Pandemic stuff (preparedness) IPC stuff and outbreaks Flashcards
What is GISRS
Global Influenza Surviellance and and response system
WHO initiative
The mission of GISRS is to protect people from the threat of influenza by continuously functioning as a:
- global mechanism of surveillance, preparedness and response for seasonal, pandemic and zoonotic influenza;
-global platform for monitoring influenza epidemiology and disease; and
-global alert for novel influenza viruses and other respiratory pathogens.
Which genetic groups of H1N1 pdm2009 have been most common
5a2a clade and 5a2a1
Describe which flu viruses have had zoonotic spread to humans in UK in the last yer
(H1N2)v
-75 y/o man who live close to a pig farm (no direct contact)
- swine influenza virus genetic clade 1B.1.1.
-November 2023
H5N1
-2 cases in poultry workers
-May 2022
https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON468
Which flus have had zoonotic tramsmission to humans, which animals
Five subtypes of avian influenza A viruses are known to have caused human infections (H5, H6, H7, H9, and H10 viruses). The most frequently identified subtypes of avian influenza A viruses that have caused human infections are H5, H7 and H9 viruses. Specifically, A(H5N1) and A(H7N9) viruses have caused the majority of avian influenza A virus infections reported in people, with HPAI A(H5N6) and LPAI A(H9N2) viruses also causing human infections in recent years. Human infections with other subtypes, such as A(H6N1), A(H10N3), A(H10N7), and A(H10N8), have been detected in small numbers of people.
H1N2v (pigs)
H3N2 (different in humans and pigs
H5N1 (birds)
H7N9
H3N8 (birds)
Describe a significant zoonotic flu not in UK
2 cases of H5N1 in Cambodia Dec 2023
Case of H10N1 + H3N2 co-infection in china (women who bought a duck), in Jan 2024
(To be completed_)
T/F
Influenza B and C have a non human resevoir
FALSE
Names of avian influenza vaccines
Celldemic and
List 5 routed of transmission of viruses
Resp (droplets and aerosols)
Vector
Sexual or blood (includ mother to child)
Oral (food and water)
Contact
Features of a CL3 lab
CL2 +
Sealable for fumigation
Negative pressure
HEPA (High efficiency Particulate Air) filitered
Single-pass air- typically 10-12 air changes/hour
Alarm systems for air leaks
Features of CL2 Lab
Restricted entry
Not positive airflow
MSC class 1 and 2 cabinets
Disinfection policy
Codes of practice
Waste policy
Accident policy
What are the 3 main threats as per national security risk assessment (UKHSA)
Emerging infectious diseases- pathogen with high mortality or those with upto 2000 cases
Pandemic infectious diseases- may arise as as an emerging disease,
AMR
List 7 characteristics for a pathogenic organism to consider for pandemic prepardeness
1) Transmissibility
2) Incubation period and serial intervention time- harder to control infections with shorter incubation and second interval times
3) Severity
4) Prolonged asymptomatic phase
5) Lack of native population immunity
6) Ability to mutate
7) Abilty to survive outside of a host
UKHSA preparedness strategies
Surveillance
Laboratory detection
-pan genus or pan-family PCR
-Novel serology and neutralisation assays for assessment of population immunity and effectiveness of vaccines
-metagenomics for emerging pathogens
Healthcare capacity: diagnostic labs, PPE, clarity on roles
Respond
vaccine development and delivery
generate public health interventions
Rapid research (study protocols)
One case of diarrhoea on ward
1) what do you do
2) 3 more cases on ward, what do you do (answer from micro)
Answer from micro exam
1) Isolate/barrier nurse symptomatic patients,
Cohort if required
Close bay or ward
Stool culture/C diff/noro testing on symptomatic patients
Ribotype if C diff positive
Cleaning/environmental audit
Environmental screening
Independent hand hygiene audit
Antibiotic audit
RCAs for cases
I would add
-call outbreak meeting, ?who to invite
What do HIS guidelines recommend for one case of norovirus
If a sporadic case of norovirus is identified, consider introducing control measures (including transmission-based precautions) to prevent an outbreak (for the next 72 h).
When can a norovirus outbreak be declared over?
Whenever possible, maintain the control measures in place for 72 h after the last episode of vomiting or diarrhoea in the last known case before declaring the end of an outbreak
Other IPC actions for noro outbreak as per the HIS norovirus guidelines
Test all symptomatic patients to establish whether their symptoms are due to norovirus infection
Risk assess whether visitors can come on to ward
Re environmental screening: Do not screen the environment routinely during an outbreak. Consider environmental sampling for norovirus to inform IPC measures during prolonged, unusual or uncontrolled outbreaks.
If the patient with norovirus infection is discharged to another facility sooner than 48 h after symptoms cease, inform the receiving facilities so that appropriate arrangements can be made.
Cleaning post norovirus
appropriate cleaning, including the removal of organic soiling, precedes disinfection
Use 0.1% (1000 ppm) hypochlorite for disinfection
Consider using automated room decontamination devices for norovirus outbreaks when, despite the standard IPC measures being in place, there is evidence of ongoing transmission from the environment
Following a norovirus outbreak should affected staff be allowed to return to work and how should their return be managed to ensure patient safety
Consider excluding symptomatic staff with norovirus infection for a minimum of 48 h after symptom resolution
In outbreaks where staff exclusion policy is not feasible (i.e. when it is not possible to replace skilled members of staff), conduct a local risk assessment that takes into account skills and staffing levels before allowing staff to return within 48 h of symptomatic norovirus infection.
Describe method of terminal cleaning in noro outbreak
For occupied single rooms, delay terminal cleaning until at least 48 h after the patient’s symptoms of norovirus have resolved.
For occupied, shared patient areas or multi-occupancy rooms, undertake terminal cleaning a minimum of 72 h after symptoms in the last case of norovirus have resolved.
Describe Mpox des-escalation from
1) hospitlisation
2) Isolation at home
https://www.gov.uk/guidance/de-isolation-and-discharge-of-monkeypox-infected-patients-interim-guidance
Describe Mpox ppe- Clade 1 and clade 2
PPE for query VHF
Double gloves
Grown and water proof arpove
hood
Eye protection
Other considerations: exposed staff
IPC for measles
Negative pressure room
Single use disposable gloves
Apron (gown if doing AGP)
RPE
Eye protection
Patient should wear surgical face mask if transfering
