(and what you can do about them) · pneumonia, bronchitis, sinus infections and ear infections are...
Post on 23-Aug-2020
9 Views
Preview:
TRANSCRIPT
(and what you can do about them)
What’s an outbreak? In general, more cases than expected (baseline) More cases clustered in a specific unit or facility than
you’d expect at a particular time of year
Some disease-specific definitions: One confirmed case of influenza in an LTC 2 or more cases (staff or residents) with vomiting,
diarrhea or both clustered by time and place
Outbreak investigation Start a line list to track ill residents and staff
Include: name, symptoms, onset of illness, resolution of illness and any lab testing/results
Notify Epidemiology (907-269-8000) of suspected outbreak Review cases and symptoms from line list Coordinate specimen (NP swab or stool) collection for lab testing
Implement infection control measures
Includes education of staff and visitors
Line list follow-up Monitor daily, confirm your cases Check each one with your case definition
What’s a line list?
https://public.health.oregon.gov/DiseasesConditions/CommunicableDisease/Outbreaks/Gastroenteritis/Pages/gastro.aspx#control
http://dhss.alaska.gov/dph/Epi/id/Pages/dod/norovirus.aspx
https://www.cdc.gov/longtermcare/prevention/index.html
Norovirus-general The most common cause of cases of acute gastroenteritis
and gastroenteritis outbreaks
Can affect nearly everyone in the population (from children to the elderly and everyone in between!) particularly because there is no long term immunity to the virus
Causes acute but self-limited diarrhea, often with vomiting,
abdominal cramping, fever, and fatigue Most individuals recover from acute symptoms with 2-3 days , but can be more severe in vulnerable populations
Burden of Norovirus Infection
#1 cause of acute gastroenteritis in U.S. 21 million cases annually 21 million cases annually 1 in 14 Americans become ill each year
71,000 hospitalized annually in U.S.
91,000 emergency room visits overall in the U.S. 80 deaths annually in UK (global disease)
Occurs year round with peak activity during the winter months Scallan et al. 2011. EID. 17(1): 7-15.; Patel et al. 2008. EID. 14(8); 1224-31.; Harris et al. 2008. EID. 14(10); 1546-52.
Norovirus Infectious dose: 18-1000 viral particles
Viral shedding is mostly in stool (can be in vomit) Shedding peaks in 4 days after exposure
Incubation period: 12-48 hours
Acute-onset vomiting and/or diarrhea
Watery, non-bloody stools Abdominal cramps, nausea, low-grade fever 30% infections asymptomatic
Most recover after 12-72 hours
More severe illness and death possible in elderly
Norovirus Transmission Highly contagious (as low as 18 virus particles)
Survives freezing and heat (140 F)
Direct person to person Fecal-oral Vomitus Indirect via fomites or contaminated environment
Food or water
Infected by food handlers Point source (e.g. food-raw, served multiple days) Well contamination or chlorination insufficient
In healthcare, the most likely and common modes of transmission are through direct contact with infected persons or contaminated equipment
What should I do for suspected cases of norovirus? Rapid identification and isolation of suspected cases Communicate and coordinate efforts with your
infection prevention team Call SOE (907-269-8000) Review norovirus guidelines (CDC, Alaska, Oregon)
Implement control measures as soon as possible;
don’t wait for lab results!
Summary Detect and confirm suspected norovirus cases rapidly During outbreaks, implement Contact Precautions,
enhanced hand hygiene, environmental infection control measures, exclusion of ill staff from work for a minimum of 48 hrs
after symptom resolution surveillance for new and resolving cases,
Develop a communication plan during outbreaks to include key departments and services
Consult with and report outbreak to state health department (907-269-8000)
Influenza Be aware of influenza activity in your area http://dhss.alaska.gov/dph/Epi/id/Pages/influenza/fluinfo.aspx
Outbreaks of flu in long-term care facilities are
COMMON have a plan! One confirmed case of influenza in an LTC is an outbreak Give antivirals and chemoprophylaxis to residents
Influenza in the Elderly Adults > 65 years higher risk for developing complications
Pneumonia, bronchitis, sinus infections and ear infections are flu-related complications that can result in hospitalization or death
Annual influenza vaccination is recommended, no preference from CDC on which type of vaccine
A few studies that have shown improved immune response to the “high-dose” versus standard dose influenza vaccine
DiazGranados, CA et.al Efficacy of High-Dose versus Standard-Dose Influenza Vaccine in Older Adults NEJM 2014; 371:635-645
How Flu Spreads People with flu can spread to others-about 6 ft away
Spread by droplets made when people with flu cough,
sneeze or talk
Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching their own mouth or nose
Most adults may infect others 1 day before symptoms develop and 5 to 7 days after becoming sick
Influenza Vaccinations for Health Care Providers (HCP) HCP can acquire flu and
transmit flu to patients or other workers
Vaccination is still the most
effective intervention
People infected with flu can spread it one day before they feel sick through five to seven days after
*Higher vaccination rates among staff are associated with lower rates of flu in
residents (LTC) and patients (hospital)
Fundamentals to Prevent Flu Have a facility plan (include your pharmacist)!
Promote and give influenza vaccine Minimize exposure-use respiratory hygiene and cough
etiquette Management of ill HCP Adhere to infection control precautions for all patient-
care activities and aerosol-generating procedures Implement environmental infection control measures
Outbreak Prevention and Prep Vaccinate residents, patients and staff!
Influenza (annual) Don’t forget other VPDs: Chickenpox/varicella, MMR
Shingles (residents in LTC)
Have records of vaccination/immunity status for everyone
Have standing orders for antivirals/antibiotics in case of an outbreak (especially for Long Term Care)
Summary Detect and confirm suspected influenza cases rapidly During outbreaks, implement Droplet Precautions,
enhanced hand hygiene, environmental infection control measures, exclusion of ill staff from work for a minimum of 24 hrs after
they no longer have a fever surveillance for new and resolving cases,
Develop a communication plan during outbreaks to include key departments and services
Consult with and report outbreak to state health department (907-269-8000)
Resources • Centers for Disease Control and Prevention https://www.cdc.gov/flu/ Alaska DHSS, Epidemiology http://dhss.alaska.gov/dph/Epi/id/Pages/influenza/fluinfo.aspx
Infectious Diseases Society of America (IDSA) http://www.idsociety.org/Influenza/
Alaska Conditions Reportable to Public Health http://dhss.alaska.gov/dph/Epi/Pages/default.aspx
Condition Timeframe Acceptable report methods
Public Health Emergencies Immediate Phone* Infectious diseases • Sexually transmitted diseases or HIV • All other infectious diseases
Within 5 days Phone*, Fax, Mail
Firearm injuries Within 5 days Phone*, Fax Occupational disease and injury Within 5 days Phone, Fax Blood lead levels (link p14) • >5 ug/dl in persons < 18 years old • >10 ug/dl in persons >18 years old
Within 1 week Phone*, Fax, Mail
Toxic or hazardous exposures Within 1 day Phone*, Fax Healthcare associated infections required to be reported to federal authorities
Follow NHSN practice
NHSN
http://dhss.alaska.gov/dph/Epi/Documents/pubs/conditions/ConditionsReportable.pdf#page=8
http://dhss.alaska.gov/dph/Epi/Documents/pubs/conditions/ConditionsReportable_LABS.pdf
top related