Tag Archives: infection control

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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CHS 2015 antibiograms are now online

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

Infectious Diseases Society – Antibiotics for bacteruria | Choosing Wisely

The Infectious Diseases Society advises against treating asymptomatic bacteruria with antibiotics.

Source: Infectious Diseases Society – Antibiotics for bacteruria | Choosing Wisely

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

Limitation of certain anti-infectives to ID service

You may already be aware of the growing menace of global antimicrobial resistance. Among the measures to control the selection pressure it was felt that certain anti-infectives should be limited to the order of ID service.

Up until this time, only two anti-infectives had such limitation, polymyxin E (COLISTIN) and fidaxomicin (DIFICID).  Several other agents will now be part of the restricted list. As you can see from the limitation list below, a number of these anti-infectives are currently non-formulary and in general are not commonly used and should therefore be reserved for specific cases.

Ceftaroline TEFLARO NON   FORMULARY
Daptomycin CUBICIN NON   FORMULARY
Doripenem DORIBAX NON   FORMULARY
Fidaxomicin DIFICID NON   FORMULARY
Ganciclovir CYTOVENE NON   FORMULARY
Imipenem PRIMAXIN FORMULARY
Linezolid ZYVOX FORMULARY
Liposomal   Amphotericin AMBISOME FORMULARY
Polymyxin   E COLISTIN FORMULARY
Tigecycline TYGACIL NON   FORMULARY
Voriconazole VFEND FORMULARY

 

We feel that this is an important and appropriate step in maintaining the current level of antimicrobial resistance that we are presently seeing at Centegra Hospitals.  We are asking for your full support in this effort.  If you have a patient that requires one or more of the drugs listed above, an ID consult will now be required.

Thank you for time and cooperation in this very important matter.

From:
R. Damaraju, M.D. Co-Chair, Pharmacy & Therapeutics Committee
M. Hoffman, M.D. Co-Chair, Pharmacy & Therapeutics Committee

Increased cases of Mumps in McHenry County

The following in a memo released by the McHenry County Dept of public health on October 15th 2013.

This memo is to alert you of an increase in mumps cases in McHenry County. As of October of this year, there have been 4 cases reported. In 2009 there was 1 case of mumps reported and between 2010 –2012 there were no cases reported.
We are encouraging all healthcare providers to suspect mumps in any patient that presents with the following symptoms (despite their immunization status), test, and report:

  • Swollen and tender salivary glands under the ears on one or both sides (parotitis)
  • Fever
  • Headache
  • Tiredness
  • Muscle Aches Loss of appetite
    

Mumps Laboratory Testing & Specimen Collection

It is very important to obtain laboratory confirmation for cases and suspect cases of mumps. Due to cross reacting antibodies and other issues, sensitivity and specificity of commercially available IgM tests are problematic. The Centers for Disease Control and Prevention (CDC) and the IDPH do not recommend mumps IgM testing by commercial laboratories for confirmation or elimination of a diagnosis of mumps. A positive laboratory confirmation for mumps virus with reverse transcription polymerase chain reaction (RT-PCR) or culture in a patient with acute characteristics of the mumps illness are the only laboratory tests that will yield a “confirmed” mumps case by CDC and IDPH case definition. Therefore, the collection of clinical specimens for mumps virus isolation on all individuals with suspected mumps is extremely important and should be done.

A positive laboratory confirmation for mumps virus with reverse transcription polymerase chain reaction (RT-PCR) or culture in a patient with acute characteristics of the mumps illness are the only laboratory tests that will yield a “confirmed” mumps

A buccal swab is the best type of sample and is the preferred specimen for viral isolation. Collect a buccal swab up to 5 days after symptom onset, preferably within 3 day after onset. In unvaccinated persons, virus may be isolated from 7 days before until 9 days after parotid swelling. Maximal viral shedding, however, generally occurs just prior to and within the first 3 days of parotitis onset. In vaccinated persons, buccal swabs should be collected within 1 to 3 days of parotitis onset, otherwise viral detection in RT-PCR or culture may have low yield. Massage the parotid gland area (the space between the cheek and teeth just below the ear) for about 30 seconds prior to collection of the buccal secretions. The parotid duct (Stenson’s duct) drains in this space near the upper rear molars.

Reporting

According to the Illinois Adm. Code, Title 77, Section 690.100, any suspect case of mumps must be reported to the McHenry County Department of Health within 24 hours by calling 815–334–4500.

References

Centegra Antibiogram now available online

Centegra antibiogram is now available under Departments → Infection control → Antibiogram