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3/19/2015
1
Respiratory Viruses in Healthcare:
Nothing to Sneeze At
Sara Podczervinski, RN, MPH, CIC
Washington State Department of Health
Healthcare Associated Infections Program Manager
sara.podczervinski@doh.wa.gov
Learning Objectives
1. Develop an awareness of the seasonal trends of several
respiratory viruses (RV)
2. Identify the period of peak infectivity for most RV infections
3. Describe the impact of increased community RV have on
healthcare
4. List two prevention strategies that are critical to fostering a
culture of RV prevention in a healthcare setting
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2
Healthy
1 Year Old
Tonic Clonic
Seizures
106.2
Admitted
Cyanotic
Nystagmus
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3
Now...
A Healthy
6 Year Old
Adenovirus
Outbreaks
• World War II
• Acute Respiratory
Disease
• Crowding
• Hardy Virus
Koirala B and Wang JP. Adenovirus Chapter in
Viruses and the Lung: Infections and Non-Infectious
Viral-Linked Lung Disorders. 2014. Pg. 35-42.
Adenovirus Infection Timeline
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I just have a cold
Coronavirus
Bocavirus
Rhinovirus
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Symptoms
Sneezing
Hoarseness
Chills
High fever
Muscle aches
Sore throat
Runny nose
CoughSinus Pain
Ear Pain
Congestion
RSVLeading Cause of Infant Hospitalization
Hall CB et al. Pediatrics 2013;132:e341–e348,
Hall CB et al. N Engl J Med 2009; 360:588-598
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Nishiyama M. Eurosurveillance, Volume 15, Issue 36, 09 September 2010
Incubation PeriodsVirus Incubation Period in Days
Influenza 1-4
Coronavirus 2-5
Rhinovirus 2-4
Parainfluenza 2-6
Adenovirus 2-14
Metapneumovirus 3-5
RSV 3-7
Lancet Infect Dis. 2009 May; 9(5): 291–300
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Source: nps.org.au
Multiphase
Turbulent
Buoyant
Cloud
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Enterovirus: Mid-August 2014
http://www.rollaecondev.org/geo-location.shtml
Enterovirus: October 2014
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Parainfluenza: Interactive Viruses
Super-spreaders!
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10
32.7
Million Children in
Child Care2011 Data: http://www.census.gov/library/infographics/child_care.html
How Long Kids in Childcare Shed Virus?
Martin ET et al. J Infect Dis. 2013;207:982-989
Community Healthcare
Community Respiratory Viruses:
The Impact on Healthcare
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Community Healthcare
Community Respiratory Viruses:
The Impact on Healthcare
Community Healthcare
HAIs
Sick Staff
Deaths
$
Community Respiratory Viruses:
The Impact on Healthcare
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12
Parainfluenza 3
Nosocomial
Leukemia
Summer
Berrueco R et al. Infection. 2013 Dec;41(6):1171-5.
Pinksy B. Emerging Infectious Diseases. Vol. 16, No. 7, July 2010
January 2008
4 ½ year old male
Immunocompromised
Influenza A in
respiratory & GI tract
Premature
Infants
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Reid A. Brief Report. Pediatric ID Journal. Vol 30. No. 12. Dec 2011
2010 Outbreak in NICUOxygen or Ventilator Support
Elderly
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Lon
g-T
erm
Ca
re 154 Outbreaks
>50% Influenza
92% Residents
Vaccinated
38% Staff Vaccinated
Decreased Mortality–
If Reported < 3 Days
Mahmud et al. (2013) Influenza and Other Respiratory Viruses 7(6), 1055–1061
Tre
atm
en
t
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A Tale of Two RSV Outbreaks
Chu H, et al. Biol Blood Marrow Transplant. 2014 Jun;20(6):844-51.
2007-0850+ Cases
1 Death
3+ Months
Shut down
Transplant Program
Tested 250+
Employees
2012
24 Cases
0 Deaths
1 Month
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3/19/2015
17
http://intermountainhealthcare.org/
Benefits
of Testing
Antibiotic
Use Early
Detection
Isolation
Treatment
Customize
Prevention
Chu H, et al. Biol Blood
Marrow Transplant. 2014
Mahony J et al. J. Clin. Microbiol. September 2009 vol. 47 no. 9 2812-2817
70 72
94
0
20
40
60
80
100
Direct Fluorescent
Antibody (DFA)
DFA + Culture Polymerase Chain
Reaction (PCR)
Sensitivity (%)
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18
Monday
Scr
ee
nin
g
Your appointment is tomorrow
at 2pm. Also, flu season is
here. If you have cold or flu
symptoms, please let your
doctor or nurse know BEFORE
you come to your appointment
by calling xxx-xxxx.
3/19/2015
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http://www.fredhutch.org/en/news/center-news/2014/10/cancer-patients-at-risk-for-colds.html
Give
Patients
a Voice
Fever?
New
Symptoms?
More than 1
Symptom?
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Top 5 Take Aways
1
2
3
4
5
Viral respiratory infections occur year-round
Community RV activity drives impact on healthcare
Immunocompromised, infants, & elderly are most
vulnerable
Treatment is limited
Prevention is key and must be bundled, visible, and
part of the healthcare culture
3/19/2015
21
Acknowledgements
Seattle Cancer Care Alliance &
Fred Hutchinson Cancer Research Center:
• Steve Pergam
• Lois Helbert
• Corey Casper
• Kim MacLeod
• Judith Davies
• Zach Stednick
• Stephanie Price
• Cheri Constantino-ShorLois Helbert, Steve Pergam,
Sara Podczervinski (me), Kim MacLeod
Questions
Sara Podczervinski, RN, MPH, CIC
Washington State Department of Health
206-418-5519
sara.podczervinski@doh.wa.gov
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