Category Archives: Infection Control

Johns Hopkins ABX Guides

Pharmacy Services has subscribed to Johns Hopkins ABX Guide for use by all associates at Centegra Health System to support our multidisciplinary approach to the Antimicrobial Stewardship Program Clinical Decision Support Tools and Education

Johns Hopkins ABX Guide is a comprehensive web source that provides regularly updated, evidence-based decision resources regarding antibiotics, diagnosis, pathogens, management of infections and vaccines.

Prior to the Guide, CHS did not have a specific detailed resource for antibiotics clinical decision support.

Johns Hopkins ABX Guide may be accessed through Unbound Medicine’s uCentral as follows:

What is a true penicillin allergy?

Did you know that most patients who give a history of “penicillin allergy” do not have a true allergy? Most of them will tolerate more effective and less expensive agents without issues.

For more information see the recently updated policy.

Weekly Flu Activity – CDC

New – Interpretation of Clostridium difficile testing

Sometimes interpretation of Clostridium difficile testing can be confusing. See this page which helps interpret the test.

It will be located under “Infection Prevention” => Interpretation of Clostridium difficile testing.

Oral and Nasopharyngeal Specimen Collection


This is a brief list of oral and nasopharyngeal specimen collection procedures.

MRSA

  • Location: Anterior nares
  • Swab: Routine cotton culture swab

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Influenza

  • Location: Posterior nasopharynx
  • Swab: Routine cotton culture swab
  • Wear a surgical mask, protective eye wear and gloves while collecting the specimen
  • Place the patients head on the bed pillow or against a wall so that they do not move backwards
  • The swab will go straight backwards like placing an NG tube, it should go the distance between the nostril and the ear into the throat.
  • The swab is rotated for a bout 5–10 seconds to get enough epithelial cells on it
  • Remove the swab and place it in the transport media and sent it to lab

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Pertussis

The PCR assay reuires a special swab, made of aluminum with a nylon tip. Traditional cotton tip swabs interfere with the test

  • Location: Posterior nasopharynx
  • A special transport media is needed- call the lab for it
  • Wear a surgical mask, protective eye wear and gloves while collecting the specimen
  • Place the patients head on the bed pillow or against a wall so that they do not move backwards
  • The swab will go straight backwards like placing an NG tube, it should go the distance between the nostril and the ear into the throat. This is different from a nasal swab for MRSA or influenza
  • The swab is rotated for a bout 5–10 seconds to get enough epithelial cells on it
  • Remove the swab and place it in the transport media and sent it to lab

Pertussis-2

Here is a video on specimen collection

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Mumps

  • Location: Specimen is collected from the parotid duct secretions preferrably within 9 days of symptoms.
  • Swab: Routine cotton swab. Specimen is sent in a viral transport media.
  • Steps
    • Massage the parotid gland for 30 seconds. Note that it is just in front of the ear lobe. CDR742039
    • Specimen should be collected from the parotid duct opening just next to the second molar.
      mumps-cavity

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Increase in pertussis cases in Harvard, IL

McHenry County Department of Health (MCDH) has noticed an increase on cases of pertussis in Harvard IL.  Please be aware of this vaccine preventable disease when evaluating any child or adult with acute cough like illness characterized by dry hacking cough which may be worse at night associated with paroxysms, a whoop or post tussle gagging or vomiting. Especially if symptoms are lasting greater than 2 weeks.

Please remember to start treatment even before laboratory confirmation

Preferred treatment included – azithromycin, erythromycin or clarithromycin.

Please note the correct way to collect specimen as shown in this video

Pertussis cases should be reported to the county health department using the attached Pertussis_Reporting_Form.

CHS 2015 antibiograms are now online

The 2015 CHS antibiograms are now available under Departments => Infection control => Antibiograms. The direct link is here.

Antibiograms updated

2014 updates to the antibiograms for both CHM and CHW are now posted here. Antibiograms provide information regarding local microbiologic susceptibility patterns.

Ebola Awareness

At this week’s Open Forums, you’ll hear information about Centegra’s preparation for the possible event that we encounter a patient suspected of having the Ebola virus. Centegra Health System is prepared. Key leaders are regularly meeting to ensure best practices are in place that align with the current recommendations from the Centers for Disease Control and Prevention (CDC).

Centegra takes this threat seriously. Our teams are working with the McHenry County Department of Health, Illinois Department of Health and other local agencies to ensure our response is well coordinated with our community partners. Please talk to your leader about your department’s role in our process.

Immediate isolation will be implemented for patients who have traveled to high-risk areas in Africa in the last 21 days and present with the following symptoms:

  • A fever of 100.5 or higher
  • Flu-like symptoms

All Associates and Physicians will wear Personal Protective Equipment (PPE) until Ebola is ruled out. Patients who call our facilities with these complaints will be triaged and directed through the Centegra Hospital-McHenry Emergency Department for instructions prior to arrival at the hospital.

Key contacts for more information:
CH-McHenry: Karen Van Buren, RN, Infection Preventionist 815-759-4574
CH-Woodstock: Cindy Schweder, RN, CIC, Infection Preventionist 815-334-3916
CPC and Centegra Immediate Care: Basia Scherbaum, RN, MSN 815-337-1985
Media Inquiries: Michelle Green, Senior PR Coordinator 847-341-0274

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Enterovirus D68 update

Enterovirus D68 (EV-D68) is one of many non-polio enteroviruses. Enterovirus D68 (EV-D68) infections are thought to occur less commonly than infections with other enteroviruses. EV-D68 was first identified in California in 1962. Compared with other enteroviruses, EV-D68 has been rarely reported in the United States for the last 40 years.

EV-D68 Infections Reported

Hospitals in Missouri and Illinois are seeing more children than usual with severe respiratory illness caused by enterovirus D68. Several other states are investigating clusters of children with severe respiratory illness, possibly due to enterovirus D68. CDC is watching this situation closely and helping the states with testing of specimens.

Symptoms

EV-D68 has been reported to cause mild to severe respiratory illness. However, the full spectrum of EV-D68 illness is not well-defined.

Transmission

EV-D68 is not frequently identified, so it is less studied and the ways it spreads are not as well-understood as other enteroviruses. EV-D68 causes respiratory illness, and the virus can be found in respiratory secretions such as saliva, nasal mucus, or sputum. The virus likely spreads from person to person when an infected person coughs, sneezes, or touches contaminated surfaces.

Treatment

  • There is no specific treatment for EV-D68 infections.
  • Many infections will be mild and self-limited, requiring only treatment of the symptoms.
  • Some people with severe respiratory illness caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy.
  • No antiviral medications are currently available for treating of EV-D68 infections.

Prevention

  • There are no vaccines for preventing EV-D68 infections.
  • You can help protect yourself from respiratory illnesses by following these steps:
  • Wash hands often with soap and water for 20 seconds, especially after changing diapers
  • Avoid touching eyes, nose and mouth with unwashed hands
  • Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick
  • Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick

Laboratory Testing

Test to be ordered is “Enterovirus Molecular by PCR” from  ARUP .  Will be a Miscellaneous test in Paragon. 

Specimen: Respiratory-bronch wash, BAL, Nasopharyngeal aspirate, sputum or tracheal aspirate.  Volume is 1.5ml.

References