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We can build infectious disease screening into our EMR, so I encourage you to sit down and work with your vendor.
A pre-admission screening functionality in an EMR prompts the screening staff to ask patients about signs and symptoms, travel and any potential exposures they may have had.
If a trigger occurs, an alert will pop up and instructs staff on the appropriate infection control measures they should take, which include personal protective equipment, patient placement, and then whom they should notify, like the IP.”
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so, you should have respiratory etiquette stations in place at your facility, especially around points of entry such as in the emergency department, outpatient clinic or admission area, and in other places where people gather,” she said.“ You want to ensure that you have signage such as the CDC’ s“ Cover Your Cough” instructional poster, as well as having on hand masks, tissues, and hand sanitizer.”
Kley alluded to the screening considerations covered in last year’ s presentation, reminding attendees to continue screening for fever and cough, or fever and rash, or all three, as well as screening for international travel within the prior 30 days, being mindful of any local transmission, as well as contact with a suspect patient or confirmed HCID case. She also emphasized the importance of using screening functionality in electronic medical records( EMRs).“ We should be leveraging this technology that we have at our fingertips,” Kley said.“ We can build infectious disease screening into our EMR, so I encourage you to sit down and work with your vendor. A pre-admission screening functionality in an EMR prompts the screening staff to ask patients about signs and symptoms, travel and any potential exposures they may have had. If a trigger occurs, an alert will pop up and instructs staff on the appropriate infection control measures they should take, which include personal protective equipment, patient placement, and then whom they should notify, like the IP.”
Kley touched on engineering controls, which include barriers such as partitions at front desks and closed-suctioning systems during aerosol-generating procedures that can help contain airborne isolation threats. Other engineering controls include using negative airflow in the AIIR.“ These rooms should have an hourly air exchange rate of six to 12 air exchanges depending on the age of your building, and you also want to ensure that those HEPA filters are installed correctly,” Kley said, adding,“ During a recent hospital investigation, NIOSH found that while the HVAC HEPA filters were indeed in place, the plastic wrap was still on the filters, rendering them completely useless. I also once found a HEPPA filter in our HVAC system that was too small, so there were gaps; it was essentially a square filter in a round hole that did not fit, so the airborne contaminants were able to get through. You also want to be super-proactive, so get with your facility engineers and have them map out which air handlers serve which areas in your hospital; that is going to save you a ton of time and stress if you have an exposure event.”
Kley added that proper transport of patients within the healthcare facility is critical, limiting transport to essential purposes only.
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“ Just like those aerosol-generating procedures, transport should be limited, so for example, if a bedside X-ray is sufficient, then do that to eliminate the need to transport them down to the radiology department. Be sure, if you do have to transport, that the receiving department is notified well in advance so that it can prepare. Consider scheduling these patients as the last cases of the day. And then importantly, you want to think about the route that you’ re going to take during transport; it should be the path with the least amount of foot traffic. The patient should be masked, and transport staff should be wearing the appropriate PPE. Lastly, you want to make sure that you have cleared others from the elevator before getting on with that infectious patient.”
Kley addressed H5N1-specific IPC measures, including transmission-based precautions for patients which consist of airborne and contact precautions, single-patient AIIR, negative pressure, door closed except to enter / exit, the use of an N95 or higher respirator, gown, gloves, eye protection( goggles or face mask), plus use of dedicated staff and logging all who enter the patient room for purposes of contact tracing. Kley emphasized the need to continue precautions for duration of the patient’ s illness, defined as being afebrile for 24 hours and resolved of all symptoms.
As for environmental cleaning and disinfection, Kley noted,“ Remember to delay room entry to allow for those sufficient air exchanges, and routine cleaning and disinfection procedures are adequate,” she said.“ This is an enveloped virus, which is among the easiest to kill through disinfection but please be mindful that these viruses – as easy as they are to kill – they can survive for prolonged periods on environmental surfaces. So, proper cleaning and disinfection is key, and you want to ensure environmental services personnel are paying special attention to those high-touch surfaces. Also, be sure that you are using an EPA-registered, healthcare-grade disinfectant from EPA’ s List M, which is appropriate for any influenza A virus, whether it’ s seasonal or whether it’ s avian flu.”
Kley continued,“ If you’ re not sure if your product has the claim, you can also use a product that has the H5N1 claim and if you’ re not sure if your product has it, remember, there’ s only so much room on that product label, so check the master label on the EPA website. That will let you know if your product is appropriate for use.”
Torres then explained the epidemiology for the measles virus, which is a single-stranded, negative-sense RNA virus that is extremely contagious. She explained that the envelope allows easy fusion with host cells but makes it fragile outside the body.
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Remember to delay room entry to allow for those sufficient air exchanges, and routine cleaning and disinfection procedures are adequate.“ This is an enveloped virus, which is among the easiest to kill through disinfection but please be mindful that these viruses – as easy as they are to kill – they can survive for prolonged periods on environmental surfaces.” |