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I forget…what did that email say? oh yeah, its at mssmem.com

Archive for the ‘ID’ Category

Ebola Updates

General Info:

Sinai is one of 8 NYS Ebola Centers

 

When you have a r/o Ebola patient:

Donning and Doffing video from GNYHA is here: http://vimeo.com/109626204

Sinai Ebola intranet site (avaialable at Sinai). And Ebola Fact Sheet.

GNYHA ebola training page.

Report any suspected cases to NYCDOHMH at 866-692-3641.

Elmhurst Ebola Command Center: Ext. 4-1423.

 

More Information:

NYC DOHMH Ebola Health Alert__8_11_14 Final

NYC DOHMH EVD Evaluation Algorithm 8_11_2014 Final

Written by phil

October 13th, 2014 at 2:33 pm

Posted in Ebola

Influenza Dispo

ou might have noticed new green signs around MC level directing patients to the new flu clinic.

We’re trying to track who is sent there, from the ED.

If you have a patient who you think can be safely sent to this clinic, when you’re dispo’ing them in Epic, click the new Flu Clinic button (see below):

The new flu clinic is open from 9a-9p and is intended for treat & release patients. They have a limited capacity to give IV fluids or meds (If you have a patient with markedly abnormal vitals or substantial comorbidities, or you think your patient may end up getting admitted, this is NOT a good candidate for the flu clinic).

Written by phil

January 15th, 2013 at 5:36 pm

Posted in Influenza

Influenza Update

the young and old
–anyone with co-morbidities (looks like if your only issue is HTN though, you can withhold on these patients)
–pregnant (though be careful with the Pregnancy Class of the anti-viral you use), immediately post-partum women
–longterm care facility patients
–the above, ESPECIALLY if it’s within 48 hours; as well as the healthy (i.e., no co-morbidities, but maybe they look particularly miserable), within 48 hours

In more detail below:

Persons at higher risk for influenza complications recommended for antiviral treatment include:

Children aged <2 years;* Adults aged ?65 years; Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury); Persons with immunosuppression, including that caused by medications or by HIV infection; Women who are pregnant or postpartum (within 2 weeks after delivery); Persons aged <19 years who are receiving long-term aspirin therapy; American Indians/Alaska Natives; persons who are morbidly obese (i.e., body-mass index ?40); and Residents of nursing homes and other chronic-care facilities. Clinical judgment, on the basis of the patient’s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for high-risk outpatients. When indicated, antiviral treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. However, antiviral treatment might still be beneficial in patients with severe, complicated or progressive illness and in hospitalized patients when started after 48 hours of illness onset In the meanwhile, a few simple things you should be doing at Sinai and Elmhurst: * Get masks on patients! The point is to prevent transmission to staff and to that liver transplant patient lying 14 inches away from your patient. Even before you make the diagnosis, if the triage complaints might be flu, bring a mask with you to the bedside. (Yes, we will work with triage to see this happens there.) When you send such patients home, give them a handful of masks * If the diagnosis is influenza or you think it might be, list the diagnosis as ‘influenza-like illness.’ Don’t just put down ‘viral syndrome’ or ‘uri’ – though you could list these as secondary diagnoses. * I tried to prescribe Tamiflu for a friend today (HIV+ and didn’t get vaccinated) and discovered that many Duane-Reade pharmacies are OUT of Tamiflu. Consider using Relenza. The full info on whom to treat is below in the CDC recs. * Consider ILI in your admitted patients as well. – There will be LOTS of communications about this so keep your eye on your inbox. More info is at: – CDC influenza activity tracking can be found at: http://www.cdc.gov/flu/weekly/usmap.htm – NYC tracking info is at http://www.nyc.gov/html/doh/flu/html/data/data.shtml – CDC summary including treatment options http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm

Written by phil

January 14th, 2013 at 9:32 pm

Posted in ID,Influenza

Communicable Disease Requirements

Written by phil

October 11th, 2012 at 7:12 am

Posted in ID

Core Measures Update

Hey guys

Actual pay for performance is starting in six months and the most recent report card does not look as good as it could (i.e. if we were paid on our current performance the hospital would lose several million dollars).

We are primarily responsible for 3 metrics

1. Door to balloon for STEMI- on this we are doing well.

2. Blood cultures prior to antibiotics for pneumonia patients

a. This we are not doing as well partially because our previous strategy (no cultures for simple CAPNA) conflicted with the dogma of the admitting teams (cultures on everyone)

b. That said… given the increasing number of resistant organisms, ID is requesting cultures before any IV antibiotics on admitted patients

c. This strategy does have the advantage of simplifying the expected behavior so please…

d. If you are providing IV antibiotics to a patient you are admitting get blood cultures first. 2 sets. Every time.

3. Appropriate antibiotics for pneumonia patients

a. We do pretty well with this

b. The only piece we often miss is atypical coverage in the ICU PNA patients

c. Give azithromicin to both community and hospital associated pneumonia patients

Again, this is a very visible issue at the level of the C Suite.
Thanks for the help.

Luke

Written by reuben

February 14th, 2011 at 4:35 pm

Posted in Cardiology,ID

Winter 2010 Adult Emergency Department Initial Empiric Antibiotic Recommendations

The enclosed are recommendations and are not to substitute for clinical judgment for the following common infections:

Pneumonia
Meningitis
Neutropenic fever
Urinary tract infections
Intra-abdominal infections
Skin and soft-tissue infections
Clostridium difficile colitis

When possible draw 2 sets of blood cultures on patients admitted with a documented or suspected infection. This increases diagnostic yield and helps tailor antimicrobial therapy.

Previous culture data should guide empiric antimicrobial choices.
Community and institutional microbiology can change and checking prior culture data on patients with frequent healthcare and antibiotic exposures is strongly recommended.

Does antibiotic need approval? PAGER 9407
Piperacillin-tazobactam, imipenem-cilastatin, meropenem, ertapenem, oral vancomycin, and aztreonam require ID approval.
Initial doses of IV fluoroquinolones, cefepime, and ampicillin-sulbactam may not need ID approval for specific indications in the ED. Documentation in IBEX reflecting indication is required. TDS (inpatient) orders need ID approval.
Between 9am – 5pm, call Antimicrobial Stewardship Program for approval of these antibiotics.
During off hours (5pm – 9am), please fill out “night time request for restricted antimicrobials” form available in IBEX.
When ordering in IBEX, chart must reflect clinical indication for restricted antimicrobial.

Antimicrobial Stewardship Program:
(ID pharmacists and ID physicians available for approvals and recommendations)
Pager 9407 (adults)
Page Pediatric ID on call (pediatrics)

Other Infectious Disease pagers:
General ID consult – Pager 0649
Transplant ID consult – Pager 8678
Jeff Gumprecht – Pager 3043, Office 212-427-9550
Glenn Hammer – Pager 2562, Office 212-427-9550
Eric Neibart – Pager 2962, Office 212-427-9550
John Wolff – Pager 917-975-3175

NOTE: If there is delay in reaching an ID pharmacist/physician, call pharmacy or ED pharmacist directly. A first dose will be released STAT if restricted antimicrobial needed emergently. All subsequent doses will need approval.

C. diff
UTI
Pneumonia
Skin
Meningitis
Abdomen
Neutropenic fever

Written by reuben

December 14th, 2010 at 6:41 am

Posted in Antibiotics,ID

Infection Control Officer for the ED

Written by reuben

December 8th, 2010 at 3:11 pm

Posted in Contacts,ID

Measles Exposure

We had confirmed Measles case in the ED last Thursday and Friday. Staff that was exposed was already contacted, or will be contacted soon.
Also some patients and family members of patients were exposed. The Department of Health may send some exposed patient or family members to the ED for testing. If a patient presents to the ED and says “The Department of Health sent me”… for measles exposure, then follow the following procedures:
1. Give the pt and “green” N 95 mask
2. sit the patient in a chair in intake
3. pull the curtain
4. quick reg, then full reg pt (EHS code)
5. Quick triage pt
6. order (as a custom order for now) “measles Igg”
7. draw gold top tube, label it with pt works label
8. send specimen on downtime form to the lab–
9. d/c “non billable visit.
Please make sure that the contact information is correct so that infection control and or the DOH can contact the patient with titer information.
Please remember. Any pt with a fever and a rash should go into an isolation or single room, at least until a provider can see the patient.
any questions?
email me at kevin.baumlin@mssm.edu

Update:

the order was put in so… no need for down time form..

look in:

I added the test in the following grp under miscellaneous:

Common labs

Common labs-peds

Common orders

Lab-miscellaneous

*Measles Antibody

is the name of the test

-kb

Written by reuben

November 25th, 2010 at 5:19 am

Posted in ID

Patients with recent I-131 Treatment

A patient who comes in s/p I 131 treatment within a month of their treatment:

Isolate the patient in an Isolation room in the ED.  Stay 6 feet away from the patient as much as possible at all times.

Keep pregnant staff and children away from the patient.

Call Endocrinology Consult 24/7 to make them aware the patient is in the Emergency Department.  The alternative will  be would be to contact the Radiation Safety Officer.

If the patient needs admission admit them to the “Radiation Room” on A3 OR a private room if this is not available.

If it was a patient recently discharged from EHC and needs admission – re-admit the patient back to the room from where they were discharged.

Of note: the patient should be wanded with a Geiger Counter.  < 2mr/ hr all children and pregnant staff need to stay 6 feet from patient.  >2mr/ hr all staff need to stay 6 feet from the patient.  If the patient is in extremis, treat the patient first as radiation emission is a secondary concern.  More on wanding and Geiger Counters to come…

Laura Iavicoli-Allensworth, MD

Written by reuben

October 13th, 2010 at 4:38 pm

Posted in ID

Pneumonia Core Measure

From: Corinne Geller

PATIENTS ARE AUTOMATICALLY GIVEN A PNEUMONIA DX FOR WRITING:
R/O PNEUMONIA
INFILTRATE
LOWER REPIRATORY IFECTION
NEED TO EVALUATE FOR PNEUMONIA
PNEUMONITIS
POSSIBLE/PROBABLE/QUESTIONABLE/ OR SUSPECTED PNEUMONIA

Once a pneumonia diagnosis is inadvertantly given, you are expected to follow all the core measure guidelines for a pneumonia pt. Otherwise, we fail. Our failures are publicized on the internet and we are financially penalized.

If you are a providor select the drop down check-box indicating:
CLINICAL PICTURE WAS UNCLEAR OR NOT SUGGESTIVE OF PNEUMONIA; DELAY IN THE DIAGNOSIS OF PEUMONIA AT TIME OF ADMISSION.
If this situation applies. Corroborate in your notes. Nurses please help remind providers. Cannot make this selection once 6 hours has already passed.
THANK YOU!

Written by reuben

October 2nd, 2010 at 5:18 pm

Posted in ID

2009 Antibiogram

Written by reuben

August 17th, 2010 at 12:41 am

Posted in Antibiotics,ID

Correct Antibiotics for immunosuppressed patients going to ICU

(PNA core measure)

B-lactam (IV) + Macrolide (IV)

B-lactam (IV) + Antipneumococcal Quinolone (IV)

If documented B-lactam allergy: Antipneumoccal Quinlone(IV) + Aztreonam

B-lactam = Ceftriaxone, Cefotaxime, Ampicillin/ Sulbactam

Macrolide = Erythromycin, Clarithromycin, Azithromycin

Antipneumococcal Quinolones = Levofloxacin, Moxifloxaxin

B-lactam (IV + Macrolide (IV)
B-lactam (IV + Antipneumococcal Quinolone (IV)
If documented B-lactam allergy: Antipneumoccal Quinlone(IV) + Aztreonam
B-lactam = Ceftriaxone, Cefotaxime, Ampicillin/ Sulbactam
Macrolide = Erythromycin, Clarithromycin, Azithromycin
Antipneumococcal Quinolones = Levofloxacin, Moxifloxaxin

Written by reuben

April 28th, 2010 at 3:03 am

HIV PEP

I just typed this up for myself into an e-version off a hard copy “Pharmacy Bulletin” that we received- thought some of you might find it useful as well…
-L

Adults/adolescents:
Truvada (Tenovir/Emtricitabine): 1tab po qd c or s food
Atazanavir(Reyataz) 300mg po qd c food
Ritonavir(Norvir) 100mg po qd c food

Pediatric:
Zidovudine (10mg/ml prep or 300mg tab) 220 mg/m2 bid (max 300 bid)
Lamivudine (10mg/ml prep or 150mg tab) 4mg/kg bid (max 150 bid)
Lopinavir/ritonavir (80/20 mg/ml prep, 100/25 tabs, 200/50 tabs)
2w-6m: 16mg/kg lopinavir bid
>6m and <15kg: 12 mg/kg lopinavir bid
>6m and 15-40kg: 10 mg/kg lopinivir bid
>6m and >40kg: 400mg lopinavir bid

Written by phil

April 4th, 2010 at 1:40 am

Posted in ID,Needlestick

CDC Advisory: Notice to Providers Concerning Potential Cases of Mumps During a Multi-State Outbreak

We have just received a CDC Advisory concerning mumps outbreak. It is available on the HAN home page, is appended to this email, and is also attached as a pdf file. To read the attachment, you will need the Adobe reader. If you do not have that software, it can be downloaded at no cost at http://www.adobe.com/products/acrobat/readstep2.html.
To log into the HAN, for this alert and many related documents, go to www.nyc.gov/health/nycmed
If you have any questions or problems, call 1-888-NYCMED9 or write to nycmed@health.nyc.gov
If healthcare providers have any concerns regarding a suspected or confirmed case related to the CDC notification below, please call the NYC DOHMH Provider Access Line at 1-866-NYC DOH1.
This is an official
CDC Health Advisory
Distributed via Health Alert Network
March 11, 2010, 14:32 EST (2:32 PM EST)
CDCHAN-00310-10-03-11-ADV-N
MARCH, 2010, Notice to Providers Conce rning
Potential Cases of Mumps During a Multi-State Outbreak
CDC, in collaboration with public health officials in numerous states in the Northeast, continues to investigate a multi-state mumps outbreak.
Who is affected: The Hasidic (Jewish) populations from New York and New Jersey are primarily affected. This outbreak is also occurring among members of the same population in Israel.
Why mumps transmission is a concern at this time: The onset of Passover (March 30th through April 5th) may offer further opportunities for mumps transmission as people from the Hasidic community travel for this major religious observance.
Recommendations for Providers:
• Healthcare providers with patients in any Hasidic community should ensure that these patients, including both children and adults, are up to date with measles-mumps-rubella (MMR) vaccine. The second dose of MMR vaccine for children may be administered as early as 28 days followi ng the first dose.
• Healthcare providers may consider offering a second dose of MMR vaccine to adults who have received one dose.
• Healthcare providers who have contact within the Hasidic community should ensure that they themselves and ALL staff are immune to mumps in accordance with ACIP recommendations http://www.cdc.gov/vaccines/recs/provisional/downloads/mmr-evidence-immunity-Aug2009-508.pdf or receive two doses of MMR vaccine.
• Persons with suspected mumps should be isolated for 5 days after onset of parotitis and, if they visit a health-care setting, droplet precautions should be initiated immediately.
• Any suspected mumps case should be reported to the health department in the area where the case-patient resides.
Resources for Providers:
Vaccine Information Statement
Yiddish: http://www.nyc.gov/html/doh/downloads/pdf/imm/mumps_vis-yi.pdf
English: http://www.cdc.gov/vaccines/pubs/vis/default .htm#mmr
Resources (fact sheets on mumps and the outbreak) for Patients:http://www.cdc.gov/mumps/about/downloads/mumps-factsheet.pdf
http://www.cdc.gov/mumps/outbreaks/outbreak-patient-qa.html
Radio PSA (free for download): http://www2c.cdc.gov/podcasts/player.asp?f=805169
For Additional Information:
For more information on MMR vaccines, visit: http://www.cdc.gov/vaccines/vpd-vac/mumps
More information about mumps can be found at http://www.cdc.gov/mumps
For the latest information about this outbreak, go to http://www.cdc.gov/mumps/outbreaks.html
For background, please refer to the following articles:
• Update: Mumps Outbreak — New York and New Jersey, June 2009–January 2010
MMWR Vol 59, No 5;February 12, 2010
• Mumps Outbreak — New York, New Jersey, Quebec, 2009
MMWR Vol 57, No 58(Dispatch);1-4 November 12, 2009

We have just received a CDC Advisory concerning mumps outbreak. It is available on the HAN home page, is appended to this email, and is also attached as a pdf file. To read the attachment, you will need the Adobe reader. If you do not have that software, it can be downloaded at no cost at http://www.adobe.com/products/acrobat/readstep2.html.

To log into the HAN, for this alert and many related documents, go to www.nyc.gov/health/nycmed

If you have any questions or problems, call 1-888-NYCMED9 or write to nycmed@health.nyc.gov

If healthcare providers have any concerns regarding a suspected or confirmed case related to the CDC notification below, please call the NYC DOHMH Provider Access Line at 1-866-NYC DOH1.

This is an official

CDC Health Advisory

Distributed via Health Alert Network

March 11, 2010, 14:32 EST (2:32 PM EST)

CDCHAN-00310-10-03-11-ADV-N

MARCH, 2010, Notice to Providers Conce rning

Potential Cases of Mumps During a Multi-State Outbreak

CDC, in collaboration with public health officials in numerous states in the Northeast, continues to investigate a multi-state mumps outbreak.

Who is affected: The Hasidic (Jewish) populations from New York and New Jersey are primarily affected. This outbreak is also occurring among members of the same population in Israel.

Why mumps transmission is a concern at this time: The onset of Passover (March 30th through April 5th) may offer further opportunities for mumps transmission as people from the Hasidic community travel for this major religious observance.

Recommendations for Providers:

• Healthcare providers with patients in any Hasidic community should ensure that these patients, including both children and adults, are up to date with measles-mumps-rubella (MMR) vaccine. The second dose of MMR vaccine for children may be administered as early as 28 days followi ng the first dose.

• Healthcare providers may consider offering a second dose of MMR vaccine to adults who have received one dose.

• Healthcare providers who have contact within the Hasidic community should ensure that they themselves and ALL staff are immune to mumps in accordance with ACIP recommendations http://www.cdc.gov/vaccines/recs/provisional/downloads/mmr-evidence-immunity-Aug2009-508.pdf or receive two doses of MMR vaccine.

• Persons with suspected mumps should be isolated for 5 days after onset of parotitis and, if they visit a health-care setting, droplet precautions should be initiated immediately.

• Any suspected mumps case should be reported to the health department in the area where the case-patient resides.

Resources for Providers:

Vaccine Information Statement

Yiddish: http://www.nyc.gov/html/doh/downloads/pdf/imm/mumps_vis-yi.pdf

English: http://www.cdc.gov/vaccines/pubs/vis/default .htm#mmr

Resources (fact sheets on mumps and the outbreak) for Patients:http://www.cdc.gov/mumps/about/downloads/mumps-factsheet.pdf

http://www.cdc.gov/mumps/outbreaks/outbreak-patient-qa.html

Radio PSA (free for download): http://www2c.cdc.gov/podcasts/player.asp?f=805169

For Additional Information:

For more information on MMR vaccines, visit: http://www.cdc.gov/vaccines/vpd-vac/mumps

More information about mumps can be found at http://www.cdc.gov/mumps

For the latest information about this outbreak, go to http://www.cdc.gov/mumps/outbreaks.html

For background, please refer to the following articles:

• Update: Mumps Outbreak — New York and New Jersey, June 2009–January 2010

MMWR Vol 59, No 5;February 12, 2010

• Mumps Outbreak — New York, New Jersey, Quebec, 2009

MMWR Vol 57, No 58(Dispatch);1-4 November 12, 2009

Written by reuben

March 11th, 2010 at 10:07 pm

Posted in ID

Current Recommendations for Antiviral Treatment of Patients with Confirmed or Suspected Influenza

Click here for Algorithm as of Nov 10 2009

Who needs to be treated with tamiflu?

What is the recommended dose of tamiflu?

How do you adjust tamiflu for patients with renal disease?

Who needs to be admited and if sent home, what are your discharge
instructions?

If you do not know (for sure) the answers, see [below].

Andy

With the continuing burden of 2009 H1N1 influenza (swine flu) in the community and questions regarding treatment, the Division of Infectious Diseases, the Antibiotic Assistance Program,  and the Infection Control Department have drafted the following treatment guidelines to aid with both the inpatient and outpatient management of patients with influenza-like illness.    Currently the overwhelming majority of circulating influenza is 2009 H1N1 (swine) influenza.  99% of 2009 H1N1 influenza remains susceptible to both oseltamivir (Tamiflu) and zanamivir (Relenza).

Recommendations

1. Diagnostic test results should not substitute for clinical judgment and if there is a suspicion of 2009 H1N1 influenza appropriate infection control precautions and management should be initiated early and empirically.

2. Most individuals without underlying medical conditions will have a self-limited respiratory illness.  Those who present with an uncomplicated febrile illness generally do not require antiviral treatment.  They are encouraged to remain out of work or school for at least 24 hours after fever has resolved.

3. Currently, when treatment is indicated, monotherapy with oseltamivir (Tamiflu) or zanamivir (Relenza) is sufficient.  Please note that these recommendations may change throughout the course of the influenza season.  Dosing recommendations for these agents are provided below.

4. There are groups who have been identified as being at increased risk for complications and/or severe disease from 2009 H1N1 influenza and these persons should be treated. These groups include:

  • All hospitalized patients with an influenza-like illness or confirmed or suspected 2009 H1N1 Influenza.
  • Persons who are at increased risk for complications or severe disease.
    • Children ? 2 years old
    • Adults ? 65 years of age
    • Pregnant women and women up to 2 weeks postpartum (including following pregnancy loss)
    • Persons with the following conditions:
      • Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), or metabolic disorders (including diabetes mellitus)
      • Disorders that that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders)
      • Immunosuppression, including that caused by medications or by HIV or solid or stem cell transplantation

These recommendations should be used together with clinical judgment in making treatment decisions for both patients who are at higher risk for influenza-related complications and patients who are not at higher risk.

Dosing and administration

MEDICATION

Treatment  (5 days)

Chemoprophylaxis

(10 days)

Oseltamivir (Tamiflu)

ADULTS

Creatinine Clearance ? 30 75 mg twice a day for 5 days 75 mg once a day for 10 days
Creatinine Clearance <30

Hemodialysis

Peritoneal Dialysis

75 mg once a day for 5 days 75 mg every other day for 10 days

CHILDREN ? 12 months

? 15 kg 30 mg twice a day for 5 days 30 mg once a day for 10 days
15-23 kg 45 mg twice a day for 5 days 45 mg once a day for 10 days
24-40 kg 60 mg twice a day for 5 days 60 mg once a day for 10 days
? 40 kg 75 mg twice a day for 5 days 75 mg once a day for 10 days

INFANTS < 12 months

< 9 months 3 mg/kg twice a day for 5 days Not recommended
9-11 months 3.5 mg/kg twice a day for 5 days 3.5 mg/kg mg once a day for 10 days

Zanamivir (Relenza)

ADULTS

10 mg (two 5 mg inhalations) twice a day 10 mg (two 5 mg inhalations) once a day

CHILDREN

? 7 years old for treatment ? 5 years old for prophylaxis
10 mg (two 5 mg inhalations) twice a day 10 mg (two 5 mg inhalations) once a day

Please note that the oral inhalation formulation of zanamivir cannot be administered by nebulization therapy.

Alternative antiviral agents

For individuals who are perceived to be failing antiviral therapy there are two investigational agents available, intravenous peramivir and intravenous zanamivir, to treat these patients.  It is strongly recommended that an Infectious Diseases consultation be obtained in cases where standard therapy is failing.

Briefly, intravenous peramivir is a neuraminidase inhibitor that works similarly to oseltamivir.  It is currently available through the FDA under an emergency use authorization.(1)  Its use should be reserved for patients deemed to be failing conventional antiviral therapy or unable to tolerate oral oseltamivir or inhaled zanamivir.  Due to reporting issues and complicated dosing regimens Infectious Diseases consultation is required.

There have been sporadic oseltamivir-resistant cases of 2009 H1N1 influenza reported worldwide.(2-3)  Most of these cases have been in the setting of oseltamivir treatment or chemoprophylaxis.  In these cases susceptibility to zanamivir has been retained.  In patients unable to tolerate inhaled zanamivir (e.g., ventilated patients) intravenous zanamivir is available in limited supply through a compassionate use program through the manufacturer.(4)  Infectious Disease consultation is required to aid in the administration and procurement of this agent if clinically warranted.

Chemoprophylaxis (5)

Post-exposure chemoprophylaxis can be considered for:

  • Persons at higher risk for complications due to influenza.
  • Health care workers exposed to influenza without adequate personal protective equipment.

Chemoprophylaxis is generally not recommended if >48 hours have elapsed since last the contact with the infectious person.  Chemoprophylaxis for exposure to 2009 H1N1 influenza is not recommended for persons who have received the H1N1 vaccine more than 14 days prior to exposure.  Chemoprophylaxis is not currently recommended for prevention of illness in healthy children or adults.

References

1      http://www.cdc.gov/H1N1flu/EUA/peramivir_recommendations (updated October 24, 2009)

2      MMWR 2009; 58 (32): 893-6

3      MMWR 2009; 58 (35): 969-72

4      Lancet 2009; 374: 1036

5      http://www.cdc.gov/h1n1flu/recommendations (updated October 16, 2009)

Written by phil

November 6th, 2009 at 5:45 pm

Posted in ID,Swine Flu

Mumps Alert

Today, the NYCDOHMH released an Alert describing an outbreak of mumps in Brooklyn.  Thus far, 57 confirmed cases of mumps, including cases among fully vaccinated persons, have been identified.  The full alert is attached and key points are noted below.  Please share this information with your colleagues and staff as appropriate.  This Health Alert will be posted on the Mount Sinai Infection Control website.

Thank you.

 

Key Points

1.      All suspected cases of mumps must be reported to the Bureau of Immunization (212) 676-2288 (212-764-7667 after hours).  [Mumps is characterized by acute onset of unilateral or bilateral tender swelling of the parotid or other salivary glands, lasting 2 or more days.  Complications can include orchitis, mastitis, oophoritis, deafness, and encephalitis.]
2.      In health care settings, patients with suspected mumps should be cared for using Standard and DROPLET PRECAUTIONS.
3.      Testing should be performed on all suspected cases.  Testing should include blood (for IgM and IgG antibodies to mumps) and a buccal swab for viral isolation.  [Please note that a negative IgM does not rule-out mumps.]  Notify the lab if sending a specimen for viral isolation if mumps is suspected.
4.      Suspected cases should be kept home for 5 days after the onset of parotitis.  Susceptible contacts should stay home for the incubation period (12 days to 25 days after exposure).
5.      It is recommended that healthcare workers born after 1957 receive 2 doses of mumps-containing vaccine (e.g., MMR) unless contraindicated.  Healthcare workers born before 1957 who do not have a history of mumps should receive 1 dose of mumps containing vaccine and, in an outbreak setting, a second dose of mumps containing vaccine should be considered.

 

 

David P. Calfee, MD, MS

Hospital Epidemiologist and Infection Control Officer

Mount Sinai School of Medicine

Box 1151

One Gustave L. Levy Place

New York, NY 10029

 

Phone: 212.659.9470

Fax: 212.849.2582

Pager: 917.457.0258

Email: David.Calfee@mountsinai.org

Written by reuben

October 23rd, 2009 at 12:27 am

Posted in ID

Antibiotic Restriction List

Written by phil

August 26th, 2009 at 10:41 pm

Posted in Antibiotics,ID,Pharmacy

Tamiflu Approval

Wed Jun 10, 2009 14:12

From: Sara Bingel, RPH

Subject: ID APPROVAL *NOT* NEEDED FOR TAMIFLU AND RELENZAFrom site: Mount Sinai ED
Hello,
As of June 10, 2009, you do NOT need to page 9407 for ID approval for Tamiflu or Relenza for ADULT patients needing anti-viral treatment. Have a nice day!

Written by phil

June 10th, 2009 at 8:37 pm

Posted in ID,Swine Flu

Influenza Like Illness Isolation

Given the current difficulty in obtaining single rooms (particularly airborne isolation – negative pressure rooms), we wanted to remind everyone that patients with suspected or confirmed influenza require only Droplet Precautions (not airborne precautions) and can be admitted to any single room. (Of course, if TB or varicella/zoster is present or on the differential, then airborne isolation would be required.)

We have had a few patients waiting in ED for negative-pressure room who required only a single room. Thus, this clarification with staff may reduce ED waiting times for admitted patients.

Written by phil

June 2nd, 2009 at 5:33 pm

Posted in Admitting,ID,Swine Flu

Tamiflu Pharmacies

The pharmacy has contacted all of the local pharmacies, below is their stock of both capsules and liquid.
           
                                                                                                Capsules                       Liquid
            Apthorp            West 77-78 & Broadway                         10 boxes                       6 bottles
            Chateau Drug    Amsterdam and W 68th Street                 4 boxes (tomorrow)        2 bottles
            CVS 540           Amsterdam & 86th Street                        2 boxes                         20 bottles
            Drug Loft           1412 Madison & 96th Street                     1 box                             6 bottles
            Duane Reade     3rd Ave & 115th Street                              15 boxes                       10 bottles
            Duane Reade     West 181st  Street & St. Nicholas            4 boxes                          None
            Duane Reade     Broadway & 97th Street                           7 boxes                         None
            Madison Avenue Madison & 97th Street                            5 boxes                         3 bottles
            Rite Aide           Amsterdam & 70th Street                        None                             None
            Rite Aide           Broadway & 110th Street                         6                                  None
            Rite Aide           West 125th Street & St. Nicholas             None                             None
            Town Drugs       West 113th Street & Amsterdam              3 Boxes                        2 Bottles
            Town Health      45 E 30th St. between Park & Madison     1 box                            None

Written by phil

May 28th, 2009 at 8:43 pm

Posted in ID,Swine Flu

Swine Flu Surge Coverage

It has been noted that a lot of attendings are behind in hours. Not as far behind as I, but behind non-the-less.

We have negotiated a “pot-sweetener”: if you are behind in hours to double- digits (that’s more than 10), you can be re-imbursed for swine hours at almost double. That’s right- 5 hours for 3.

Note that if you are ahead in hours, not behind, you are being paid at $150, which is higher than moonlighting rate. It seemed unfair to pay those ahead at a higher rate, while re-imbursing those behind at the base rate.

We are now re-imbursing both those ahead and those behind at higher, crisis pay rates.
Take another look at the spreadsheet now.

If you have a gmail account, you can add your name to the schedule yourself.

Written by admin

May 28th, 2009 at 7:47 pm

Posted in Admin,Swine Flu

Nasal Specimen Collection Guide

with one comment

Nasopharyngeal Specimen Guide

Note that as of today we do not have flexible rayon swabs, but may be getting them-

Note also that an order for Flu DFA is now in Ibex under a “flu lab” order set…no more paper forms please

Thanks

Scot

Addendum from Kevin:

Culture media is in the fridge in Pediatric ED utility room with swabs.  Cut swab and place tip in the tube

Ordering the test in ibex

Go to “Flu labs”

Click both “Influenza DFA” and “Rapid flu” test for now

Written by reuben

April 27th, 2009 at 9:23 pm

Posted in ID

Swine Flu

with 5 comments

May 24 Flowsheet

May 22 Guidelines.

modified-strict-precautions-sign_english

swine_influenza_home-isolation_4_30_09af

updated-screening-tool_swine-influenza_2may09

Update 5/6/09

Here is the latest on H1N1

Recommendations are same as those for seasonal flu

patients with fever and cough or fever and sorethroat require mask and single room or 3-6 feet separation

Negative pressure Airborne Isolation and N95 are no longer routinely required

STANDARD and DROPLET precautions for routine medical care

Aersol generating procedures require N95 and eye protection preferably in a negative pressure room

Obtaining nasopharyngeal swabs for Flu testing requires surgical mask

Influenza testing should continue on patients admitted with fever and acute respiratory illness.

current reporting, diagnostic testing, antiviral treatment and prophylaxis remain unchanged

please review attached and information below

There are new discharge instructions for home isolation

Read the rest of this entry »

Written by reuben

April 25th, 2009 at 7:28 am

Posted in ID

Respiratory / Droplet Isolation

Written by phil

February 24th, 2009 at 5:32 pm

Posted in ID

No more blood cultures for PNA patients

Just to be clear- blood cultures are NO LONGER NEEDED for core measure compliance in pneumonia patients.
 
This is consistent with available evidence so you are no longer faced with deciding between good medicine and core measure compliance.
 
Continue to order blood cultures on the patients you believe are septic (regardless of source) just please, please, please… no more blood cultures on the routine PNA admit.

One additional point:
 
If you order and draw blood cultures after antibiotics are given the case becomes a core measure outlier so please discourage your medicine colleagues from ordering late blood cultures on admitted pneumonia patients…
 
Thanks,
 
Luke

Written by reuben

January 23rd, 2009 at 8:58 am

Posted in ID,JCAHO

HIV Test Results Access Through EDR

Good evening, just a reminder about needlestick patients – we are able to obtain the results of the rapid HIV tests done on the patient  – it is in EDR – see below for details
in EDR – put in pt name/mr

Resident Menu
Date/Time: select: ALL DATA
Format: select: SHOW DETAILS OF ALL TESTS
Select: PROTECTED  (last on the pull down menu)
Click Get Data

thank you
Meika

Written by reuben

January 17th, 2009 at 3:32 am

Posted in ID,Needlestick

Discharge of HIV patients

Written by phil

January 2nd, 2009 at 4:58 pm

2008-2009 MSSM Influenza Recommendations

Written by reuben

December 30th, 2008 at 8:47 pm

Posted in ID

Influenza 2008 – 2009

The CDC issued interim recommendations for use of antiviral medications for the treatment of influenza during the 2008-2009 influenza season due to a high rate of resistance to oseltamivir (Tamiflu) among circulating influenza A (H1N1) strains.   The information below (and in the attached document) provides updated recommendations for the diagnosis and treatment of influenza at the Mount Sinai Medical Center that have been developed by the Pharmacy, Clinical Microbiology Laboratory, and the Divisions of Infectious Diseases and Pediatric Infectious Diseases.  Additional updates will be provided as needed throughout the course of influenza season.

Thank you.

David P. Calfee, MD, MS

Hospital Epidemiologist and Infection Control Officer

—————————————————————————————————————————

Revised Recommendations for Treatment of Influenza: 2008-2009

Mount Sinai Hospital

On December 19, 2008 the CDC issued interim recommendations for use of antiviral medications for the treatment of influenza during the 2008-2009 influenza season due to a high rate of resistance to oseltamivir (Tamiflu) among circulating influenza A (H1N1) strains.   These oseltamivir-resistant viruses have remained susceptible to other antiviral agents, including zanamivir (Relenza), rimantadine, and amantadine.  Circulating H3N2 influenza A viruses and influenza B viruses have been susceptible to oseltamivir and zanamivir but resistant to rimantadine and amantadine.  In response to this new information, the following recommendations have been developed by the Department of Pharmacy, the Clinical Microbiology Laboratory, and the Divisions of Infectious Diseases and Pediatric Infectious Diseases.

1. Laboratory testing: Confirmatory testing for influenza is strongly recommended, especially during the early part of influenza season.  The DFA test is the preferred rapid diagnostic test and it is available 7 days per week during the dayshift.  Rapid antigen testing is available at all other times but it has lower sensitivity and specificity than the DFA.   Both of these tests are able to distinguish influenza A from influenza B.  The preferred specimen for both testing methods is a nasopharyngeal aspirate or wash. A nasopharyngeal (not nasal) swab is an alternative.  The techniques for collecting these specimens are described below. Culture is also available and should be considered when the rapid tests are negative and the index of suspicion for influenza is high. In addition, you may be contacted to order a viral culture for your patients with a positive rapid test result so that the Department of Health laboratory can determine which subtype(s) of influenza are circulating in the community.  In very young patients and in older adults, testing for respiratory syncytial virus (RSV) should also be included in the initial evaluation.

2. Vaccination:  Vaccination remains the primary approach to influenza prevention and early data indicates that there is a good match between vaccine strains and circulating strains.  Efforts to vaccinate patients and healthcare workers should continue.   Employee Health Service continues to offer the influenza vaccine at no charge to all employees, faculty, and volunteers.  No appointment is necessary.

3. Antiviral therapy for influenza infection:

a. Based on currently available data, two regimens can be considered for use in the empiric treatment of influenza:

i. zanamivir (Relenza)

or

ii. oseltamivir (Tamiflu) plus rimantadine (or amantadine).

b. If it is subsequently determined that the patient is infected with influenza A, then one of the empiric regimens should be continued for the full treatment course because the results of subtype testing to distinguish H1N1 from H3N2 will not be available in real-time.

c. If it is subsequently determined that the patient is infected with influenza B, treatment with either oseltamivir or zanamivir monotherapy is appropriate.

d. Comments regarding the use of anti-influenza medications:

i. Adult and pediatric dosing recommendations are provided below.

ii. The recommended treatment course is 5 days.

iii. Zanamivir will not be available from the Mount Sinai pharmacy until December 26, 2008.

iv. Rimantadine and zanamivir cannot yet be ordered via TDS.  Please call the Mount Sinai pharmacy to order these medications.

v. Zanamivir is available only as an oral inhalation.  The delivery system is different from common metered-dose inhalers.  Patients and healthcare personnel will need to be pay careful attention to the instructions for proper use of the delivery system.

vi. Zanamivir is not recommended for use in persons with underlying airway disease and should be discontinued in any patient who develops bronchospasm or decline in respiratory function.

4. Chemoprophylaxis:  Infectious Diseases should be consulted if chemoprophylaxis is being considered for persons at high risk who have been exposed to influenza.


Influenza Treatment Dosing Recommendations*

Adult Patients

Creatinine Clearance (mL/min)

Drug

>50

30-50

10-30

<10

Amantadine

100 mg Q12h

100 mg daily

100 mg Q48h

200 mg Qwk

Oseltamivir (Tamiflu®)

75 mg Q12h

75 mg daily

No data

Rimantadine1

100 mg Q12h

100 mg daily

Zanamivir2 (Relenza®)

10 mg (2 inhalations) Q12h

1Rimantadine dosing should also be adjusted to 100 mg daily for severe hepatic impairment

2Zanamivir doses on day 1 should be administered between 2-12 hrs apart; on day 2-5, give Q12h

Written by phil

December 24th, 2008 at 8:25 pm

Posted in ID

Annual OSHA & NYS Infection Control Tests

Compliance with Infection Control training requirements is very important from both the patient safety and regulatory standpoints.  Compliance with these requirements is federally and/or state mandated and subject to review and enforcement by OSHA and accrediting agencies, including JCAHO.

1.  OSHA Bloodborne Pathogen Training:

All employees with the potential for exposure to blood and/or other body fluids (designated “category A” employees) are required to complete this training annually. The attached report indicates the date upon which each employee’s current certificate for OSHA Bloodborne Pathogen Training expires.  Employees with expired certificates are indicated by a comment in the far right column of the table.  Department administrators should notify these employees so that the renewal process can be completed immediately.

OSHA Training opportunities:

The OSHA retraining course lasts approximately one hour and is offered by the Department of Infection Control throughout the year.  The schedule of course dates, times, and locations is available on the Infection Control website (<http://intranet1.mountsinai.org/> >>Medical Services>> Infection Control).  Pre-registration is not required.

Licensed health care professionals also have the option to complete the OSHA retraining course online.  The online course is available on the Infection Control website (<http://intranet1.mountsinai.org/> >>Medical Services>>Infection Control).  In order to receive credit for the online course, the post-test must be successfully completed after review of the slide presentation.  The confirmation certificate generated after successful completion should be printed for the employee’s records.

2. New York State Infection Control Training:

New York State requires that certain healthcare professionals receive training in infection control every four years.  Information regarding an employee’s NYS certification status can be obtained from the appropriate Mount Sinai credentialing office.

For a list of other approved New York State Infection Control course providers, visit http://www.op.nysed.gov/icproviders.htm.  Licensed health professionals can also fulfill the course requirements online at www.proceo.com.

Written by phil

December 2nd, 2008 at 3:35 pm

Posted in ID,JCAHO

HIV PEP – 2 options

with one comment

NB.There are two different packages of HIV PEP (Kaletra and Truvada) in the Pyxis—a 5 day supply and a 1 dose supply.

Use the single dose HIV PEP for needlesticks and body fluid exposures where the SOURCE

patient is known, consentable  and can have rapid HIV testing return within few hours, ie. Inpatient at Mount Sinai and patient or surrogate can give consent.

ALL other patients who have a significant exposure within the 36 hour time frame, unknown source or unavailable source—this would include sexual assault patients—should receive the 5 day starter HIV PEP and be referred to the appropriate area for follow up—EHS (employees

off for the weekend who cannot return until Monday), sexual assault survivors, etc go to Jack Martin Clinic or Adolescent Health depending upon age.

The reason for 2 different packaging methods is cost—the majority of needlesticks from inhospital known source can get rapid HIV testing (and this is usually negative and the rest of the 5 day course is wasted. If the employee is exposed to KNOWN positive patient, consider ID consult to see if this regimen is best and give 5 day course with referral to JMC.

Thanks for you attention!

Barbara Richardson

Written by reuben

November 17th, 2008 at 8:59 pm

Posted in ID,Needlestick

ID Approval

You can find the list of meds needing ID approval from the intranet (it took me a while but it’s here). The formal approval process is also described, but summarized below:

From 9-5 if a drug needs approval, page 9407 for adults, 3737 for kids. After hours, fill out the form from IBEX and send it to the inpatient pharmacy, at tube station 39. Drugs that require waking up an ID specialist include amphotericin B, capsofungin, tigecycline, daptomycin, linezolid, and for peds: IV vanc and IV acyclovir.

Written by phil

September 26th, 2008 at 4:04 pm

Posted in ED Guidelines,ID

Rabies Vaccine Shortage

ID Consult now required for Rabies Vaccination.

From Ruben Olmedo:

The Antibiotic Monitoring Group / P&T committee asked me to forward the attached DOH alerts regarding the rabies vaccine shortage to the faculty. Because of this shortage (~20 doses left in the hospital) , they would like ID consult to be called on cases that may that need vaccination. And if it is used, they will need the password given by the DOH for replenishment of the vaccine to the hospital by Novartis.

Also – earlier email:

Notify Local Health Department if considering immunization/pep @ 212-788-9830 or 212-788-4160 or after hours @ 212-764-7667.

Written by phil

September 4th, 2008 at 2:27 pm

Posted in ID

MRSA Reporting Requirements

As of February 27, 2008, methicillin-resistant Staphylococcus aureus (MRSA) is reportable to the New York City Department of Health and Mental Hygiene. Although most of the reporting for Mount Sinai will be done electronically by the clinical microbiology laboratory, there are a few circumstances that require healthcare providers to directly report individual cases of MRSA to the Department of Health. These circumstances are mostly related to MRSA infections that are acquired in or develop in the community, and include:

Clusters of MRSA infection – these are defined as two or more confirmed cases of MRSA with suspected common association, such as members of a family, roommates, or schoolmates.

Unusual manifestations of MRSA infection, such as the death of a child.

Single cases of MRSA in which there is a higher risk of transmission to others, such as infections that occur among children or young adults in interscholastic and competitive sports teams; children in daycare; and persons living in congregate settings (e.g., shelters).

Cases that meet any of these criteria are to be reported, regardless of whether the individuals are treated as outpatients or if they require hospital admission. If you become aware of any cases that appear to meet any of the three criteria above, please report the case(s) to the Department of Health by calling the Bureau of Communicable Disease at 212-788-9830. After hours, call the Poison Control Center at 212-764-7667 (or 800-222-1222) and ask for the doctor on call.

If you have questions about the reporting requirements, please contact Dr. David Calfee in the Department of Infection Control at 8-9450.

Written by reuben

April 3rd, 2008 at 5:40 pm

Posted in ID

Measles in Brooklyn


Measles is an acute viral illness characterized by a prodrome of fever (101o – 105oF), cough, coryza, conjunctivitis and Koplik’s spots (punctate blue-white spots on the bright red background of the buccal mucosa). The measles rash is erythematous, maculopapular and lasts 5-6 days. It usually starts on the face and proceeds down the body to involve the extremities last, including the palms and soles. The maculopapular rash is usually discrete but may become confluent on the upper body. The rash resolves in the same order that it appeared. Complications such as diarrhea, otitis media and pneumonia are frequent in young children.

Written by phil

February 26th, 2008 at 5:03 pm

Posted in ID

TB Isolation Rule

Written by phil

January 30th, 2007 at 1:30 pm

Posted in ID

E.Coli Spinach Info

Dear HAN Subscriber:

We have just released a DOHMH Alert concerning E. coli O157:H7 Infections Associated with Bagged, Fresh Spinach in Multiple States. It is available on the HAN home page , is appended to this email, and is also attached as a pdf file. To read the attachment, you will need the Adobe reader. If you do not have that software, it can be downloaded at no cost at http://www.adobe.com/products/acrobat/readstep2.html.

To log into the HAN, for this alert and many related documents, go to www.nyc.gov/health/nycmed

If you have any questions or problems, call 1-888-NYCMED9 or write to nycmed@health.nyc.gov

2006 Alert # 37
E. coli O157:H7 Infections Associated with Bagged, Fresh Spinach in Multiple States

. As of this morning, 50 E. coli O157:H7 cases had been reported in 8 states; all isolates demonstrate an indistinguishable PFGE pattern. Preliminary epidemiologic findings suggest that prepackaged, fresh spinach is the likely source of illness.
. Healthcare providers should specifically request testing for Shiga toxin producing E. coli (STEC) in patients being evaluated for bloody diarrhea or hemolytic uremic syndrome (HUS)
. Immediately report all suspected and confirmed cases of STEC infection or HUS to the New York City Department of Health and Mental Hygiene (DOHMH)
. Send culture confirmed STEC (including E. coli O157:H7) isolates to the Public Health Laboratory (PHL) for confirmation, serotyping, and pulsed-field gel electrophoresis (PFGE)
o Timely submission of STEC specimens is crucial to facilitate prompt recognition and investigation of potential outbreaks of E. coli O157:H7
o Laboratories should send original stool specimens (or broths) to PHL when patients are shiga toxin positive, even in the absence of culture confirmation

September 15, 2006

Dear Colleagues,

State and local public health officials in the United States and the Centers for Disease Control and Prevention (CDC) are investigating a large outbreak of E. coli O157:H7 infections. As of this morning, 50 cases with isolates demonstrating an indistinguishable PFGE pattern in CT, ID, IN, MI, OR, NM, UT, and WI have been reported. Of these, 8 patients developed HUS and one patient died. Of those with known illness onsets, onset dates ranged from August 25 to September 3, 2006. Preliminary case interviews indicate that prepackaged spinach is the likely source of illness. Additional investigation is ongoing to determine the specific brand(s) of prepackaged spinach involved and the geographic extent of the outbreak. Until the definite source of the outbreak is identified, given the severity of STEC and HUS illness, the Food and Drug Administration is advising persons to not eat any brands of bagged fresh spinach at this time.

Since August 1st, the NYC Department of Health and Mental Hygiene (DOHMH) has investigated 8 cases of STEC infection and 2 cases of Hemolytic Uremic Syndrome (HUS) in New York City residents. Although one of the cases had an isolate that matches the outbreak strain, this patient denied eating pre-packaged spinach. None of the other 7 E. coli O157:H7 isolates obtained from STEC/HUS cases in NYC matched the outbreak strain.

The E. coli O157:H7 bacterium causes diarrhea that is often bloody and accompanied by abdominal cramps, but fever is absent or mild. The illness typically resolves within a week. However, some patients, especially young children and the elderly, may develop HUS. HUS is characterized by the acute onset of microangiopathic hemolytic anemia, renal injury, and low platelet count. Treatment is supportive; anti-diarrheal medications and antibiotics are not recommended as both have been associated with adverse outcomes.

DOHMH advises healthcare providers to specifically request testing for STEC (including E coli O157:H7) in individuals, especially children, who present with bloody diarrhea, hemolytic anemia, or renal failure. E. coli O157:H7 is not detected by standard methods used for other common bacterial enteric pathogens. The medium of choice for isolation is sorbitol-MacConkey (SMAC) agar. Laboratories should attempt to isolate E. coli O157:H7 in addition to standard testing for detection of Shiga-toxin producing bacteria.
In order to completely investigate these reports it is necessary for all culture confirmed STEC (including E. coli O157:H7) isolates to be forwarded to the Public Health Laboratory (PHL) for confirmation, serotyping, and pulsed-field gel electrophoresis (PFGE). As laboratories are increasingly using non-culture based methods (e.g., rapid diagnostic tests for shiga toxin production), laboratories should send original stool specimens (or broths) to PHL when a patient is Shiga toxin positive and either culture negative or no culture test was done. Specimens that are both shiga toxin negative and culture negative do not need to be forwarded.

All STEC isolates should be forwarded to NYC DOHMH’s Public Health Laboratory (PHL) for confirmation, serotyping, and PFGE. Labs which are only performing rapid diagnostic testing to determine shiga toxin production should forward all original stool specimens or broths to PHL for culture. Please forward cultures and specimens to:
Lillian Lee MS, SM (NRM-ASCP), Chief of Microbiology Services
Public Health Laboratory, Rm 136
455 First Ave
New York, NY 10016
(212) 447-6970

All laboratory positive STEC cases and any suspected cases of HUS should be reported immediately, to help us identify outbreak-associated cases. Please contact us as follows:

During business hours: Bureau of Communicable Disease at (212) 788-9830. After hours: Poison Control Center at 800-222-1222.

As always, we appreciate your continued assistance in addressing emerging disease issues.

Sincerely,
Vasudha Reddy, MPH Marcelle Layton, MD
Vasudha Reddy, MPH Marcelle Layton, MD
Bureau of Communicable Disease Bureau of Communicable Disease

Written by phil

September 18th, 2006 at 7:03 pm

Posted in ID