pseudo outbreak of group a strep (gas) at concord hospital a collaborative review
DESCRIPTION
Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review. Review Participants IP , ID, Lab, Micro, QA, Materials Management, Lean, DHHS Presented by Lynda Caine, Infection Prevention Officer. Agenda. Background Reviews Conducted Line Listing - PowerPoint PPT PresentationTRANSCRIPT
Pseudo Outbreak of Group A Strep (GAS)
at Concord HospitalA Collaborative Review
Review Participants IP, ID, Lab, Micro, QA, Materials Management, Lean,
DHHS
Presented by Lynda Caine, Infection Prevention Officer
Agenda
• Background• Reviews Conducted– Line Listing– Process and Observation– Product Review– Case Studies and Lab Data Correlation with
Timeline• DHHS Reports
Background• 8 cases of Group A Strep were identified in
blood cultures over several weeks in April-May• In 2013, 5 cases of GAS were reported for the
entire year• This could be a serious finding as GAS in the
blood is a serious infection and can be fatal• Occurrences are reportable to DHHS• Note: all 8 cases were present on admission
Background continued
• This is a higher number of positives than our usual or expected number
• Concern of whether this represented a possible pseudo outbreak
• Decision to review all cases and blood culture process
• Decision to contact the State for possible assistance
• Were we dealing with a contamination issue or was it a coincidence?
Pseudo outbreak
• Type: Term
Pronunciation: sū-dō-out brāk′Definitions:1. Episode of increased disease incidence due to enhanced surveillance or other factor not related to the disease under study
Line Listing
• 8 symptomatic patients seen in the ED between 4/1/14 and 5/3/14
• No common links were identified – except all blood cultures were drawn in the ED– No community commonalities were identified– Different room locations in ED – Different Phlebotomists drew blood– No illness of ED and Phlebotomy Staff– Patients received antibiotics after blood draw
Process Observation
• Reviewed Lab Policy• Looked at all supplies used for a blood draw• Looked at all of the steps in a blood draw• Created a flow map of laboratory blood culture
collection and processing steps• One simulated blood draw observation was
conducted• No discrepancies identified between stated and
observed practices
Product Review
• Micro conducted testing on all lots of current blood culture bottles as well as chlorhexidine swabs – with no positive results
• Collected a sample of all supplies used for blood culture collection
• Materials Management compiled a list of vendors and manufacturers – although no further action was needed at this time
CH Case Timeline
Plotted:• Blood Culture Collection Time• Antibiotic Administration• Blood Culture Result Time
Finding: blood cultures were obtained prior to antibiotic administration
Lab Data Correlation
• Medical record review supported intermittent bacteremia or septicemia present on admission– Symptoms: including fever– Lab results: WBC, Lactic Acid, Absolute
Neutrophils, etc.
• NOTE: Group A strep is not a typical blood culture contaminate
Community Data from CH Micro: Positive Group A Strep Throat Cultures
DHHS: Group A Strep by Age Group
DHHS: Group A Strep Rate and Cases by Age Group
DHHS: Group A Strep Cases by Sex and Year
DHHS: Group A Strep Cases by County and Year
DHHS: Group A Strep Rate by County and Year
DHHS: Group A Strep Rate by County and Year
DHHS: Group A Strep Rate by County
DHHS: Group A Strep Rate by Month
DHHS: Group A Strep Rate and Cases by Year
Summary
• No further cases have been identified• Increased incidence of group A Strep noted in
Concord and in other New Hampshire communities• DHHS was not concerned but reviewed NH data• Continue to monitor for new incidence• Save future isolates for PFGE testing at the State
Lab through June 1, 2014• Re-emphasize to Staff to not come to work when ill
Special THANKS to DHHS!!!