1. PREVENTING/CONTROLLING TRANSMISSION OF INFECTIOUS AGENTS PRESENTED FOR APIC DISCUSSION 10/15/14 CHRISTINE A. BLACKMORE, MPH, RN INFECTION PREVENTIONIST LENOX HILL HOSPITAL DEPARTMENT OF EPIDEMIOLOGY

2. CASE # 1 Aspergillosis is suspected after oncology patients are identified with positive cultures. IP suspects (HVAC) malfunction, begins an investigation and is asked to recommend env. cultures. All of the following must be considered except: A. Identifying the purpose of culturing and appropriate methods beforehand. B. Meeting facility legal staff to discuss patient notification. C. Anticipating discussions and planned actions to culture results before undertaking the process. D. Determining whether there are existing standards to interpret results.

3. CASE # 1 ANSWER B. Meeting with the facility legal staff to discuss notification of the patients. Rationale: When an outbreak is identified or suspected, environmental source may be present and testing appropriate. Critical review of indications for airborne particulate monitoring/culture must be done in light of basic outbreak investigation principles (e.g., -establishing outbreak existence).

4. CASE #1 ANSWER (CONT’D) May consider this guidance: Purpose of culturing and appropriate methods should be identified beforehand. Decisions and planned actions regarding results of culturing should be anticipated before undertaking the process. Determination should be made whether there are existing standards to interpret results. REFERENCE: APIC TEXT, 5 TH EDITION, CHAPTER 5- PREVENTING/CONTROLLING THE TRANSMISSION OF INFECTIOUS AGENTS. P.121

5. CASE #2 A woman in active labor with confirmed influenza is admitted. Recommendations for preventing influenza transmission between hospitalized mothers and their infants include all of the following except: A. The mother should be placed on Droplet Precautions. B. The baby should stay in the same room with the mother. C. Keep the isolette at least 3 feet away from the mother when she isn’t interacting with the baby. D. The baby should receive formula during the 5-day period following symptom onset.

6. ANSWER CASE #2 D. The baby should receive formula during the 5-day period following the mother’s symptom onset. Rationale: Pregnant women and infants are at increased risk of hospitalization from influenza complications. Pregnant women with influenza in L&D- placed on Droplet Precautions. Don’t need mask during delivery. Her newborn infants may stay 3 ft. away in an isolette if possible when she’s not interacting with baby. REFERENCE: APIC TEXT, 5 TH EDITION, CHAPTER 5- PREVENTING/CONTROLLING THE TRANSMISSION OF INFECTIOUS AGENTS. P.118

7. ANSWER, CASE #2 (CONT’D) Should breast feed with a surgical mask and practice HH before each feeding or other contacts. This practice should continue with each feeding during the 5-day period following mom’s symptom onset. REFERENCE: APIC TEXT, 5 TH EDITION, CHAPTER 5- PREVENTING/CONTROLLING THE TRANSMISSION OF INFECTIOUS AGENTS. P.118

8. REFERENCES APIC Certification Study Guide, 5 th Edition, Chapter 5- Preventing/controlling the transmission of infectious agents. APIC Text, 4 th Edition, Chapter 114-Heating, Ventilation and Air Conditioning APIC Text, 4 th Edition, Chapter 82-Influenza