2018 Infection Prevention and Control Update. Lisa Caffery, MS,BSN,RN- BC,CIC, FAPIC

Transcription

1 2018 Infection Prevention and Control Update Lisa Caffery, MS,BSN,RN- BC,CIC, FAPIC

2 Influenza

3 Influenza (1/19/18) Iowa activity IDPH has investigated 40 outbreaks in nursing homes 29 Deaths Activity will continue too increase

4 Nationwide

5 Activity in Iowa Pre-dominate strain is Influenza A (H3N2) Associated with high levels of hospitalizations and death, especially the elderly and very young Early use of antivirals are encouraged

6 Influenza Prevention Wear PPE Wash or gel hands often Stay home if you are ill It is not too late to get a flu shot

7 Vaccine Not a good match with the pre-dominate A strain. Better match to the other strains in circulation

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10 Norovirus GI Virus No vaccine Spreads easily person to person Can be airborne Nausea/vomiting/diarrhea Lasts hours

11 Norovirus Must use soap and water for hand washing Bleach for cleaning Consider wearing a mask

12 Treatment Fluids Rest

13 ZIKA

14 Zika Virus Spread through the bite of a Aedes aegypti species mosquito Bite during the day and at night Infection during pregnancy can cause birth defects No vaccine

15 Zika Still a concern for those who travel to the affected areas Mosquito will not survive in Iowa

16 Travel Precautions Avoid travel to areas with on-going transmission Wear mosquito repellent (DEET)

17 Map of Zika Cases

18 Cases as of 12/20/17 US and DC 385 symptomatic 378 returning travelers 3 cases transmitted trough local exposure 4 cases acquired through sexual transmission US Territories 61 symptomatic All through local transmission

19 Cases in Pregnant Women ( ) US and DC 2,364 US Territories 4690

20 Signs/Symptoms Majority do not have symptoms Usual findings are: Rash Joint pain Conjunctivitis Muscle aches Headache

21 How is it Diagnosed? Clinical signs/symptoms Travels history Blood test for the virus

22 Treatment No specific treatment available Manage signs/symptoms Rest Fluids Tylenol

23 Transmission Mosquito bite Mother to child in utero Sexual transmission Blood transfusion

24 Zika Virus and Sexual Transmission Couples in which the woman is pregnant Abstain or use barrier method against infection for duration of pregnancy

25 Zika Virus and Sexual Transmission Couples who are NOT pregnant Males: abstain or use condoms for 6 months after return or symptoms begin Female with symptoms-use barrier method or abstain for at least 8 wks. after symptoms begin Female without symptoms-use barrier methods against infection for at least 8 wks. after return

26 Rabies/Animal bites

27 Rabies in History First written about in 2300 B.C. First vaccine developed by Louis Pasteur in 1885 What performer visited Iowa in 1982 and had to get rabies shots before leaving the state? What did the person do? In which city did this occur?

28 Worldwide Impact of Rabies Approximately 59,000 deaths each year More than 15 million people receive post bite vaccine Occurs in more than 150 countries and territories Dogs are the most common source of rabies exposures and cases

29 Rabies in the United States Changed over the last 100 years More than 90% of all animal cases occur in wild animals Approximately 8% are in domestic animals

30 Rabies in US At the turn of the century approximately 100 people/year died of rabies. In the 1990 s 1-2 deaths/year Modern day prophylaxis about 100% effective Human fatalities occur in people who fail to seek medical treatment, or did not know they were exposed

31 Rabies in the US Over $300 million spent annually of rabies prevention Cost includes vaccination of animals, animal control programs, maintenance of rabies laboratories, and medical costs

32 Occurrences All mammals have strains of rabies including humans In the Midwest skunks are the most common wild animal Farm cats are the most common domestic animal, followed by dogs and cattle

33 Rabies in Iowa animals tested positive for rabies 7 bats 1 skunk 1 cat 3 dogs Zero in Scott County

34 Rabies in Iowa Bats (final numbers not yet available) Zero in Scott County

35 Human Rabies Incubation period: days First Symptoms are vague Weakness, discomfort, fever, headache Prickling or itching at site of exposure Progresses within days to-- Cerebral dysfunction, anxiety, confusion, agitation, delirium, abnormal behavior, aggression, insomnia, and hallucination Negative indicators for Rabies Improvement or no change in neurologic status Illness with > 2 to 3 wks. duration

36 Human to Human transmission Well documented cases include: 8 recipients of transplanted corneas 3 recipients of solid organs Theoretical transmission Bite and non-bite exposures (none documented)

37 Human Rabies in Iowa Most Recent 2002 due to Bat strain Previous Case 1951 due to Dog strain Which no longer circulates in the US Dogs in the US and Iowa still get rabies

38 What is an Exposure? Bite from a potentially infected animal Infectious material (saliva or nervous tissue) contact to open wound Infectious material contact to mucous membranes (eyes, nose, mouth)

39 What is not an Exposure Saliva contact to INTACT SKIN Contact with blood, urine, or feces Touching or petting an animal

40 Human Exposure to Bats Known bite from a bat Waking up to find a bat in the room you are sleeping in Finding a bat in a room with a small child that is unsupervised Finding a bat in a room with an incapacitated person Contact with a bat and unsure whether you were bitten (i.e. bat flies into your arm)

41 Human Post Exposure Prophylaxis Wash all bite wounds with soap and water Wound cleaning has been shown to markedly reduce the risk of rabies transmission Consider tetanus prophylaxis Assess risk of bacterial infection

42 Iowa Vaccine Requirements for Animals Illegal to own a dog in Iowa age 6 month or over which has not been vaccinated. All dogs 4 months of age and older coming into to Iowa must have a current rabies vaccination Local law/code may be more restrictive

43 Bettendorf-- Reporting Requirements Reporting of bites is required Any person having knowledge of any dog, cat, or ferret bite or scratch which has caused a skin abrasion upon any person or for which the victim required medical attention, and the bite or scratch occurred within the city, shall immediately report it to the police.

44 Davenport Reporting Requirements Any person having knowledge of any dog, cat, or ferret bite or scratch which has caused a skin abrasion upon any person or for which the victim required medical attention, which bite or scratch occurred within the city, shall immediately report such fact to the Davenport Police Department.

45 Davenport The owner of an animal that has been reported as having inflicted a bite on a person or other animal shall, on demand, produce the animal for examination and quarantine to an animal control officer or police officer.

46 Reporting Requirement Any animal that has been involved in biting a person or other animal must be quarantined for ten days from the date of the bite. If the animal is euthanized they must be tested.

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48 Other odd things that come my way

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50 Rattlesnake Pills and Salmonella Pill contains dehydrated rattlesnake meat Reptiles and their meat can carry Salmonella People with compromised immune systems are at greatest risk

51 Questions???