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Delayed Identification of Measles in a Pediatric Hospital
Poster Abstracts / American Journal of Infection Control 42 (2014) S29-S166
Outbreak Investigation and Emerging/Reemerging Infectious Diseases/Efficacy and Impact Publication Number 10-318 Delayed Identification of Measles in a Pediatric Hospital Judy Tran MPH, MT (ASCP), CIC, Infection Prevention Specialist, Children’s Medical Center Dallas; Sharon Holmes MPH, MT(ASCP), CIC, Director, Infection Prevention and Control, Children’s Medical Center ISSUE: A 14 month old female with recent travel history to Ethiopia was admitted from an outside facility on 5/19/13 for persistent fever. Her initial clinical Presentation was not consistent with measles; however during her hospital course she was noted to have fever, rash, cough, and coryza. The hospitalist added Rubeola IgM to other testing because the child was behind on her vaccinations. The unit was notified of the positive result on 5/23/13. PROJECT: The patient was on contact and droplet precautions the first 5 days of admission. The Infection Prevention and Control department was notified on the following morning, and an investigation of all potential exposures was immediately initiated. A multidisciplinary response team was quickly assembled. Patient census data was pulled for all patients on the unit within the 5 day period and split into two patient categories, high risk and low risk, based on age and underlying disease. The immunization status was verified by the state immunization registry or located in the electronic medical record. RESULTS: The response team determined that all patients on the same unit from 5/19/13 to 5/23/13 were considered potentially exposed. A total of 28 patients (19 high risk, 11 low risk) were reviewed from the 5 day census report. Three were post renal transplant patients and given prophylactic immunoglobulin provided by the state health department. The local health department contacted low risk patients who had already been discharged; one secondary case was identified. Occupation health determined that all exposed employees were either documented to have 2 doses of MMR or confirmed immune status by serology. LESSON LEARNED: Measles is highly contagious and must be considered in the initial differential diagnosis of susceptible patients with compatible symptoms, particularly those who have traveled abroad. A measles investigation at a large pediatric facility requires a multidisciplinary team approach. A strong relationship with the local health department is essential to limiting further exposures in the community.
Publication Number 10-319 The Impact of Temperature and Absolute Humidity on the Incidence of Influenza in Hospitalized Patients with Lower Respiratory Tract Infections Mohammad Khan PhD, Clinical and Translational Research Fellow, University of Louisville School of Medicine Division of Infectious Diseases Clinical and Translational Research Support Center; Timothy Wiemken PhD, MPH, CIC, Assistant Professor,
S145
Assistant Director of Epidemiology and Biostatistics, University of Louisville School of Medicine, Division of Infectious Diseases; Daniel Curran MD, Clinical Research Fellow, University of Louisville, Division of Infectious Diseases; Robert Kelley PhD, Assistant Professor of Medicine, University of Louisville School of Medicine Division of Infectious Diseases; Emily Pacholski MPHc, Student/Research Associate, University of Louisville, Division of Infectious Diseases; Ruth Carrico PhD, FSHEA, RN, CIC, Associate Professor, University of Louisville Hospital Division of Infectious Diseases; Paula Peyrani MD, Medicial Director of 550 Clinic, Division of Infectious Diseases, University of Louisville School of Medicine; Julio Ramirez MD, FACP, DIvision Chief, University of Louisville Hospital Division of Infectious Diseases BACKGROUND/OBJECTIVES: Epidemics of influenza during winter seasons are associated with substantial morbidity and mortality. There is conflicting evidence as to the role of temperature and humidity on influenza infection. The objective of this study was to evaluate the impact of the temperature and humidity level on the incidence of influenza in hospitalized patients with lower respiratory tract infections (LRTIs). METHODS: This was a secondary analysis of the Rapid Empiric Treatment with Oseltamivir Study database. All patients admitted to 9 hospitals in Louisville, Kentucky, during the flue seasons between December 2010 to April 2013 with a diagnosis of LRTI were invited to participate. The presence of influenza was determined by RT-PCR. Temperature and humidity data were obtained from the National Weather Service. To evaluate the correlation of temperature and absolute humidity on the weekly LRTI rate due to influenza, the Spearman Rank-Order Correlation test was used. RESULTS: Of the 1259 patients enrolled in the study, 206 (16%) had influenza. There was an average of 11% influenza LRTI per week. The average weekly temperature and weekly absolute humidity were inversely correlated with weekly influenza LRTI incidence, with correlation coefficients -0.75(p<0.001) and -0.71(p<0.001) respectively. CONCLUSIONS: Although the seasonality of influenza virus infections is likely multifactorial, this study indicates that temperature and absolute humidity impact incidence of LRTIs due to influenza. Decreased humidity levels may favor greater viral survival, longer shedding, increased viral virulence, or decreased host defense mechanisms. Manipulation of the environmental humidity level may decrease the incidence of influenza infections.
Publication Number 10-320 West Michigan Point Prevalence Study for Carbapenem Resistant Enterobacteriacea Colonization, 2013 Dorine Berriel-Cass RN, BSN, MA, CIC, Manager Infection Prevention, Spectrum Health; Kerrie VerLee MPH, CIC, Epidemiologist, Spectrum Health; Chau Nguyen MS, Epidemiologist, Spectrum Health; Daniel Sundin PhD, D(ABMM), Director of Microbiology, Spectrum Health; Jennifer Grile BSN, RN, CMSRN, Infection Preventionist, Spectrum Health; Molly KaneCarbone RN, BSN, MEd, Infection Preventionist, Spectrum Health; Theresa Klein BSN, RN, CCRN, Infection Preventionist, Spectrum Health; Dina Aper BSMLS (ASCP), CM, Clinical Quality Specialist, Spectum Health- United Memorial and Kelsey Hospitals BACKGROUND/OBJECTIVES: Carbapenem Resistant Enterobacteriacea (CRE) are concerning, emerging pathogens because of their plasmid mediated enzymatic resistance to many antibiotics. Recent
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014
Outbreak Investigation and Emerging/Reemerging Infectious Diseases/Efficacy and Impact Publication Number 10-318 Delayed Identification of Measles in a Pediatric Hospital Judy Tran MPH, MT (ASCP), CIC, Infection Prevention Specialist, Children’s Medical Center Dallas; Sharon Holmes MPH, MT(ASCP), CIC, Director, Infection Prevention and Control, Children’s Medical Center ISSUE: A 14 month old female with recent travel history to Ethiopia was admitted from an outside facility on 5/19/13 for persistent fever. Her initial clinical Presentation was not consistent with measles; however during her hospital course she was noted to have fever, rash, cough, and coryza. The hospitalist added Rubeola IgM to other testing because the child was behind on her vaccinations. The unit was notified of the positive result on 5/23/13. PROJECT: The patient was on contact and droplet precautions the first 5 days of admission. The Infection Prevention and Control department was notified on the following morning, and an investigation of all potential exposures was immediately initiated. A multidisciplinary response team was quickly assembled. Patient census data was pulled for all patients on the unit within the 5 day period and split into two patient categories, high risk and low risk, based on age and underlying disease. The immunization status was verified by the state immunization registry or located in the electronic medical record. RESULTS: The response team determined that all patients on the same unit from 5/19/13 to 5/23/13 were considered potentially exposed. A total of 28 patients (19 high risk, 11 low risk) were reviewed from the 5 day census report. Three were post renal transplant patients and given prophylactic immunoglobulin provided by the state health department. The local health department contacted low risk patients who had already been discharged; one secondary case was identified. Occupation health determined that all exposed employees were either documented to have 2 doses of MMR or confirmed immune status by serology. LESSON LEARNED: Measles is highly contagious and must be considered in the initial differential diagnosis of susceptible patients with compatible symptoms, particularly those who have traveled abroad. A measles investigation at a large pediatric facility requires a multidisciplinary team approach. A strong relationship with the local health department is essential to limiting further exposures in the community.
Publication Number 10-319 The Impact of Temperature and Absolute Humidity on the Incidence of Influenza in Hospitalized Patients with Lower Respiratory Tract Infections Mohammad Khan PhD, Clinical and Translational Research Fellow, University of Louisville School of Medicine Division of Infectious Diseases Clinical and Translational Research Support Center; Timothy Wiemken PhD, MPH, CIC, Assistant Professor,
S145
Assistant Director of Epidemiology and Biostatistics, University of Louisville School of Medicine, Division of Infectious Diseases; Daniel Curran MD, Clinical Research Fellow, University of Louisville, Division of Infectious Diseases; Robert Kelley PhD, Assistant Professor of Medicine, University of Louisville School of Medicine Division of Infectious Diseases; Emily Pacholski MPHc, Student/Research Associate, University of Louisville, Division of Infectious Diseases; Ruth Carrico PhD, FSHEA, RN, CIC, Associate Professor, University of Louisville Hospital Division of Infectious Diseases; Paula Peyrani MD, Medicial Director of 550 Clinic, Division of Infectious Diseases, University of Louisville School of Medicine; Julio Ramirez MD, FACP, DIvision Chief, University of Louisville Hospital Division of Infectious Diseases BACKGROUND/OBJECTIVES: Epidemics of influenza during winter seasons are associated with substantial morbidity and mortality. There is conflicting evidence as to the role of temperature and humidity on influenza infection. The objective of this study was to evaluate the impact of the temperature and humidity level on the incidence of influenza in hospitalized patients with lower respiratory tract infections (LRTIs). METHODS: This was a secondary analysis of the Rapid Empiric Treatment with Oseltamivir Study database. All patients admitted to 9 hospitals in Louisville, Kentucky, during the flue seasons between December 2010 to April 2013 with a diagnosis of LRTI were invited to participate. The presence of influenza was determined by RT-PCR. Temperature and humidity data were obtained from the National Weather Service. To evaluate the correlation of temperature and absolute humidity on the weekly LRTI rate due to influenza, the Spearman Rank-Order Correlation test was used. RESULTS: Of the 1259 patients enrolled in the study, 206 (16%) had influenza. There was an average of 11% influenza LRTI per week. The average weekly temperature and weekly absolute humidity were inversely correlated with weekly influenza LRTI incidence, with correlation coefficients -0.75(p<0.001) and -0.71(p<0.001) respectively. CONCLUSIONS: Although the seasonality of influenza virus infections is likely multifactorial, this study indicates that temperature and absolute humidity impact incidence of LRTIs due to influenza. Decreased humidity levels may favor greater viral survival, longer shedding, increased viral virulence, or decreased host defense mechanisms. Manipulation of the environmental humidity level may decrease the incidence of influenza infections.
Publication Number 10-320 West Michigan Point Prevalence Study for Carbapenem Resistant Enterobacteriacea Colonization, 2013 Dorine Berriel-Cass RN, BSN, MA, CIC, Manager Infection Prevention, Spectrum Health; Kerrie VerLee MPH, CIC, Epidemiologist, Spectrum Health; Chau Nguyen MS, Epidemiologist, Spectrum Health; Daniel Sundin PhD, D(ABMM), Director of Microbiology, Spectrum Health; Jennifer Grile BSN, RN, CMSRN, Infection Preventionist, Spectrum Health; Molly KaneCarbone RN, BSN, MEd, Infection Preventionist, Spectrum Health; Theresa Klein BSN, RN, CCRN, Infection Preventionist, Spectrum Health; Dina Aper BSMLS (ASCP), CM, Clinical Quality Specialist, Spectum Health- United Memorial and Kelsey Hospitals BACKGROUND/OBJECTIVES: Carbapenem Resistant Enterobacteriacea (CRE) are concerning, emerging pathogens because of their plasmid mediated enzymatic resistance to many antibiotics. Recent
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014