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An Outbreak of Conjunctivitis and Respiratory Infection in a Long-Term-Care Facility
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Vol. 32 No. 3
Cooling towers have been implicated as a disseminator of Legionella, which occurs most often in autumn months. No recent outbreaks of Legionnaires’ disease had been reported from either the surrounding community or Brookdale University Medical Center (BUMC). Between August and October 2002, eight cases of Legionella were reported to the Department of Infection Control by the BUMC laboratory. All cases were in turn reported to the New York City (NYC) New York State (NYS) departments of health. PROJECT: To determine if a cluster of Legionella cases were nosocomial or a seasonal community-acquired outbreak and to pinpoint the source of the cluster. RESULTS: Cases were diagnosed by Legionella pneumophila serogroup urine antigen testing. A line listing was compiled of all cases reported from laboratory reports and information systems including date of admission, previous admission history, chest X-ray results, and specimen results. The cases were reported to the NYC and NYS departments of health and the investigation was conducted in conjunction with epidemiologists and public health investigators. Medical records were reviewed for all cases. Patient zip codes and addresses were acquired to rule out a common source exposure. Record reviews and interviews did not indicate common workplaces, housing areas, or social gathering sites for the patients (i.e., areas where contaminated water sources could be found). LESSON LEARNED: Healthcare facilities should be vigilant for clusters of patients with Legionella symptoms, educate their staff about the disease, perform prompt reporting, and enhance communication between the hospital lab, infection control, and the local health department. An investigation to rule out a nosocomial outbreak should include the compilation of specific information that differentiates between nosocomial and communityacquired infection.
An Outbreak of Conjunctivitis and Respiratory Infection in a Long-Term-Care Facility VD Moroz Thompson Health Canandaigua, New York
BACKGROUND: Conjunctivitis, or ‘‘pinkeye,’’ can be either infectious (bacterial or viral), allergic, or an irritant (caused by something in the eye). Bacterial conjunctivitis may be caused by several different types of bacteria, including Haemophilus influenzae, Pneumococci, Staphylococci, or Streptococci. This long-term-care skilled nursing facility has five units (Avenues) and a total of 188 beds. The Avenue affected by this outbreak contains 39 beds. OBJECTIVE: To investigate and control an outbreak of conjunctivitis and/or respiratory infections. METHODS: Cases were retrospectively and prospectively identified and were defined as acute once there were signs of pinkeye or eye drainage and/or respiratory symptoms. Eye cultures and sputum cultures were obtained from residents and healthcare workers and sent for viral and bacterial testing. Residents were placed on contact precautions, and healthcare workers were not permitted to work until they were free of respiratory illness or their pinkeye had resolved. Residents and staff were treated with antibiotics and/or eye drops. Increased frequency of environmental cleaning of all contact points was instituted. During this outbreak period, residents and staff were not permitted to travel to other Units (Avenues) for meals or common activities. Floating was strongly discouraged. RESULTS: A total of 18 residents and 11 healthcare workers were identified over a 3–4 week period. Eleven cultures were positive for Haemophilus influenzae and three grew out coagulase-negative staph. CONCLUSIONS: Haemophilus influenzae outbreaks can present a challenge to the elderly in long-term-care settings. Healthcare workers can be the source of your outbreak and your index case. In this outbreak, although cultures were not obtained on most of the healthcare workers, two healthcare workers were the first individuals to
May 2004
E77
become ill and two healthcare workers grew out Haemophilus influenzae on their cultures. Control of conjunctivitis and respiratory illness in long-term-care settings requires quick identification of healthcare workers and residents who have pinkeye and/or respiratory symptoms. Culturing for pathogen identification is important to determine a bacterial or viral source.
Hand Hygiene—Action Gets Results C Paulus* C Clark Gottlieb Memorial Hospital, Melrose Park, Illinois
ISSUE: To educate staff on revised CDC guidelines for hand hygiene and improve hand hygiene compliance. PROJECT: Develop an interactive, educational year-long campaign to increase staff awareness of the importance of hand hygiene. Each month, based on a seasonal theme, we took pictures of staff performing hand hygiene. These photos were then used to make posters with educational information. To increase interest in the program, we used various ‘‘props’’ and ‘‘slogans’’ to promote our message. The posters were then placed in departments throughout the facility. To monitor the success of the program hand hygiene compliance was measured by random observations of hand hygiene compliance. The annual campaign ended with a 2004 calendar featuring photos of our staff performing hand hygiene. This calendar will continue to promote the message of ‘‘clean hands’’ throughout the next year. RESULTS: Hand hygiene compliance increased by 11% over the baseline rate. Staff participated in the creativity of developing unique photos and slogans. LESSONS LEARNED: Staff compliance with hand hygiene increased by promoting awareness and involving staff from all departments to promote the message. Visible reminders posted in the facility helped to promote awareness of the importance of hand hygiene.
Patient Safety: Reduce the Risk of Ventilator-Associated Pneumonia S Hillis* R Hall N Simpson Blount Memorial Hospital, Maryville, Tennessee
ISSUE: Ventilator-associated pneumonia (VAP) is a common complication in the intensive care unit (ICU) in ventilated patients. PROJECT: To reduce the risk of healthcare-acquired, ventilator-associated pneumonia with nursing practice improvements and a comprehensive oral care program. A multidisciplinary team reviewed infection rates and current patient-care practices of ventilated patients in the ICU. Actions were taken and evaluated during a 6-month period. Intubated patients were provided oral care every 2 hours and more often as needed. Teeth were brushed every 12 hours and the mouth swabbed every 2 hours. Patients were assessed to determine the need for removal of subglottic secretions every 6- 8 hours as well as prior to repositioning the tube or deflation of the cuff. Head of bed was raised to 30 degrees at all times. A dedicated oral suction line was used. Oral-care supplies were packaged and placed in easily obtained location in patient room. The contents included one covered yankauer tip, suction handle, and y-connector; suction toothbrush with sodium bicarbonate; mouth moisturizer; and applicator swabs. The products were packaged with quantity needed for 24-hour period, with a team member reviewing
Vol. 32 No. 3
Cooling towers have been implicated as a disseminator of Legionella, which occurs most often in autumn months. No recent outbreaks of Legionnaires’ disease had been reported from either the surrounding community or Brookdale University Medical Center (BUMC). Between August and October 2002, eight cases of Legionella were reported to the Department of Infection Control by the BUMC laboratory. All cases were in turn reported to the New York City (NYC) New York State (NYS) departments of health. PROJECT: To determine if a cluster of Legionella cases were nosocomial or a seasonal community-acquired outbreak and to pinpoint the source of the cluster. RESULTS: Cases were diagnosed by Legionella pneumophila serogroup urine antigen testing. A line listing was compiled of all cases reported from laboratory reports and information systems including date of admission, previous admission history, chest X-ray results, and specimen results. The cases were reported to the NYC and NYS departments of health and the investigation was conducted in conjunction with epidemiologists and public health investigators. Medical records were reviewed for all cases. Patient zip codes and addresses were acquired to rule out a common source exposure. Record reviews and interviews did not indicate common workplaces, housing areas, or social gathering sites for the patients (i.e., areas where contaminated water sources could be found). LESSON LEARNED: Healthcare facilities should be vigilant for clusters of patients with Legionella symptoms, educate their staff about the disease, perform prompt reporting, and enhance communication between the hospital lab, infection control, and the local health department. An investigation to rule out a nosocomial outbreak should include the compilation of specific information that differentiates between nosocomial and communityacquired infection.
An Outbreak of Conjunctivitis and Respiratory Infection in a Long-Term-Care Facility VD Moroz Thompson Health Canandaigua, New York
BACKGROUND: Conjunctivitis, or ‘‘pinkeye,’’ can be either infectious (bacterial or viral), allergic, or an irritant (caused by something in the eye). Bacterial conjunctivitis may be caused by several different types of bacteria, including Haemophilus influenzae, Pneumococci, Staphylococci, or Streptococci. This long-term-care skilled nursing facility has five units (Avenues) and a total of 188 beds. The Avenue affected by this outbreak contains 39 beds. OBJECTIVE: To investigate and control an outbreak of conjunctivitis and/or respiratory infections. METHODS: Cases were retrospectively and prospectively identified and were defined as acute once there were signs of pinkeye or eye drainage and/or respiratory symptoms. Eye cultures and sputum cultures were obtained from residents and healthcare workers and sent for viral and bacterial testing. Residents were placed on contact precautions, and healthcare workers were not permitted to work until they were free of respiratory illness or their pinkeye had resolved. Residents and staff were treated with antibiotics and/or eye drops. Increased frequency of environmental cleaning of all contact points was instituted. During this outbreak period, residents and staff were not permitted to travel to other Units (Avenues) for meals or common activities. Floating was strongly discouraged. RESULTS: A total of 18 residents and 11 healthcare workers were identified over a 3–4 week period. Eleven cultures were positive for Haemophilus influenzae and three grew out coagulase-negative staph. CONCLUSIONS: Haemophilus influenzae outbreaks can present a challenge to the elderly in long-term-care settings. Healthcare workers can be the source of your outbreak and your index case. In this outbreak, although cultures were not obtained on most of the healthcare workers, two healthcare workers were the first individuals to
May 2004
E77
become ill and two healthcare workers grew out Haemophilus influenzae on their cultures. Control of conjunctivitis and respiratory illness in long-term-care settings requires quick identification of healthcare workers and residents who have pinkeye and/or respiratory symptoms. Culturing for pathogen identification is important to determine a bacterial or viral source.
Hand Hygiene—Action Gets Results C Paulus* C Clark Gottlieb Memorial Hospital, Melrose Park, Illinois
ISSUE: To educate staff on revised CDC guidelines for hand hygiene and improve hand hygiene compliance. PROJECT: Develop an interactive, educational year-long campaign to increase staff awareness of the importance of hand hygiene. Each month, based on a seasonal theme, we took pictures of staff performing hand hygiene. These photos were then used to make posters with educational information. To increase interest in the program, we used various ‘‘props’’ and ‘‘slogans’’ to promote our message. The posters were then placed in departments throughout the facility. To monitor the success of the program hand hygiene compliance was measured by random observations of hand hygiene compliance. The annual campaign ended with a 2004 calendar featuring photos of our staff performing hand hygiene. This calendar will continue to promote the message of ‘‘clean hands’’ throughout the next year. RESULTS: Hand hygiene compliance increased by 11% over the baseline rate. Staff participated in the creativity of developing unique photos and slogans. LESSONS LEARNED: Staff compliance with hand hygiene increased by promoting awareness and involving staff from all departments to promote the message. Visible reminders posted in the facility helped to promote awareness of the importance of hand hygiene.
Patient Safety: Reduce the Risk of Ventilator-Associated Pneumonia S Hillis* R Hall N Simpson Blount Memorial Hospital, Maryville, Tennessee
ISSUE: Ventilator-associated pneumonia (VAP) is a common complication in the intensive care unit (ICU) in ventilated patients. PROJECT: To reduce the risk of healthcare-acquired, ventilator-associated pneumonia with nursing practice improvements and a comprehensive oral care program. A multidisciplinary team reviewed infection rates and current patient-care practices of ventilated patients in the ICU. Actions were taken and evaluated during a 6-month period. Intubated patients were provided oral care every 2 hours and more often as needed. Teeth were brushed every 12 hours and the mouth swabbed every 2 hours. Patients were assessed to determine the need for removal of subglottic secretions every 6- 8 hours as well as prior to repositioning the tube or deflation of the cuff. Head of bed was raised to 30 degrees at all times. A dedicated oral suction line was used. Oral-care supplies were packaged and placed in easily obtained location in patient room. The contents included one covered yankauer tip, suction handle, and y-connector; suction toothbrush with sodium bicarbonate; mouth moisturizer; and applicator swabs. The products were packaged with quantity needed for 24-hour period, with a team member reviewing