Infection Control Q and A APIC Greater NY Chapter 13 May 17, 2017 Beth Nivin BA MPH NYC DOHMH Communicable Disease Program bnivin@health.nyc.gov

a. The patient’s diagnosis b. The risk of transmission Q1. The most important factor in deciding if one of our patients needs precautions beyond Standard Precautions is: (Choose all that apply) a. The patient’s diagnosis b. The risk of transmission c. What the hospital was doing d. The physicians orders

Response A, B, and C

b) Legionella culture of sputum c) Single Legionella serology Q2. What test should you use to confirm a diagnosis of Legionnaires’ disease pneumonia? a) Urine antigen test b) Legionella culture of sputum c) Single Legionella serology d) Legionella PCR

Response To confirm a case of Legionnaires’ disease pneumonia you should use the Urine antigen test or culture for Legionella on specialized media. Paired serology would be required to confirm a case and must be performed in the same lab using the same test. This is rarely reported and single serology is not diagnostic for Legionnaires’ disease pneumonia. Legionella PCR does not confirm Legionnaires’ disease pneumonia.

Q3. Which of these is false? The following microbes can survive on environmental surfaces for: A. C. difficile spore for over a year B. MRSA for up to 7 months C. Norovirus for up to a week D. Influenza virus for up to a week

Response D- depending on the type of surface, influenza virus can live for 8-48 hours.

Q4. What are examples of indirect transmission within a healthcare environment? A. Shared toys among pediatric patients B. Clothing, uniforms, laboratory gowns C. Water D. Coughing visitor E. All of the above

Response E- All of the above. A coughing visitor, depending on how he coughs and where he touches, can leave virus on an environmental surface for up to 2 days.

Type of precaution ___________________, especially when dealing with: Q5. What kind of precautions should you utilize with a patient with CJD? Type of precaution ___________________, especially when dealing with: a. Skin to skin contact b. Respiratory droplets c. Body fluids d. Blood

Response A, B, and C have very low infectivity. D - Standard precautions, with blood, as with other patients.

Q6. Who should report a suspect case of CJD to DOH? a. Neurologist b. Laboratory c. Infection Control d. Any of the above

Response Anybody, please! CJD was made reportable in July, 2011 but is an under-detected and under-reported disease. We don’t mind getting multiple reports.

Q7a. Could this be influenza? It is January. An older person (>65) has come into your facility with a two-day history of syncope and falling. His grandchild who visited him was home from school with an influenza-like illness. The rapid antigen test for this older person was negative. He received flu vaccine in October.

Response- Yes Note that elderly persons, including those who are medically fragile and those with neurological or neurocognitive conditions, may manifest atypical signs and symptoms with influenza virus infection, and may not have fever or cough. Influenza vaccine for older people are about 30% effective in preventing flu but very effective in preventing complications and death. The Rapid Antigen Test is insensitive and can have as much as a 50% false-negative rate.

Q7b. How would you handle this patient:

CDC Recommendations Placing him in a private room. If a private room is not available, place (cohort) patients suspected of having influenza patients with one another; Wear a facemask (e.g., surgical or procedure mask) upon entering the patient’s room. Remove the facemask when leaving the patient’s room and dispose of the facemask in a waste container. If patient movement or transport is necessary, have the patient wear a facemask (e.g., surgical or procedure mask), if possible. Communicate information about patients with suspected, probable, or confirmed influenza to appropriate personnel before transferring them to other departments. Treatment should not wait for laboratory confirmation of influenza. Antiviral treatment works best when started within the first 2 days of symptoms. However, these medications can still help when given after 48 hours to those that are very sick, such as those who are hospitalized, or those who have progressive illness.

1) Positive test for IgM antibodies Q8. What are the defining symptoms and laboratory tests for a confirmed case of hepatitis A? 1) Positive test for IgM antibodies 2) Positive test for IgG antibodies 3) Elevated liver function tests (ALT, AST, Bilirubin) 4) Presence of jaundice 5) Upper respiratory symptoms

Response 1, 3 and 4. False-positive test results may be due to presence of cross-reactive antibodies from other viral infection or underlying illnesses. Positive results should be correlated with the patient's clinical history and epidemiologic exposure.

Other Hepatitis A Reminders A nationally reportable condition Surveillance case definition includes both clinical criteria and serologic confirmation. Epi investigations are challenging for persons with positive serologic tests for acute hepatitis A virus (HAV) infection (i.e., IgM anti-HAV) whose illness is not consistent with clinical HAV disease Should case-contacts in these situations receive post- exposure immunoprophylaxis? Clinicians should limit laboratory testing for acute HAV infection to persons with clinical findings typical of hepatitis A or to persons who have been exposed to settings where HAV transmission is suspected.