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Intermountain APIC and Qualis Health

present

I-APIC HAI Prevention Learning Network Webinar Series

Summer Epidemiology Trends And Healthcare Impact

July 11, 2012

Jim Schwendinger MSN MPH NP

Summer Season Infectious Diseases: Picnics, camping and vacations – Oh My !

Centers for Disease Control and Prevention

Office of Public Health Preparedness and Response

Jim Schwendinger MSN MPH NP

Director, Epi-X, HAN and CDC-SEND

Intermountain APIC HAI Prevention Webinar Series

11 July 2012

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The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).

Objectives

� Review summer season infectious disease situations – foodborne, vector borne, travel-related and similar.

� Review some common disease situations associated with summer which might impact healthcare facilities and staff.

� Review basic epidemiological principles which can be applied to clusters and outbreaks.

� Discuss the importance of immunizations and personal infection control during travel.

� Review selected resources for further information.

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The CDC Mission

� Safer, Healthier People

� Saving Lives

� Protecting People

� Saving Money Through Prevention

� Actions

� Prevention

� Health Education

� Early Identification and Intervention

� Research

Summer Season Epi

� What conditions often occur in the Summer ?

� URIs – coxsackie, echoviruses, parainfluenza

� GI – enterovirus, norovirus, Staph, botulism

� Vectorborne – Lyme, RMSF, erlichiosis

� Other – PAM (Naegleria fowleri ), tetanus, MRSA

� Why ?

� School age children ‘mixing’

� Camps

� Vacations / travel

� Seasonal activities – grilling

� Recreational activities – fishing, hiking

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Implications for Healthcare Facilities

� Case example: a staff physician took his family on a cruise. The family became infected with norovirus. He brought donuts into the staff meeting on his first day back. Guess how many staff ultimately became infected out of 35 ? (Answer: 31)

� Case example: a pharmacist traveled to Europe and acquired measles. After onset of clinical symptoms, she had to miss more work time. (10 more days)

Polling Question: Your Experience

� How many of you have investigated seasonal and recreational illnesses in your facility that spread or had the potential to spread to staff, patients, or visitors?

� Yes

� No

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More examples of Implications for HCFs

� Potential for infecting staff, patients, visitors

� Possible exposures from visitors from out of town

� Unusual or not immediately anticipated pathogens due to outdoor activity

� Bacterial

• Clostridium botulinum, Campylobacter, Shigella, Listeria

� Viral

• Norovirus, MMR, Rhinovirus

� Fungal

• Coccydiomycosis, sporotrycosis

� Other

• Amoebae

• Staph toxins

Epidemiology & Surveillance� Be aware of seasonal trends and expected (typical)

rates

� Be likewise aware of aberrations

� Novel or unusual pathogens,

� Larger than ‘normal’ case numbers

� Anything atypical

� Know who to contact for reporting or more information !

� Facility infection control

� Local and/or state depts of public health

� CDC

• 1-800-CDC-INFO (800-232-4636) and/or,

• if appropriate, the CDC Emergency Operations Center (770.488.7100)

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Polling Question: Reporting Procedures

� How many of you are familiar with reporting procedures for unusual conditions or those conditions on your state notifiable conditions list?

� Yes

� No

Data Collection and Reporting

� Basic demographics

� Age

� Medical status, if applicable

� Immunization status, if known and applicable

� Diagnosis, if known

� Confirmed by diagnostic testing or not

� Description of signs / symptoms, onset, progression

� Geographic info, if applicable

� Cluster mapping (micro location – family unit, common activity, etc.), if possible / applicable.

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Immunizations

� What should I be immunized against ?

� http://www.cdc.gov/vaccines/schedules/

� http://wwwnc.cdc.gov/travel/page/vaccinations.htm

� Why Immunize ?

� http://www.cdc.gov/vaccines/vac-gen/why.htm

� Case study: Japan and pertussis:

• 1974 ~80% of children were vaccinated / 393 cases

• 1976 ~10% vaccination rate

• 1979 > 13,000 clinical cases and at least 41 deaths !

� NIH website – The Benefits of Vaccinating

http://www.niaid.nih.gov/topics/vaccines/understanding/pages/vaccinebenefits.aspx

Other Protective Steps� Hand washing

� Hand wipes, waterless cleanser

� Cough hygiene

� Facemasks ?

� Water & Food awareness !

� Bottled water (not just water in a bottle…)

� Avoid ice & iced foods

� Fresh veggies and fruits should be washed

� Seafood, other fresh animal products

� Social distancing

� Have a travel kit

� Consider medications, such as antibiotics, if appropriate

• Prophylactic (malaria)

• Self-care (traveler’s diarrhea, skin infection)

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Specific Resources

� Morbidity and Mortality Weekly Report (MMWR)

� http://www.cdc.gov/mmwr/

� Manual for the Surveillance of Vaccine-Preventable Diseases, 5th Edition, 2011

� http://www.cdc.gov/vaccines/pubs/surv-manual/index.html

� Epidemiology and Prevention of Vaccine-Preventable Diseases - 12th Edition – aka ‘The Pink Book’

� http://www.cdc.gov/vaccines/pubs/pinkbook/index.html

� Preventing Healthcare-associated Infections� http://www.cdc.gov/nhsn/RA/PDF/csteWorkshopDHQP6709Final.pdf

Where to Look for More Info

� CDC Website – www.cdc.gov� Healthcare Associated Infections - http://www.cdc.gov/hai/

� Traveler’s Health - http://wwwnc.cdc.gov/travel/

� Food Safety - http://www.cdc.gov/foodsafety/

� The main CDC webpage ‘Features’ sections

� Subscribe to CDC Health Alert Network messages

� http://emergency.cdc.gov/HAN/

� Subscribe to COCA Updates� http://emergency.cdc.gov/coca/

� RSS feed from CDC web pages such as:� http://emergency.cdc.gov/

� http://www.cdc.gov/HealthyLiving/

� http://wwwnc.cdc.gov/travel/

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Where to Look…cont.

� CDC Program websites� Division of Healthcare Quality Promotion (DGMQ)

- http://www.cdc.gov/ncezid/dhqp/index.html

� TB - http://www.cdc.gov/tb/

� FoodNet - http://www.cdc.gov/foodnet/

� Partner websites

� US FDA - http://www.fda.gov/Food/default.htm

� US Dept of Agriculture (USDA) http://www.usda.gov/wps/portal/usda/usdahome?navid=FOOD_SAFETY

� Ready.gov - http://www.ready.gov/

• Many resources on preparedness in general and specific hazards – which can be

used locally !

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CDC Programs Supporting Public Health You May Not Know About…

� Epi-X – The Epidemic Information Exchange System

� Epi-X is the secure system for exchange of provisional & developing information between CDC and public health at the state, territorial, tribal, state and other levels.

� http://www.cdc.gov/epix/

� BioSense

� An organized infrastructure that enables the ongoing, systematic collection, management, analysis, interpretation, and dissemination of health-related data.

� http://www.cdc.gov/biosense/

� PulseNet

� A national network of public health and food regulatory agency laboratories coordinated by CDC. The network consists of: state health departments, local health departments, and federal agencies (CDC, USDA/FSIS, FDA).

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Epi-X Partners

� Internal CDC entities – DGMQ, NCIRD, DFBMD� Federal agencies – DoS, DoD, FDA, FEMA� Tribal, state, and local health departments� National/international organizations – WHO, IRC

AAPCC – American Association of Poison Control Centers

APHL – Association of Public Health Laboratories

ASTHO – Association of State and Territorial Health Officials

CSTE – Council of State and Territorial Epidemiologists

NACCHO – National Association of County and City Health Officials

NASPHV – National Association of State Public Health Veterinarians

Epi-X Activity Highlights

� AMERITHRAX 2001-2002

� SARS – 2003

� Fusarium keratitis – contaminated contact lens solution – 2006

� MDR TB in an overseas traveler – 2007

� Neurological illness among pork processing plant workers – 2008

� Novel influenza A (H1N1) – 2009

� First cluster reports in Mexico 3/27

� Haiti cholera – 2010

� Primary amebic meningoencephalitis – 2011

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BioSense

� BioSense integrates current health data shared by health departments from a variety of sources to provide insight on the health of communities and the country.

� Highlights of data sources include:

� Commerical pharmacy data,

� Healthcare facility census & diagnostic code data,

� Diagnostic laboratory data.

� By getting more information faster, local, state, and federal public health partners can detect and respond to more outbreaks and health events more quickly.

PulseNet: Mission

� Detect foodborne disease case clusters by PFGE.

� Allow for real-time communication among state, local health departments, and international partners.

� Facilitate early identification of common source outbreaks.

� Help food regulatory agencies identify areas where implementation of new measures are likely to increase the safety of our food supply.

� PulseNet participants perform standardized molecular subtyping (or “fingerprinting”) of foodborne disease-causing bacteria by pulsed-field gel electrophoresis (PFGE).

� The data are submitted electronically to a dynamic database at the CDC. These databases are available on-demand to participants—this allows for rapid comparison of the patterns.� Escherichia coli O157:H7, Salmonella, Shigella, Listeria, or Campylobacter .

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Summary and Conclusions

� There are seasonal patterns to illness – especially infectious diseases.

� Knowing what the ‘norms’ are can help highlight anything novel quickly.

� Reporting – even of suspicions – is vital !

� There are systems in place to monitor and trigger investigation of suspect situations.

� Know your contacts and don’t be shy !

� You are a vital link in the chain that is public health !

Thank you for all you do !

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333

Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official

position of the Centers for Disease Control and Prevention.

Questions ? More Info ?

Centers for Disease Control and Prevention

Office of Public Health Preparedness and Response

Centers for Disease Control and Prevention

Jim Schwendinger MSN MPH NP

1600 Clifton Road NE, Atlanta, GA 30333

Telephone: 1-800-CDC-INFO (232-4636) / TTY: 1-888-232-6348

E-mail: cdcinfo@cdc.gov

Web: www.cdc.gov

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Save-the-Date: I-APIC HAI Series

Preventing Carbapenem-resistant Enterobacteriaciae InfectionsWednesday, August 8, 1pm MT/12pm PT

Influenza UpdateSeptember 12, 1pm MT/12pm PTChristine Hahn, MD – Idaho State Epidemiologist, IDHW

I-APIC 13th Annual Educational ConferenceKeeping Patients as Our North Star: Are You Pointing Due North?

October 25: NHSN Use and Analysis WorkshopOctober 26: Educational ConferenceMeridian, IdahoRegister by Oct 19 for best rate of $75 for APIC members (covers both days!)Student and non-member rates also available.

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Contact Information

Quality Improvement Organizations

Jennifer PalagiQualis Health, Idaho QIO

jenniferp@qualishealth.org208.383.5944

Tina SchwienQualis Health, Washington QIO

tinas@qualishealth.org206.288.2466

Laurie Murray-SnyderAcumentra Health, Oregon QIOlmurraysnyder@acumentra.org

503.382.3927

Jim Schwendingerbrt0@cdc.gov404.639.4520

Intermountain APIChttp://apicintermountain.com/Trish Heath, Education Lead

trishh@slhs.orgGinna Maggard, President

ginna.maggard@hcahealthcare.com

This material was prepared by Qualis Health, the Medicare Quality Improvement Organization for Idaho and Washington, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. ID/WA-C7-QH-846-06-12

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