As part of Vanderbilt's mission to create safe patient care through education, research, and quality care, the department of Infection Prevention provides evidence-based, scientific, and proven resources to Vanderbilt faculty and staff as well as our patients and families. Through surveillance activities we detect potential healthcare-associated infections and develop action plans in collaboration with our quality and unit-based partners to mitigate those risks. We are a liaison to the Tennessee Department of Health and report communicable diseases for the institution as well as establishing a link to public health infrastructure in an effort to provide quality care to our patients. We are the content experts for infection prevention operations, research and educational activities, a position that we exercise regularly through our numerous publications and abstract presentations both inside and outside of the institution.
2019 Novel Coronavirus – 01/20/2020
In December 2019, an emerging human coronavirus, dubbed 2019 Novel Coronavirus (2019-nCoV), was first reported. Cases originated in Wuhan City, Huban Province in China, and epidemiologic investigation linked these cases to an outdoor seafood and animal market, suggesting this emerged from exposure to animals (as was the case with two other recent emerging coronavirus infections, SARS and MERS).
To date, there have been more than 9000 confirmed infections with over 200 reported fatalities with cases reported in more provinces within China. In addition, on 1/20/2020, China reported the first instances of human-to-human spread with reported cases among healthcare personnel. On January 21, 2020, the US Centers for Disease Control and Prevention (CDC) announced the first case in the US, a traveler who had been in Wuhan City. As of January 31, 2020, there have been 6 confirmed cases reproted in the US.
No vaccine or specific treatment is currently available for 2019-nCoV infection, so it is imperative that we remain vigilant for any potential cases and implement infection prevention precautions rapidly. In light of these reports, we remind all VUMC faculty and staff about several important ways to minimize the spread of this infection:
Fever with symptoms of lower respiratory illness (e.g. cough or shortness of breath)
A) History of travel within 14 days of symptom onset from China (any location).
B ) In the last 14 days before symptom onset, close contact with a person who is under investigation for or who has confirmed 2019-nCoV while that person was ill.
NOTE: The eStar Travel Screening currently will alert you if a patient has recently travelled to China and has fever and respiratory symptoms.
Patients who respond “yes” to these questions should be provided a surgical mask that they should wear immediately and be placed in an airborne isolation negative pressure room (or private room with door closed if negative pressure room is not available).
The Department of Infection Prevention should also be contacted IMMEDIATELY at 835-1205 (24/7). Enhanced Precautions (wear gloves, gown, eye protection [other than prescription eye glasses], and N-95 Respirator or PAPR) should be followed. Visitors to the room should be limited will the patient is a suspected 2019-nCoV case.
VUMC Encourages Judicious Use of Personal Protective Equipment in Light of Novel Coronavirus Outbreak
With the emerging 2019 Novel Coronavirus (2019-nCoV) outbreak, there are concerns if the outbreak amplifies shortages of key personal protective equipment (PPE) necessary not only to care for suspect and confirmed 2019-nCoV cases but also to use for daily care of patients on an array of isolation precautions for other reasons may occur. VUMC currently has ample supplies of PPE and is working with suppliers to maximize PPE availability as the outbreak evolves. However, we must be prepared in the event PPE supplies become limited due to manufacturer issues or shortages.
Given the uncertainty of the outbreak and impact on PPE supplies, VUMC asks clinicians to be proactive in their daily PPE use to minimize any excessive use or waste. This includes the following:
For any questions regarding PPE or other 2019-nCoV issues, please refer to the Department of Infection Prevention website at https://www.vumc.org/infectioncontrol/ or call Infection Prevention On-Call at 615-835-1205.
PREVENT THE SPREAD OF INFLUENZA!!
VUMC policy requires annual influenza vaccination or exemption. Exemptions may be for religious or personal/philosophical beliefs or for medical contraindications. Those who wish to be exempted from receiving the flu vaccine must complete an exemption form, available on the OHC website beginning in September. Exempted personnel must wear a mask during influenza season as noted in the VUMC Immunization policy. More details on masking may be found here.
Do you never get an annual influenza vaccination?
Do you come to work with a "cold?"
If you answered "yes," you could be spreading infleunza to
your patients and colleagues (even when you don't feel sick!)
It's influenza season again -- find out how you can protect yourself,
your colleagues, and your patients from influenza.
CLICK HERE FOR MORE INFO
***Tennessee Department of Health Measles Diagnosis Algorithm (UPDATED MAY 7, 2019)***
VUMC Lab Forms:
The diagnosis of Clostridioides difficile infection (CDI) requires the detection of bacterial toxin and/or antigens in the stool. Due to the need to better assess whether a patient has active CDI vs. stool colonization of a toxin-capable strain, the VUMC lab is migrating to a multistage reflexive test for CD. The previous CD test was a molecular PCR test that only could detect whether the patient had a strain of CD that could produce toxin (which causes clinical disease) NOT whether the toxin was being actively produced. Hence, there was a risk that a patient who was merely colonized with toxin-capable CD strains but had diarrhea due to other causes (e.g. tube feeds, laxatives) would be misdiagnosed as having CD infection and treated as such. The new test is a multistage test that first looks for the toxin gene by PCR (just like the old test) but then, if the gene is present (“PCR Positive), the second test looks for active production of the toxin (“PCR and Toxin Positive”).
VUMC Named First APIC Program of Distiction in Infection Prevention!
Vanderbilt University Medical Center (VUMC) is the first hospital system in the nation to receive the Association for Professionals in Infection Control and Epidemiology (APIC) Program of Distinction designation, an acknowledgement of excellence for infection prevention and control programs that meet stringent standards established by the association.
The designation is the culmination of an intensive review process that began last summer when an APIC survey team visited VUMC to evaluate infection prevention practices at Vanderbilt University Adult Hospital and Monroe Carell Jr. Children’s Hospital at Vanderbilt as well as numerous off-site locations.
APIC is the leading professional association for infection preventionists (IPs) in the United States, with more than 15,000 members. APIC’s Program of Distinction designation measures excellence in infection prevention policies and procedures and ongoing quality improvement efforts, as well as compliance with federal regulations.
For more information: CLICK HERE
More information can be found below (click on topic):
MERS testing at TN DoH and/or CDC should begin with consultation by a state epidemiologist, prior to specimen collection. Please contact a member of the microbiology service if MERS is under consideration and prior to specimen to collection. One of the microbiologists will coordinate with the clinical team and specimen-receiving lab to support safe and efficient specimen handling for eventual routing to the state laboratory. If/when the state epidemiologist approves testing, the specimen(s) should be collected per instructions at http://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html
and submitted to our central receiving lab with the following documentation: VUMC test requisition, state specimen submission form (CLICK HERE), and CDC specimen submission form (http://www.cdc.gov/laboratory/specimen-submission/pdf/form-50-34.pdf). Please VERY CLEARLY indicate the suspicion for MERS on the test requisition to help avoid unintentional testing or opening of the specimen in the VUMC laboratory. If the DDx expands to include MERS after respiratory specimens have been collected and submitted to the laboratory for other testing, please immediately contact the microbiology service so that we can assist in the safe management of those materials pending a determination of whether the patient meets PUI criteria.
Urine Culture Testing Algorithm
for Adult and Pediatric ED and Inpatient Units
In order to reduce the risk of false positive/contaminated urine cultures and to help better guide clinicians in the interpretation of positive urine cultures, VUMC has implemented a standardized urine culture testing process (known as U/A with reflexive culture) as part of a multi-part program to reduce variability around urine cultures. This program also includes guidance on the indications for urine culture ordering that will be presented on order entry, standardized specimen collection protocols, and tracking of urine culture contamination rates.
For the U/A with reflexive culture process, a U/A will be sent with every culture specimen order. Clinicians will be asked on order entry if the patient has a recognized condition that could either impact the U/A interpretation or where national guidelines recommend treating positive cultures even in the absence of positive U/A results. These are 1) pregnant patients, 2) patients undergoing urologic surgery, 3) neutropenic patients, and 4) children under 25 months of age. In the absence of any of these conditions, if the U/A is negative (defined as negative nitrites, less than small leukocyte esterase, and <5 WBC/hpf), then the urine culture will not be processed. If the U/A is positive, the urine culture will be processed without requiring any additional action from the ordering clinicians. If the clinician notes the presence of any of the 4 conditions listed above, they will have the option of ordering either a U/A with urine culture or urine culture alone.
The test can be ordered by selecting U/A or urine culture and selecting the U/A with reflexive culture option. You do not need to order the U/A as a separate test, as it is part of the reflexive testing. For more information about the urine culture standardization, please click on the links below:
HEPATITIS A ALERT – 07/16/2018
Tennessee is currently in the middle of a growing hepatitis A outbreak, centered primarily within Davidson County. The outbreak started in December 2017 and to date there have been 80 cases reported. In light of this outbreak, the VUMC Department of Infection Prevention reminds you of some important steps to prevent ongoing spread of this infection.
All VUMC healthcare providers should
a. Persons who use recreational drugs (injection or non-injection)
b. Men who have sex with men
c. Homeless persons
d. Persons with chronic liver disease, including chronic hepatitis B or C
Resources for the public and medical community are available at: https://www.tn.gov/health/cedep/tennessee-hepatitis-a-outbreak.html, including a data collection tool for clinicians when encountering a suspected case. For questions or additional information, please contact the VUMC Department of Infection Prevention at 936-0725 or via pager 835-1205.
Ebola Advisory (8/8/2014)
National and international health authorities are currently working to control a large, ongoing outbreak of Ebola involving areas in West Africa. There are currently no reports of endemic cases of Ebola infection in the United States. There is no vaccine to prevent Ebola infection, and treatment is supportive.
Despite recent media reports that suggest the contrary, Ebola patients can be safely managed in any acute care hospital if CDC recommended precautions are strictly followed. The Department of Infection Prevention is working closely with many key stakeholders across the medical center to ensure we are prepared to care for patients with suspected or confirmed Ebola infection. More details on the recommended infection prevention practices can be found below.
Contact 875-4000 and activate the EBOLA RESPONSE TEAM if you encounter a patient in which Ebola infection is suspected.
As mumps cases continue to arise throughout Middle Tennessee, we’d like to remind you of some important aspects of mumps to ensure that we identify any suspect cases and prevent spread of the mumps virus to others:
CLINICAL PRESENTATION AND ILLNESS COURSE:
What is mumps?
How does a case of mumps present?
When do symptoms appear?
How serious is mumps?
How does the mumps virus spread?
What specimens should be collected from patients who meet the mumps clinical case definition?
How do I collect a buccal swab?
Is there a vaccine against mumps?
When would CDC recommend giving individuals a 3rd MMR dose?
Occupational Health Clinic Recommendations:
Recommendations for all VUMC Clinicians:
Please contact Infection Prevention with any questions at 615-835-1205.
ZIKA VIRUS GUIDANCE & RESOURCES (UPDATED 8/1/2016)
ZIKA GENERAL INFORMATION:
ZIKA & PREGNANCY: CDC Guidelines
TESTING FORM (Specimens sent to CDC via TN State Lab): Please note the lab client services number, 5-LABS (615-875-3227) on the test requisition as contacts for questions from the receiving lab. TDH will perform PCR and serology (IgM, IgG) for CHIK and forward specimens to CDC for Zika testing, which may involve a combination of serology, PCR, and culture-based demonstration of Zika-specific neutralizing antibodies. Note: per CDC, Because Zika virus testing is not listed in the drop-down menu for the Test Order Name field of form 50.34 (located on 1st page, top left), you will need to select ARBOVIRUS SEROLOGY and then type Zika testing in the Brief Clinical Summary field located at the top of the second page of the form. According to the CDC web site, results are usually available 4-14 days after specimen receipt, longer during summer months. A positive initial serologic screen for Zika will trigger confirmatory testing, which may delay final results. A report hardcopy will be available ~2 weeks after test completion and communicated directly to TDH Lab.