Category Archives: Infection Control

MRSA Isolates and E Test

Centegra lab will now perform an e-test on all MRSA isolates obtained from a sterile site with microscan mic >=2.

With additional testing e-testing many isolates may have lower had mic of <1.5 expanding options for treatment.

This additional step will take an additional day to report out.

Antimicrobial Stewardship – New Program

Starting Feb 2018 we will move to a three tiered system of antimicrobial stewardship. For all the details go to Clinical -> Infection prevention -> Antimicrobial Stewardship.

Clostridium Difficile Guidelines 2017 – Updated

IDSA and SHEA have updated guidelines for 2017. Please see here for details.

For other guidelines

Influenza Vaccination in Patients with Egg Allergy

Guideline Watch | GENERAL MEDICINE, INFECTIOUS DISEASES

January 11, 2018

Influenza Vaccination in Patients with Egg Allergy

David J. Amrol, MD reviewing Greenhawt M et al. Ann Allergy Asthma Immunol 2018 Jan .

All available flu vaccines are safe in all egg-allergic patients.

Sponsoring Organizations: American Academy of Allergy, Asthma, and Immunology (AAAAI); American College of Allergy, Asthma, and Immunology (ACAAI)

Target Audience: All providers who administer influenza vaccines

Background

Historically, patients with egg allergy have been told to avoid flu vaccines, because most flu vaccines are produced in embryonated chicken eggs; the concern was that a vaccine might contain residual egg protein, which could lead to anaphylaxis. Many studies have shown that flu vaccines are safe for egg-allergic patients, but many physicians still have been hesitant to vaccinate such patients. This updated practice parameter incorporates recent data on flu vaccine safety in egg-allergic patients, including children.

Key Recommendations

  • Flu vaccines should be administered annually to patients with egg allergy of any severity, with no need to ask recipients about egg-allergy status and no special precautions beyond those recommended for administering any vaccine to any patient. This recommendation applies to both injected and intranasal formulations (although the latter should not be used in the 2017−2018 flu season).
  • Non−egg-containing vaccines can be used but are not necessary or preferred over standard vaccines.
  • The intranasal live attenuated flu vaccine also might be used, if it’s shown to be efficacious and is approved for use.
Comment

Egg-allergic patients can be vaccinated safely with any available age-appropriate flu vaccine, with no special precautions, regardless of egg-reaction history (including anaphylaxis). Concern for egg allergy only adds another barrier to universal flu vaccination, and this practice parameter concludes by stating the following: “Vaccine providers and screening questionnaires do not need to ask about the egg allergy status of recipients of influenza vaccine.”

Editor Disclosures at Time of Publication

Disclosures for David J. Amrol, MD at time of publication

Consultant / Advisory board CSL Behring; Horizon Pharmaceuticals
Citation(s):

Greenhawt M et al. Administration of influenza vaccines to egg allergic recipients: A practice parameter update 2017. Ann Allergy Asthma Immunol 2018 Jan; 120:49. (http://dx.doi.org/10.1016/j.anai.2017.10.020)

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.