Category Archives: Infection Control

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

First case of Middle East Respiratory Syndrome Coronavirus infection (MERS) in the United States

CDC confirmed the first US case of MERS in a traveller from Riyadh to Indiana.

All suspect cases of MERS should be reported to the McHenry County Department of Health immediately. A suspect case, as defined by the CDC, is:

A patient under investigation (PUI) is a person with the following characteristics:

  • Fever (≥38°C, 100.4°F) and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence);

AND EITHER

  • history of travel from countries in or near the Arabian Peninsula within 14 days before symptom onset;

OR

  • close contact with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula

OR

  • is a member of a cluster of patients with severe acute respiratory illness (e.g. fever and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments.

Any suspect cases must be reported immediately. Please contact the McHenry County Department of Health 815-459-5757

Pneumonia antibiotic selection added to core measure quick list

For the convenience of clinicians a list of approved antibiotics for the treatment of pneumonia is available here. A quick link is also added to the right sidebar.

Albumin replacement does not improve survival from sepsis – NEJM

The New England Journal of Medicine published the results of a trial by Caironi et al in the March 18th issue comparing survival in patients admitted with sepsis who did or did not receive albumin as part of the resuscitation.

The study found no survival advantage to giving albumin in addition to crystalloids.

Reference

Changes to reporting of SSI to CDC

The following information will be added to the current report to CDC/NHSN

  • Patient height, weight, and diabetes status will be reported for all procedures.
  • Operative duration, NHSN will adopt the Association of Anesthesia Clinical Directors definitions of Procedure/Surgery Start Time (PST), and Procedure/Surgery Finish.
  • NHSN is broadening its definition of an operative procedure to include those procedures that were not closed primarily. The closure type will be recorded for all procedures as either primarily closed or non-primarily closed, and this information will be used for risk adjustment purposes. NHSN has closely adapted the American College of Surgeons, NSQIP definition of primary closure.
    • Primary Closure is defined as closure of all tissue levels during the original surgery, regardless of the presence of wires, wicks, drains, or other devices or objects extruding through the incision. This category includes surgeries where the skin is closed by some means, including incisions that are described as being “loosely closed” at the skin level. Thus, if any portion of the incision is closed at the skin level, by any manner, a designation of primary closure should be assigned to the surgery.
    • Non-primary Closure is defined as closure that is other than primary and includes surgeries in which the superficial layers are left completely open during the original surgery and therefore cannot be classified as having primary closure. For surgeries with non-primary closure, the deep tissue layers may be closed by some means (with the superficial layers left open), or the deep and superficial layers may both be left completely open.
  • Hip arthroplasy (HPRO) and Knee arthoroplasty (KPRO): additional detail about procedures; total, hemi, and resurfacing (HPRO only) will be collected.
  • NHSN will adopt the Muscular Skeletal Infection Society’s (MSIS) Definition of Periprosthetic Joint Infection as a new organ/space infection site, SSI-PJI, which will replace SSI-JNT for HPRO and KPRO procedures.

Definition of Periprosthetic Joint Infection (PJI)

Joint or bursa infections must meet at least 1 of the following criteria:

  1. Two positive periprosthetic (tissue or fluid) cultures with identical organisms
  2. A sinus tract communicating with the joint
  3. Having three of the following minor criteria:
    1. Elevated serum C-reactive protein (CRP; >100 mg/L) AND erythrocyte sedimentation rate (ESR; >30 mm/hr).
    2. Elevated synovial fluid white blood cell (WBC; >10,000 cells/μL) count OR ++ (or greater) change on leukocyte esterase test strip of synovial fluid.
    3. Elevated synovial fluid polymorphonuclear neutrophil percentage (PMN% >90%).
    4. Positive histological analysis of periprosthetic tissue (>5 neutrophils (PMNs) per high power field).
    5. A single positive periprosthetic (tissue or fluid) culture.

Cases of Mumps Identified in Morgan County

Two cases of mumps, a vaccine preventable communicable viral disease, were identified in Morgan County.

Mumps, an acute vaccine-preventable viral illness transmitted by respiratory droplets and saliva, has an incubation period of 16–18 days (12–25 days min/max respectively). A statewide notification is being sent since the cases are widespread across the Morgan County community and a common exposure has not been identified. Continue reading

Antibiotic usage in hospitalized patients

CDC reported in the March 7th 2014 issue of MMWR that based on a 2010 study conducted across the US that upto 30% of non ICU antibiotics used in hospitalized patients are unecessary. The most common overusage of antibiotics was for “UTI” and the use of vancomycin without proven positive cultures. Appropriate usage of antibiotics can reduce the incidence of clostridium difficile infections. [1]