Hospital Outbreaks Allison McGeer Mount Sinai Hospital 416-586-3118

Slides:



Advertisements
Similar presentations
DAVID R. WOODARD MSC, CIC, CPHQ, CLS Hospital Ecology.
Advertisements

Infection Control: IV Drug Administration
IV Medicine Administration: Infection Control September 2009.
Disease Transmission Good morning..
HICC An Infection Control Committee provides a forum for multidisciplinary input and cooperation, and information sharing This committee should include.
1.We investigate an outbreak to put in place a surveillance system (Yes / no) 2.One of the objectives to investigate an outbreak is to identify the population.
Outbreak Investigation
Role of the laboratory in disease surveillance
Update on Antimicrobial Resistance Allison McGeer, MD, FRCPC Mount Sinai Hospital
Outbreak Investigation: The First 48 Rachel Radcliffe, DVM, MPH Career Epidemiology Field Officer Division of Infectious Disease Epidemiology West Virginia.
Insert name of presentation on Master Slide Epidemiology Toolkit for Outbreak Investigation Meirion Evans Communicable Disease Surveillance Centre.
NICU Outbreaks Nawaf M. Al-Dajani. Disclosure Infection Components Host Organisms Environment.
Field Epidemiology in Practice: A Hospital Outbreak of Acinetobacter Suzanne Beavers, M.D EIS Officer Kentucky Department for Public Health.
Principles of Outbreak Management
Outbreak Scenario S. marcescens At a multi-disciplinary meeting on the surgical unit concerns are raised regarding a possible increase in.
Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review Review Participants IP, ID, Lab, Micro, QA, Materials Management, Lean,
Hospital Surveillance. Impact of infectious diseases  IDs are considered to be the leading cause of death  Mass population movement  Emerging and re-emerging.
MRSA and VRE. MRSA  1974 – MRSA accounted for only 2% of total staph infections  1995 – MRSA accounted for 22% of total staph infections  2004 – MRSA.
MRSA and VRE. MRSA  1974 – MRSA accounted for only ____of total staph infections  1995 – MRSA accounted for _____ of total staph infections  2004 –
NOSOCOMIAL INFECTION SURVEILLANCE METHODS Masud Yunesian, M.D., Epidemiologist.
Laboratory Training for Field Epidemiologists Strengthening Laboratory and Epidemiology Collaboration Introduction May 2007.
CLS 212 medical microbiology Mrs. Basmah Al-Maarik.
Infection Control and the Bugs. Blanche Lenard RN, CIC Education Session Infection Control in Healthcare  Environmental Cleaning  Routes of Transmission.
Infection Prevention & Control (IPAC) at RCHT Dr Tristan Clark Infectious Diseases physicin and joint DIPC.
Health Care Associated Infections (Nosocomial infections) By Dr.Sabah M.A.Abdelkader Assist. Prof. of Public Health.
CSI 101 Skills Lab 2 Standard Precautions Personal Protective Equipment (PPE) Daryl P. Lofaso, M.Ed, RRT.
Infection Control Plan MHA, NURSPH Rose Hogan Oct 2013 Infection Prevention and Control.
Nosocomial infection Hospital Infection. Hospital acquired infections Nosocomial infections are those that originate or occur in a hospital or hospital-like.
SPM 100 Clinical Skills Lab 1 Standard Precautions Sterile Technique Daryl P. Lofaso, M.Ed, RRT.
Using and Sharing Findings from Surveillance: Rates, Ratios Proportions, Data Display & OUTBREAKS Russ Olmsted, MPH, CIC
Part I BACKGROUND VENTILATOR ASSOCIATED PNEUMONIA.
Investigation and Control of Outbreaks of Foodborne Illness Ralph Cordell, PhD.
Infectious Disease Epidemiology, Module I Introduction.
SPM 100 Skills Lab 1 Standard Precautions Sterile Technique Daryl P. Lofaso, M.Ed, RRT Clinical Skills Lab Coordinator.
CNA 2 OSBN Curriculum. layer/movie.php?movie= mrn.com/flv/78808ar_sec01_300k.flv&title =&detectflash=false.
Getting Started or so you are the new Infection Preventionist – what now? Karen Hoover Russ Olmsted Ruth Anne Rye.
Outlines At the completion of this lecture the student will be able to identify the concept and related terms of: Infection- Infection control-
Standard and Transmission-Based Precautions
Disease Outbreak Maria del Rosario, MD, MPH Infectious Disease Epidemiology Program WVDHHR/BPH/DSDC February
INVESTIGATION of EPIDEMIC. LEARNING OBJECTIVES  Recognize trends of disease occurrence.  Recognize trends of disease occurrence.  Define epidemic and.
 Aseptic practices: used to keep an area free of disease producing microorganisms  Medical Asepsis: “clean technique”, purpose is to keep a clean environment.
INTRODUCTION TO INFECTION CONTROL ICNO Infection Control Unit, Teaching Hospital, Jaffna.
Infectious disease e.g. cholera, typhoid are common in developing tropical countries. Epidemics are caused also by diseases other than infectious diseases.
Nosocomial infection Hospital acquired infections.
Introduction to Microbiology & Handwashing
MICROBIOLOGICAL EPIDEMIOLOGY OF RESPIRATORY SPECIMENS IN ICU PATIENTS Dr Farooq Cheema, Dr Waseem Tariq, Dr Raja Ishtiaq, Dr Tabassum Qureshi, Dr Vincent.
KJO Hospital Infection Control Local 2176/2097 Ross Ibabao/ICCo.
Nosocomial infection Hospital acquired infections.
Describe OHS Describe Routine Practises Aware of neddle stick Policy Explain types of precautions.
How I deal with an outbreak? Prof Bertrand SOUWEINE Medical ICU Clermont-Ferrand France ISICEM March 2009.
Outbreak Investigation
Understanding Epidemiology
Outbreak Investigations
So Why All the Fuss About Hand Hygiene?
By Hatim Jaber MD MPH JBCM PhD
Hand Hygiene. HLTIN301A Comply with infection control policies and procedures in health work.
Hospital acquired infections
HOSPITAL INFECTIONS Norazli Ghadin.
CSI 101 Skills Lab 3 Universal Precautions and
APIC Greater new York Chapter 13
Disease Detective Team!
Neonatal sepsis in Kilifi
Hand Hygiene Hands: most common mode of transmission of pathogens
So Why All the Fuss About Hand Hygiene?
EPI MR OGUNDELE.
So Why All the Fuss About Hand Hygiene?
“Bug of the month “ Pseudomonas aeruginosa (Gram negative bacilli)
So Why All the Fuss About Hand Hygiene?
So Why All the Fuss About Hand Hygiene?
So Why All the Fuss About Hand Hygiene?
Presentation transcript:

Hospital Outbreaks Allison McGeer Mount Sinai Hospital

Outbreaks Anything out of the ordinary An increase in the occurrence of a complication or disease above the background rate A statistically significant increase in the incidence of an infection

Why are hospitals a problem? PATHOGENS –They concentrate virulent pathogens ACCESS –By hands on care, they allow transmission of these pathogens –By devices & parenteral therapy, they permit access HOSTS –They admit susceptible hosts (elderly, immunocompromised) –They make them more susceptible (chemotherapy, surgery)

Hospital Outbreaks 1 in 8 patients in Canadian hospitals acquire an infection as a result of their hospital stay –5-10% of these are part of outbreaks Rate: 1/10,000 admissions (Wenzel, 1981) 1/12,000 admissions (Haley, 1985) at least an equal number of “clusters”

Outbreaks to be prepared for: MRSA/VRE; S. aureus (nurseries); S. pneumoniae; GAS P. aeruginosa, Serratia, Salmonella; resistant gram negs (ICU) Legionella, Mycobacteria, C. difficile Scabies Candida, Aspergillus Influenza, Hepatitis A/B/C, SREV, Adeno

Outbreaks to be prepared for: MRSA/VRE; S. aureus (nurseries); S. pneumoniae; GAS P. aeruginosa, Serratia, Salmonella; resistant gram negs (ICU) Legionella, Mycobacteria, C. difficile Scabies Candida, Aspergillus Influenza, Hepatitis A/B/C, SREV, Adeno PEOPLE ARE THE RESERVOIR TRANSMISSION FROM PERSON TO PERSON IS THE PROBLEM

“Other” hospital outbreaks E. coli O157:H7 in a salad served to patients, and in cafeteria Legionella pneumophila in water supply Pseudomonas aeruginosa from water/sinks Ralstonia picketii from contaminated normal saline Aspergillus fumigatus from an air conditioner Serratia marcescens blood infections from propofol Candida spp. from vacuum seals in equipment for preparation of TPN

Hospital vs. Community Outbreaks Reservoir/propagation –Reservoir is people (usually patients) –Propagation is person to person We provide medical care to patients, as well as outbreak management –Easier to get medical/laboratory information –Differences between goals more evident

Preparing for outbreaks - Prevention Physical structure Private rooms Adequate space – between patients, for cleaning Adequate ventilation Enough handwashing sinks, well-placed Design in purchased equipment Glucometers Needleless IV systems Monitors for negative pressure rooms Machines for cleaning/disinfecting endoscopes/ endoscopes themselves Cleaning/disinfection/sterilization Adequate policies Adherence to policies

Preparing for outbreaks - Prevention Handwashing –Accessibility –Programs for compliance Education –Aseptic technique –Handwashing –Isolation precautions –Surveillance/reporting

Preparing for outbreaks Detection –surveillance, awareness –culture, lab processing protocols –thresholds, time frames Preservation of samples/isolates (typing)

Preparing for outbreaks Lines of communication –awareness among administrative staff –media relations Funding –microbiology lab services Policies for outbreak management

Goals of outbreak investigation/management

Outbreak types Cause unknown Control uncertain Disease severe/many cases Something to learn Cause is known Exposure/transmission known Control measures effective Small number/non-severe cases “Nothing to learn” ManagementInvestigation

Outbreak investigation Verify diagnosis Confirm the outbreak Develop a case definition Obtain descriptive epidemiology Develop a hypothesis Test the hypothesis Refine hypothesis/additional studies Implement control and prevention measures Communicate findings

Hospital outbreak investigation Verify diagnosis Confirm outbreak Perform literature review/call experts Develop a case definition Obtain descriptive epidemiology Open lines of communication Implement control measures Consider definitive investigation

Initial Investigation 1Verify diagnosis 2Confirm the existence of a problem -confirm the diagnosis -review existing data (surveillance records, interviews, microbiology records, charts) 3Perform a literature review/ call experts -reservoirs, mode of transmission -things that went wrong

Initial Investigation 4Develop a case definition -microbiology -other lab, radiology -clinical signs/symptoms -other (e.g. skin testing for TB) -set time/place parameters 5Identify, count, describe cases -line listing -time/place person -describe nature and severity -plot epidemic curve

Initial Investigation 6Open lines of communication -consider media strategy -ensure all isolates/potential isolates are saved 7 Implement control measures -enforce existing measures -supplement

Initial Investigation 8 Consider definitive investigation -formulate hypotheses -case control/cohort studies -cluster analysis

Problem #1 3 candidemias on 14th level at MSH in one month 14th level is gi medicine/general surgery –68 beds –large oncology/IBD population –25 pts per month on TPN

Problem #2

Invasive GAS disease, LTCFs

Other presentations/articles slides.pdfhttp:// slides.pdf health/Outbreak_Investigation.ppthttp:// health/Outbreak_Investigation.ppt Investigation.ppt ngold.htm