and onshore.

Vetting of Onshore Medical Facilities. Understanding the capabilities of medical facilities onshore is an important step in the development of an effective emergency-response procedure. This information should be available before an incident develops and should be updated regularly because clinical-care status and level of service of local facilities will change over time.

Hygiene. In the case of mumps, respiratory and personal hygiene is important to reduce transmission. This includes health education on practices such as the following:

  • Keeping a distance (at least 3 ft) from people who are obviously sick (coughing, sneezing)
  • Covering coughs and sneezes with a tissue or the upper sleeve or inner elbow
  • Washing hands often and well
  • Carrying hand sanitizer when hand-washing facilities are not readily available
  • Refraining from touching the face
  • Not sharing food, drink, or utensils

Vaccination. Vaccination against mumps is recommended as routine for children in many countries. Only a combined vaccine, known as MMR (measles, mumps, rubella), is available. The vaccine contains live, weakened virus. Two doses of vaccine are usually recommended to achieve immunity. All adults are advised to receive vaccination, especially those who are more likely to be exposed, such as international travelers, healthcare workers, and those in educational facilities. During an outbreak, a booster dose may be administered to fully vaccinated people who are at an increased risk of infection.

It is important to remember that some people cannot be vaccinated, including those who are pregnant, have underlying immune deficiency, or are allergic to the vaccine.

Screening. This is the examination of a group of usually asymptomatic individuals to detect those with a high probability of having or developing a given disease. In the case of mumps, identified cases should be given a surgical mask and moved to an isolation room until they are able to leave the premises. Anyone assisting the patient should be known to be immune to mumps and should be provided with appropriate personal protective equipment (PPE). Ideally, any room that an infectious person has been in should be left vacant for 2 hours after being cleaned.

Isolation. All individuals with suspected mumps infection should be isolated to minimize transmission of infection. Onsite, cases should be given a surgical mask, and individuals should be kept isolated from other people until they can leave the premises. Criteria for a successful isolation room onsite include the following:

  • Location away from staff traffic
  • Location away from galley or recreational rooms
  • Access to dedicated toilet and sink
  • Comfortable and furniture-equipped
  • Adequate size
  • Privacy ensured
  • Signage on the door
  • PPE available by the room entrance
  • Restriction of visitors

PPE. Standard droplet and airborne-transmission precautions (gown, gloves, and masks) should be used by anyone who comes in contact with a suspected or confirmed case of mumps or their environment. Those in contact with the patient must be immune. This does not mean that routine infection-control principles can be disregarded. Staff must continue to pay attention to personal hygiene, including hand washing and respiratory hygiene. Suspected and confirmed mumps cases should wear a face mask.

Cleaning and Disinfection. The virus can be spread by indirect transmission through shared objects. Cleaning and disinfection of potentially contaminated surfaces and objects will minimize the risk of transmission. Cleaning should be performed by staff known to be immune to mumps and fully immunized for routine and other relevant diseases. Cleaning staff should wear gloves as a routine precaution. As previously mentioned, entry of any nonimmune people into any room that a known infectious person has been in should be prevented until 2 hours after they have left and the room has been cleaned. After 2 hours, regular cleaning (surface cleaning and disinfection) is to continue as usual.

The following cleaning and disinfection guidelines apply:

  • The frequency of cleaning of high-traffic areas, frequently touched surfaces, and shared objects should be increased.
  • Cleaning staff should be known to be immune to mumps and up to date with routine vaccinations and should wear gloves when cleaning.
  • Cleaning staff should pay strict attention to personal hygiene.
  • If bodily fluids and excretions are involved, cleaning staff must be appropriately trained and must wear full PPE (gloves, gowns, masks, and eye protection).
  • Environmental Protection Agency-registered cleaning and disinfection solutions should be used.
  • Cleaning should continue per usual guidelines, including wiping all touched surfaces.
  • Curtains, towels, and bed linens should be washed and dried in appropriate machines. Cleaning staff should wash their hands after handling these items.
  • If practical, entry of other employees and visitors to any room that had been occupied by a known infectious person should be prevented until 2 hours after they have left and the room has been cleaned.

Food Handling and Caterers. No changes are required for onsite practices. A food handler who provides meals to the isolation room offshore should follow PPE recommendations.

Management of Contacts. All possible contacts working together or sharing the same room should be traced and screened regularly for possible signs and symptoms until clearance of the incident. A contact-tracing document should be maintained onsite and considered a confidential medical record. All contacts should be given information on mumps. Anyone who is not immune (or does not know their immune status) should be advised to seek medical attention.

Reporting. Many countries require special reporting standards in the circumstances of identification of infectious illness for purposes of control, case monitoring, and data collection. Understanding these requirements in specific nations is critical. Within the organization, reporting is a vital part of communication and is necessary to keep stakeholders informed to ensure proper case management.

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 199458, “Management of Infectious Diseases Offshore,” by Salwan Ibrahim, International SOS, and Andry Nowosiwsky, ExxonMobil, prepared for the 2020 SPE International Conference and Exhibition on Health, Safety, Environment, and Sustainability, originally scheduled to be held in Bogota, Colombia, 28–30 July. The paper has not been peer reviewed.

Preparedness Holds Key to Management of Infectious Diseases Offshore

01 August 2020

Volume: 72 | Issue: 8

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