Id 5T3: Hospital Infections

Front 1

(Learning Objective)
If this had been Strep. pneumo, H. flu, Enterovirus, HSV or any OTHER cause of meningitis aside from meningococcus?

Woul there be concern for person-person transmission?

Need for employee follow-up?

Back 1

There would be no concern for person-person transmission, no need for employee follow-up

Front 2

CDC Guidelines for HCW

Immediately offer antimicrobial prophylaxis to:

Back 2

personnel who have had intensive close contact (e.g., mouth-to-mouth resuscitation, endotracheal intubation, endotracheal tube management),

without the use of proper precautions,

with a patient with meningococcal disease

before administration of antibiotics. (Category IB)

Front 3

(Reminder: only ______________meningitis requires isolation
and post-exposure prophylaxis.)

Back 3

MENINGOCOCCAL

Front 4

HCW Post-Exposure Evaluation
(Learning Objective)

Baseline TST placed when?

Follow-up TST placed _-_ weeks after exposure to assess for?

Prior +TST: used for?

Back 4

Baseline TST placed as soon as possible after exposure

Follow-up TST placed 8-10 weeks after exposure to assess for conversion = identification of latent infection

Prior +TST: Symptom screening only

Front 5

Infection Risk (%) per Exposure

Percutaneous injury? HIV risk?

HBsAg+, HBeAg+; HBV risk?

HCV RNA: HCV risk?

Back 5

HIV risk = 0.25%

HBV risk = 20-40%

HCV risk = 1.0-6.0%

Front 6

HBV Vaccine for HCWs

HBV vaccination = Lifetime protection after __ doses (with adequate response); Need for boosters?
What if measured antibody level wanes, then need boosters?

Current recommendation = document adequate antibody response in vaccinated HCWs
- _-_ months after 3rd dose
- Adequate = > __ mIU/ml

Are adequately vaccinated HCWs protected?
Need further testing?
Treatment?

Back 6

HBV vaccination = Lifetime protection after 3 doses (with adequate response) and no need for boosters
Even if measured antibody level wanes

Current recommendation = document adequate antibody response in vaccinated HCWs
1-2 months after 3rd dose
Adequate = > 10 mIU/ml

Adequately vaccinated HCWs are protected; no further testing, treatment needed

Front 7

Current HCV Post-exposure Management

HCV ____ and ____ (at 4-6 weeks, 3 months, 6 months, or with symptoms) detected

HCV ___ at baseline and __ months

At present, what are indications for PEP for needlestick exposure to HCV?

No evidence of efficacy
Risk of acute infection is low
Therapy for acute HCV is promising
Treatment side effects are high

Back 7

HCV RNA and ALT (at 4-6 weeks, 3 months, 6 months, or with symptoms)

HCV Ab at baseline and 6 months


At present, there is no indication for PEP for needlestick exposure to HCV because:
No evidence of efficacy
Risk of acute infection is low
Therapy for acute HCV is promising
Treatment side effects are high

Front 8

Post exposure prophylaxis (PEP_ details: use 2-3 drugs X 28 days

Basic __ drug PEP
For low risk exposures (cutaneous, Mucous Membrane) AND low risk source (low VL)

Expanded __ drug PEP = add (usually) a _______ ________
- For high risk exposure (percutaneous) AND/OR high risk source (high VL)
How long?

Follow-up testing at __ weeks, __ months and __ months (or with symptoms)

Back 8

Basic 2 drug PEP
For low risk exposures (cutaneous, MM) AND low risk source (low VL)

Expanded 3 drug PEP = add (usually) a protease inhibitor
- For high risk exposure (percutaneous) AND/OR high risk source (high VL)
28 DAYS!!

Follow-up testing at 6 weeks, 3 months and 6 months (or with symptoms)