Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review
description
Transcript of Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review
![Page 1: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/1.jpg)
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
![Page 2: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/2.jpg)
Agenda
• Background• Reviews Conducted– Line Listing– Process and Observation– Product Review– Case Studies and Lab Data Correlation with
Timeline• DHHS Reports
![Page 3: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/3.jpg)
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
![Page 4: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/4.jpg)
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?
![Page 5: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/5.jpg)
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
![Page 6: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/6.jpg)
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
![Page 7: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/7.jpg)
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
![Page 8: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/8.jpg)
![Page 9: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/9.jpg)
![Page 10: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/10.jpg)
![Page 11: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/11.jpg)
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
![Page 12: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/12.jpg)
CH Case Timeline
Plotted:• Blood Culture Collection Time• Antibiotic Administration• Blood Culture Result Time
Finding: blood cultures were obtained prior to antibiotic administration
![Page 13: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/13.jpg)
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
![Page 14: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/14.jpg)
Community Data from CH Micro: Positive Group A Strep Throat Cultures
![Page 15: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/15.jpg)
DHHS: Group A Strep by Age Group
![Page 16: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/16.jpg)
DHHS: Group A Strep Rate and Cases by Age Group
![Page 17: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/17.jpg)
DHHS: Group A Strep Cases by Sex and Year
![Page 18: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/18.jpg)
DHHS: Group A Strep Cases by County and Year
![Page 19: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/19.jpg)
DHHS: Group A Strep Rate by County and Year
![Page 20: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/20.jpg)
DHHS: Group A Strep Rate by County and Year
![Page 21: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/21.jpg)
DHHS: Group A Strep Rate by County
![Page 22: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/22.jpg)
DHHS: Group A Strep Rate by Month
![Page 23: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/23.jpg)
DHHS: Group A Strep Rate and Cases by Year
![Page 24: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/24.jpg)
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
![Page 25: Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review](https://reader035.fdocuments.us/reader035/viewer/2022062520/568165df550346895dd8fd59/html5/thumbnails/25.jpg)
Special THANKS to DHHS!!!