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Isolation Precautions: “Look It Up, Don’t Make It Up” Bud Wiedermann, MD, MA Attending in Infectious Diseases, CNMC Professor of Pediatrics, GWUSMHS November 7, 2014 The single most effective measure for preventing spread of infectious agents is ,d up it Lo ok 0% 0% 0% as hi on ng Pr ’ t op m er ak e do it ffi up ng of pe rs on .. dw ha n os e pi ck in g 0% Go od gn di n Av oi rb o rn e is o la t io n 0% Ai A. Airborne isolation B. Avoiding nosepicking C. Good handwashing D. Look it up, don’t make it up E. Proper doffing of personal protective equipment Roberta is a 6 mo girl with 2 days of runny nose, fever, and cough, now with fast breathing. Exam shows tachypnea, copious rhinorrhea, and bilateral wheezing with rhonchi. Rapid RSV test is positive. Which of the following is the most appropriate isolation choice? 0% St an da r d, c a. .. 0% d an on ta c an d d da r t, dr op l d. .. d an St an d, c da r 0% et ct t, co nt a d da r St an St an 0% on ta c an d da r d on ly 0% St an A. Standard only B. Standard and contact C. Standard, contact, and droplet D. Standard and droplet E. Standard, contact, and airborne Barbara is in the bay next to Roberta, with identical history, exam, and RSV results. The ED is overflowing, and you need more exam room availability. Cohorting of these 2 children is acceptable because they have the same virus. A. True B. False se 0% Fa l Tr ue 0% Suppose Roberta’s RSV test was negative. Which of the following is the most appropriate isolation choice for her? 0% St an da r d, c a. .. 0% d an on ta c an d d da r t, dr op l d. .. d an St an d, c da r 0% et ct t, co nt a d da r St an St an 0% on ta c an d da r d on ly 0% St an A. Standard only B. Standard and contact C. Standard, contact, and droplet D. Standard and droplet E. Standard, contact, and airborne David is a 3 mo boy with fever and loose, watery stools for 2 days. His exam is pertinent only for 3% dehydration, and his stool rotavirus antigen test is positive. Which of the following is the most appropriate isolation choice for him? 0% St an da r d, c a. .. 0% d an on ta c an d d da r t, dr op l d. .. d an St an d, c da r 0% et ct t, co nt a d da r St an St an 0% on ta c an d da r d on ly 0% St an A. Standard only B. Standard and contact C. Standard, contact, and droplet D. Standard and droplet E. Standard, contact, and airborne Pavan is a 19 yo U. Maryland student with fever, rash, and dizziness starting this morning. His exam is pertinent for signs of shock and a diffuse petechial rash. He improves with fluids and antibiotics, and CSF shows WBC 2800 (95% polys), protein 197, glucose 20, and Gram-negative diplococci on stain. Which of the following is the most appropriate isolation choice for him? 0% 0% t, an d a. .. et St an da r d, c on ta c an d d da r St an 0% dr op l d. .. d an t, co nt a ct 0% on ta c d, c da r ta n St an da r d an d da r d on ly 0% St an A. Standard only B. Standard and contact C. Standard, contact, and droplet D. Standard and droplet E. Standard, contact, and airborne Of the following conditions, which does NOT require airborne isolation (possibly with other precautions) because it is transmitted via small particle aerosol route? Ebola Measles SARS Smallpox Tuberculosis Varicella el ic Va r sis Tu be r cu lo al lp 0% la 0% ox 0% Sm M ea sle a 0% SA RS 0% s 0% Eb ol A. B. C. D. E. F. As of 10/18/14 MMWR 2014; 63:978 New Cases 9/28-10/18/14 MMWR 2014; 63:978 MMWR 2014; 63:978 Ebola: Identify, Isolate, Inform http://www.cdc.gov/vhf/ebola/pdf/ambulatory-careevaluation-of-patients-with-possible-ebola.pdf Ebola: Identify, Isolate, Inform http://www.cdc.gov/vhf/ebola/pdf/ambulatory-careevaluation-of-patients-with-possible-ebola.pdf http://www.cdc.gov/vhf/ebola/pdf/ambulatory-care-evaluation-ofpatients-with-possible-ebola.pdf PPE in the ambulatory care setting No one should have direct contact with a Person Under Investigation for Ebola without wearing appropriate PPE If PPE is available and direct patient contact necessary, a single staff member (trained in proper donning and removal of PPE) should be designated to interact with the Person Under Investigation At a minimum, health care workers should use the following PPE before direct patient contact: Face shield & surgical face mask, impermeable gown, and two pairs of gloves The designated staff member should refrain from direct interaction with other staff and patients in the office until PPE has been safely removed in a designated, confined area Examples of safe donning and removal of PPE should be reviewed: http://www.cdc.gov/hicpac/2007IP/2007ip_g.html I practice within a health system which has defined Ebola protocols for my practice. A. True B. False se 0% Fa l Tr ue 0% If you answered “False,” I suggest….. Appoint an Ebola Czar in your practice to check CDC and state DOH web site frequently Meet with stakeholders to determine plan Signage, telephone screening PPE Patient placement Who you gonna call? http://www.cdc.gov/vhf/eb ola/index.html Questions and Shameless Self-Promotion Holy Cross Peds ID Clinic 301-754-7630 Wed AM, Fri PM Visit my blog, with the AAP Evidence eMended (just Google it)