Management of a Sabiá Virus-Infected Patient in a US Hospital

1999 ◽  
Vol 20 (03) ◽  
pp. 176-182 ◽  
Author(s):  
Lori R. Armstrong ◽  
Louise-Marie Dembry ◽  
Petrie M. Rainey ◽  
Mark B. Russi ◽  
Ali S. Khan ◽  
...  
Keyword(s):  
Infected Patient ◽  
Clinical Laboratory ◽  
Single Case ◽  
Medical Center ◽  
Secondary Infection ◽  
Tertiary Care ◽  
Hospital Setting ◽  
The United States ◽  
Case Patient ◽  
Local Hospital

AbstractObjective:To describe the hospital precautions used to isolate a Sabiá virus (arenavirus: Arenaviridae)-infected patient in a US hospital and to protect hospital staff and visitors.Design:Investigation of a single case of arenavirus laboratory-acquired infection and associated case-contacts.Setting:A 900-bed, tertiary-care, university-affiliated medical center.Patients or other Participants:The case-patient became ill with Sabiá virus infection. The case-contacts consisted of healthcare workers, coworkers, friends, and relatives of the case-patient.Intervention:Enhanced isolation precautions for treatment of a viral hemorrhagic fever (VHF) patient were implemented in the clinical laboratory and patient-care setting to prevent nosocomial transmission. The enhanced precautions included preventing aerosol spread of the virus from the patient or his clinical specimens. All case-contacts were tested for Sabiá virus antibodies and monitored for signs and symptoms of early disease.Results:No cases of secondary infection occurred among 142 case-contacts.Conclusions:With the frequency of worldwide travel, patients with VHF can be admitted to a local hospital at any time in the United States. The use of enhanced isolation precautions for VHF appeared to be effective in preventing secondary cases by limiting the number of contacts and promoting proper handling of laboratory specimens. Patients with VHF can be managed safely in a local hospital setting, provided that appropriate precautions are planned and implemented.

scholarly journals Communications and Screening for 2019 Novel Coronavirus at a Tertiary-Care Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s84-s84
Author(s):  
Lorinda Sheeler ◽  
Mary Kukla ◽  
Oluchi Abosi ◽  
Holly Meacham ◽  
Stephanie Holley ◽  
...  
Keyword(s):  
Screening Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The United States ◽  
World Health ◽  
Communication Campaign ◽  
Electronic Screening ◽  
Novel Coronavirus ◽  
The Impact

Background: In December of 2019, the World Health Organization reported a novel coronavirus (severe acute respiratory coronavirus virus 2 [SARS-CoV-2)]) causing severe respiratory illness originating in Wuhan, China. Since then, an increasing number of cases and the confirmation of human-to-human transmission has led to the need to develop a communication campaign at our institution. We describe the impact of the communication campaign on the number of calls received and describe patterns of calls during the early stages of our response to this emerging infection. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center with >200 outpatient clinics. In response to the coronavirus disease 2019 (COVID-19) outbreak, we launched a communications campaign on January 17, 2020. Initial communications included email updates to staff and a dedicated COVID-19 webpage with up-to-date information. Subsequently, we developed an electronic screening tool to guide a risk assessment during patient check in. The screening tool identifies travel to China in the past 14 days and the presence of symptoms defined as fever >37.7°C plus cough or difficulty breathing. The screening tool was activated on January 24, 2020. In addition, university staff contacted each student whose primary residence record included Hubei Province, China. Students were provided with medical contact information, signs and symptoms to monitor for, and a thermometer. Results: During the first 5 days of the campaign, 3 calls were related to COVID-19. The number of calls increased to 18 in the 5 days following the implementation of the electronic screening tool. Of the 21 calls received to date, 8 calls (38%) were generated due to the electronic travel screen, 4 calls (19%) were due to a positive coronavirus result in a multiplex respiratory panel, 4 calls (19%) were related to provider assessment only (without an electronic screening trigger), and 2 calls (10%) sought additional information following the viewing of the web-based communication campaign. Moreover, 3 calls (14%) were for people without travel history but with respiratory symptoms and contact with a person with recent travel to China. Among those reporting symptoms after travel to China, mean time since arrival to the United States was 2.7 days (range, 0–11 days). Conclusion: The COVID-19 outbreak is evolving, and providing up to date information is challenging. Implementing an electronic screening tool helped providers assess patients and direct questions to infection prevention professionals. Analyzing the types of calls received helped tailor messaging to frontline staff.Funding: NoneDisclosures: None

scholarly journals An innovative resident-driven mortality case review curriculum to teach and drive system-based practice improvements in the United States

2018 ◽  
Vol 15 ◽  
pp. 31
Author(s):  
Nila S. Radhakrishnan ◽  
Margaret C. Lo ◽  
Rohit Bishnoi ◽  
Subhankar Samal ◽  
Robert Leverence ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Systems Of Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The United States ◽  
Case Review ◽  
Failure To Rescue ◽  
Internal Medicine Residents ◽  
Mortality Case

Purpose: Traditionally, the morbidity and mortality conference (M&MC) is a forum where possible medical errors are discussed. Although M&MCs can facilitate identification of opportunities for systemwide improvements, few studies have described their use for this purpose, particularly in residency training programs. This paper describes the use of M&MC case review as a quality improvement activity that teaches system-based practice and can engage residents in improving systems of care. Methods: Internal medicine residents at a tertiary care academic medical center reviewed 347 consecutive mortalities from March 2014 to September 2017. The residents used case review worksheets to categorize and track causes of mortality, and then debriefed with a faculty member. Selected cases were then presented at a larger interdepartmental meeting and action items were implemented. Descriptive statistics and thematic analysis were used to analyze the results. Results: The residents identified a possible diagnostic mismatch at some point from admission to death in 54.5% of cases (n= 189) and a possible need for improved management in 48.0% of cases. Three possible management failure themes were identified, including failure to plan, failure to communicate, and failure to rescue, which accounted for 21.9%, 10.7 %, and 10.1% of cases, respectively. Following these reviews, quality improvement initiatives proposed by residents led to system-based changes. Conclusion: A resident-driven mortality review curriculum can lead to improvements in systems of care. This novel type of curriculum can be used to teach system-based practice. The recruitment of teaching faculty with expertise in quality improvement and mortality case analyses is essential for such a project.

Office-Based Anesthesia

2011 ◽  
pp. 228-235
Author(s):  
Laurence M. Hausman
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Small Community ◽  
Respiratory Compromise ◽  
Tertiary Care Medical Center ◽  
Difficult Airways ◽  
Risk Of Exposure ◽  
American Society ◽  
American Society Of Anesthesiologists

There are many advantages to office-based procedures for both patients and practitioners. The patient is afforded more privacy with a more personal experience, as well as decreased facility fee if paying out of pocket and less risk of exposure to nosocomial infections. The practitioner will generally have improved ease in scheduling of cases, the convenience of being able to perform surgery within the same office as preoperative and postoperative care, and in some cases will receive an enhanced professional fee.5 An office practice cannot provide the same level of care as a tertiary care medical center or even a small community hospital. For this reason, not all surgical procedures or patient populations are appropriate for this venue. For example, procedures associated with large fluid shifts, blood loss, excessive postoperative pain, or respiratory compromise should continue to be performed in the hospital setting. Likewise, patients with significant comorbidities, potentially difficult airways, or those at risk for aspiration should not be considered suitable candidates for an office-based procedure. The American Society of Anesthesiologists (ASA) has published specific recommendations regarding what types of surgery and patient populations should be excluded from this venue.6

scholarly journals Duplicate Type and Screen Testing: Waste in the Clinical Laboratory

2017 ◽  
Vol 142 (3) ◽  
pp. 358-363
Author(s):  
Margaret L. Compton ◽  
Penny C. Szklarski ◽  
Garrett S. Booth
Keyword(s):  
Clinical Laboratory ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Transfusion Medicine ◽  
Laboratory Cost ◽  
System A ◽  
Medicine Service ◽  
Additional Education ◽  
Clinical Laboratory Testing

Context.— In the United States, approximately $65 billion dollars is spent per year on clinical laboratory testing, of which 20% to 30% of all testing is deemed inappropriate. There have been multiple studies in the field of transfusion medicine regarding evidence-based transfusion practices, but limited data exist regarding inappropriate pretransfusion testing and its financial and clinical implications. Objective.— To assess duplicative testing practices in the transfusion medicine service. Design.— A 24-month retrospective review was performed at a 1025-bed tertiary care center, identifying all duplicate type and screen (TS) tests performed within 72 hours of the previous TS. Duplicative testing was classified as appropriate or inappropriate by predetermined criteria. The level of underordering was analyzed through a query of the electronic event reporting system. A cost analysis was performed to determine the financial impact of inappropriate duplicative TS. Results.— The mean rate of inappropriate, duplicative TS orders was 4.13% (standard deviation ± 4.09%). Rates of inappropriate ordering ranged from 0.01% to 15.5% depending on the clinical service and did not correlate with volume of tests ordered. There were 8 reported cases of delayed blood delivery due to lack of a valid TS during the study period, demonstrating that underordering is also a harmful practice. The laboratory cost of inappropriate testing for the study period was $80,434, and phlebotomy costs were $45,469. Conclusions.— Our study demonstrates that inappropriate TS ordering is costly, both financially and clinically. By evaluating the percentage of inappropriate TS tests by clinical services, we have identified services that may benefit from additional education and technologic intervention.

Interactive iBook-Based Patient Education in a NeuroTrauma Clinic

Neurosurgery ◽  
2017 ◽  
Vol 81 (5) ◽  
pp. 787-794 ◽  
Author(s):  
Ronald Sahyouni ◽  
Amin Mahmoodi ◽  
Amir Mahmoodi ◽  
Ramin R Rajaii ◽  
Bima J Hasjim ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Educational Interventions ◽  
The United States ◽  
Outpatient Setting ◽  
Educational Material ◽  
Patient Knowledge ◽  
Academic Medical ◽  
Baseline Knowledge

Abstract BACKGROUND Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Educational interventions may alleviate the burden of TBI for patients and their families. Interactive modalities that involve engagement with the educational material may enhance patient knowledge acquisition when compared to static text-based educational material. OBJECTIVE To determine the effects of educational interventions in the outpatient setting on self-reported patient knowledge, with a focus on iPad-based (Apple, Cupertino, California) interactive modules. METHODS Patients and family members presenting to a NeuroTrauma clinic at a tertiary care academic medical center completed a presurvey assessing baseline knowledge of TBI or concussion, depending on the diagnosis. Subjects then received either an interactive iBook (Apple) on TBI or concussion, or an informative pamphlet with identical information in text format. Subjects then completed a postsurvey prior to seeing the neurosurgeon. RESULTS All subjects (n = 152) significantly improved on self-reported knowledge measures following administration of either an iBook (Apple) or pamphlet (P < .01, 95% confidence interval [CI]). Subjects receiving the iBook (n = 122) performed significantly better on the postsurvey (P < .01, 95% CI), despite equivalent presurvey scores, when compared to those receiving pamphlets (n = 30). Lastly, patients preferred the iBook to pamphlets (P < .01, 95% CI). CONCLUSION Educational interventions in the outpatient NeuroTrauma setting led to significant improvement in self-reported measures of patient and family knowledge. This improved understanding may increase compliance with the neurosurgeon's recommendations and may help reduce the potential anxiety and complications that arise following a TBI.

scholarly journals 1217. Clinical and Microbiological Characteristics of Patients with Bacteremia and Normal Procalcitonin at Single Tertiary Care Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S630-S630
Author(s):  
Leora Boussi ◽  
Tarun Popli ◽  
Nicholas Feola ◽  
Rajat Nog
Keyword(s):  
Blood Culture ◽  
Bacterial Infections ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Tertiary Care ◽  
High Sensitivity ◽  
Culture Collection ◽  
Contributing Factors ◽  
Tertiary Care Medical Center ◽  
Microbiological Characteristics

Abstract Background Procalcitonin (PCT) is a serum biomarker used to diagnose bacterial infections and guide antibiotic therapy. Many studies highlight its high sensitivity, specificity, and negative predictive value for bacteremia. PCT > 2ng/mL has been reported to be strongly indicative of systemic bacterial infection, with values of .5-2ng/mL suggesting localized infection and < .5ng/mL strongly suggesting absence of infection. However, emerging reports have raised concerns about PCT in bacteremia, demonstrating low sensitivity. Few studies have characterized patients with bacteremia and low PCT. We aimed to analyze the clinical and microbiological characteristics of patients with bacteremia and PCT < 2ng/mL. Methods Adult patients admitted at Westchester Medical Center with bacteremia and associated PCT level within 24 hours (hrs) prior to 48 hrs post blood culture collection from 1/1/2014-9/30/2019 were included. Demographic, clinical, laboratory, and microbiological data were retrospectively collected and analyzed. Results There were 414 total cases of bacteremia with an associated PCT level within 24 hrs prior to 48 hrs post blood culture collection. 209 of 414 (50.5%) patients had PCT < 2ng/mL. Of these, 86 were excluded (73 contaminants, defined as bacteremia not causing systemic inflammation and not treated, 10 fungal cultures, and 3 lacking data). Of the remaining 123 (37.5%) patients with PCT < 2ng/mL, 66 (53.7%) had PCT<. 5ng/mL. The leading infection source was endovascular/line-related at 31.7%, followed by intraabdominal/gastrointestinal and urinary. 30.9% of bloodstream organisms were gram negative. Among these 123 patients with PCT < 2ng/mL, in-hospital mortality with bacteremia clinically contributing to death was 13%. Characteristics of patients with bacteremia and procalcitonin < 2ng/mL Conclusion Despite literature supporting the use of PCT algorithms in initiation and de-escalation of antibiotics in patients with suspected bacterial infections, a substantial percentage of bacteremic patients can have low PCT but significant infection-related mortality. Therefore, PCT should not be the only factor utilized by clinicians in the management of such patients, including initiating or deescalating antibiotics. Further studies are needed to characterize patient characteristics as contributing factors for bacteremia with low PCT. Disclosures All Authors: No reported disclosures

Utility of Dual Skin Tests to Evaluate Tuberculin Skin Test Reactions of 10 to 14 mm in Healthcare Workers

2003 ◽  
Vol 24 (11) ◽  
pp. 821-824 ◽  
Author(s):  
Bryan J. Marsh ◽  
Joshua San Vicente ◽  
C. Fordham von Reyn
Keyword(s):  
Occupational Health ◽  
Skin Test ◽  
Healthcare Workers ◽  
Medical Center ◽  
Skin Testing ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Health Department ◽  
The United States ◽  
Skin Tests

AbstractObjective:To define the utility of 10- to 14-mm reactions to a Mycobacterium tuberculosis purified protein derivative (PPD) skin test for healthcare workers (HCWs).Design:Blinded dual skin testing, using PPD and M. avium sensitin, of HCWs at a single medical center who had a 10-to 14-mm reaction to PPD when tested by personnel from the Occupational Health Department as part of routine annual screening.Setting:A single tertiary-care academic medical center.Participants:Employees of the medical center who underwent routine annual PPD screening and were identified by the Occupational Health Department as having a reaction of 10 to 14 mm to PPD.Results:Nineteen employees were identified as candidates and 11 underwent dual skin testing. Only 4 (36%) had repeat results for PPD in the 10- to 14-mm range, whether read by Occupational Health Department personnel or study investigators. For only 5 (45%) of the subjects did the Occupational Health Department personnel and study investigators concur (± 3 mm) on the size of the PPD reaction. Two of the 4 subjects with reactions of 10 to 14 mm as measured by the study investigators were M. avium sensitin dominant, 1 was PPD dominant, and 1 was nondominant.Conclusion:A reaction of 10 to 14 mm to PPD should not be used as an indication for the treatment of latent tuberculosis (TB) infection in healthy HCWs born in the United States with no known exposure to TB.

scholarly journals Antibiotic resistance among clinical isolates of Haemophilus influenzae in the United States in 1994 and 1995 and detection of beta-lactamase-positive strains resistant to amoxicillin-clavulanate: results of a national multicenter surveillance study.

1997 ◽  
Vol 41 (2) ◽  
pp. 292-297 ◽  
Author(s):  
G V Doern ◽  
A B Brueggemann ◽  
G Pierce ◽  
H P Holley ◽  
A Rauch
Keyword(s):  
Haemophilus Influenzae ◽  
Antimicrobial Agents ◽  
Clinical Laboratory ◽  
Rank Order ◽  
Medical Center ◽  
The United States ◽  
Clinical Isolates ◽  
National Committee ◽  
Beta Lactamase ◽  
Amoxicillin Clavulanate

A total of 1,537 clinical isolates of Haemophilus influenzae were recovered in 30 U.S. medical center laboratories between 1 November 1994 and 30 April 1995 and were characterized in a central laboratory with respect to serotype and beta-lactamase production and the in vitro activities of 15 oral antimicrobial agents. Overall, 36.4% of the isolates were found to produce beta-lactamase. The rank order of activity of six cephalosporins on the basis of MICs was cefixime > cefpodoxime > cefuroxime > loracarbef > or = cefaclor > cefprozil. On the basis of current National Committee for Clinical Laboratory Standards (NCCLS) breakpoints ages of isolates found to be resistant or intermediate to these agents were as follows: 0.1, 0.3, 6.4, 16.3, 18.3, and 29.8, respectively (National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically, 4th ed. M7-A4, 1995). Azithromycin was, on a weight basis, the most potent of the macrolides tested in this study, followed by erythromycin and then clarithromycin. Azithromycin was typically fourfold more active than erythromycin, which was, in turn, slightly more active than clarithromycin. However, when compared on the basis of the frequency of resistance determined by using current NCCLS breakpoints, there was essentially no difference between azithromycin and clarithromycin, i.e., 0.5 and 1.9%, respectively (P = 0.086). Interpretive breakpoints for erythromycin MIC tests versus H. influenzae have not been developed. Resistance to other non- beta-lactam agents was variable, as follows: trimethoprim-sulfamethoxazole, 9.0%; chloramphenicol, 0.2%; tetracycline, 1.3%; and rifampin, 0.3%. Two conspicuous findings in this study were the identification of 39 strains H. influenzae that were beta-lactamase negative but ampicillin intermediate or resistant (BLNAR) and, even more surprisingly, 17 beta-lactamase-positive isolates that were resistant to amoxicillin-clavulanate (BLPACR). Strains of H. influenzae in the first group have heretofore been very uncommon; organisms in the second group have not previously been described in the literature. The percentages of all study isolates comprised of BLNAR and BLPACR organisms were 2.5 and 1.1, respectively. Overall resistance to ampicillin was thus 38.9%, and that to amoxicillin-clavulanate was 4.5%.

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