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);
- history of travel from countries in or near the Arabian Peninsula within 14 days before symptom onset;
- 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
- 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
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:
- Two positive periprosthetic (tissue or fluid) cultures with identical organisms
- A sinus tract communicating with the joint
- Having three of the following minor criteria:
- Elevated serum C-reactive protein (CRP; >100 mg/L) AND erythrocyte sedimentation rate (ESR; >30 mm/hr).
- Elevated synovial fluid white blood cell (WBC; >10,000 cells/μL) count OR ++ (or greater) change on leukocyte esterase test strip of synovial fluid.
- Elevated synovial fluid polymorphonuclear neutrophil percentage (PMN% >90%).
- Positive histological analysis of periprosthetic tissue (>5 neutrophils (PMNs) per high power field).
- A single positive periprosthetic (tissue or fluid) culture.
Did you wonder what all the fuss about DVT prophylaxis is about and why it is part of every admission order set? Look at this article from CDC reviewing the data on DVT and its prevention 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.
On December 7, 2013, the World Health Organization (WHO) reported the first local (autochthonous) transmission of chikungunya virus in the Americas. As of December 12th, 10 cases of chikungunya have been confirmed in patients who reside on the French side of St. Martin in the Caribbean. Laboratory testing is pending on additional suspected cases. Onset of illness for confirmed cases was between October 15 and December 4. At this time, there are no reports of other suspected chikungunya cases outside St. Martin. However, further spread to other countries in the region is possible. Continue reading
Today is world rabies day. Increase your awareness of rabies. See the CDC site for more information.
As the 2013-14 influenza season approaches. I have added a link to the current US influenza activity to the right sidebar and a link to CDC flu view, an interactive detailed influenza monitoring tool. This helps gauge the local community activity of influenza. This is particularly useful in community preparedness and assessing pretest probability of influenza in cases presenting with influenza like illness (ILI).
Note: As the season has not officially started, the map as of today (09/26/13) is showing data from last season.