Kelly Romano, MPH Director, Infection Control and Patient Safety Einstein Medical Center Montgomery

 (Lack of)Isolation Gear(PPE)  Ebola  R/o Meningitis  Gastrointestinal bugs  Tuberculosis  Influenza  Vector-borne illness  Bed Bugs (not infectious)  Blood-borne Pathogens  Multi-drug resistant organisms

 Difficult to wear protective gear in an emergency  May not be the first thing on your mind  How readily available are gowns and masks?  Wearing and removing them properly

 Ebola has been around for many years-why did this create such a crisis in the US?  Education among ED staff on the proper way to don/doff PPE  Need to begin screening patients for travel history upon, and sometimes prior to entry to the ED

 There are several different types of Meningitis.  Bacterial Meningitis is the only type of meningitis that requires isolation and follow up with exposed staff.  ALWAYS….err on the side of caution with precautions (and contact infection control for clarification).

 Diarrheal illness could be anything.  A good patient history can explain what could be going on.  A medication history can also help with identification.  What the patient has recently consumed: lunch meat, restaurant, ground beef, chicken, eggs.  The type and frequency of the stool.  Foodborne vs Fecal/oral route or medication related

 Travel history is important, especially relative to possible MDR-TB  What is your community assessment? Your facility assessment? Are you high risk?  Most identification in the ED is going to rely heavily on clinical information.  Different stages of Tuberculosis, not all are contagious  Exposure follow up to confirmed cases can last for years after exposure.

 Flu Vaccine campaigns  Patient triaging for symptoms-provide masks  Staff wearing masks while caring for patients with symptoms  No airborne precautions are necessary, just droplet  Seasons can vary-ask Infection Prevention or listen for important information from your IP staff.

 You are contending with different types of viruses and fevers linked to bugs  How do you decide which is what you are looking for  That’s right-a good travel history!  Vector-borne illnesses are not transmitted from person-person  WNV, EEE, Dengue Fever, Lyme Disease, Chikungunya

 Their back and smarter then ever, we have made them resistant to some pesticides.  Having just one male bed bug can cause a problem, but just one female is different.  They do not live on people, they live on objects/belongings. Mainly objects that they can attach to.  Temperature has a large impact on the bug.  Bed bugs don’t spread organisms.

 Use standard precautions for all patients.  You never know what you are going to get.  If it’s wet and doesn’t belong to you, put a barrier on.  Utilize sharps safety devices.  Follow up right away on any potential bloodborne exposures.

 There is a growing problem in healthcare with MDRO’s.  Check any alerts in the chart for a past history.  Your review of the chart can also help the admissions staff and receiving nursing staff.  According to the CDC, healthcare workers share the same colonization rate of MRSA as the community. Not all healthcare workers are colonized with MRSA.

 Wear your PPE when appropriate, know how to put it on and take it off.  Get a good patient history.  Pay attention to information coming from the Infection Prevention Department.  Get to know your IP’s, they have a lot of knowledge about infections and how to prevent them.