Question from S 14 Flashcards
Verbal actual
What are the challenges of IP&C and clinical management, in the absence of test results (pretend testing has been discontinued)
How would you manage these challenges?
Summarise problem - without diagnostic testing, there will be a significant impact on IP&C and management of patients.
This will include:
increased HAI/outbreaks
delayed discharge
increased Abx use
inappropriate anti-viral use
increased morbidity/ mortality
Verbal actual
What are the challenges of IP&C and clinical management, in the absence of test results (pretend testing has been discontinued)
How would you manage these challenges?
potential solutions
Management:
cohort patients by symptoms/ clinical syndrome and local epidemiological data
High risk patients (immunosuppressed) - put in side rooms as high risk of acquiring HAI
Update IP&C guidelines to reflect new practice
Consider sending a few samples as send-away tests, to establish outbreaks in your hospital e.g local network hospitals/ reference labs
Communicate new guidelines to stakeholders - IPC/ A&E/ GP etc
Verbal actual
Absence of clinical test results
What regulations do this break?
Who would you inform?
UKAS/ UKHSA
Inform them early, so they are aware of circumstances.
Including change to plan or change of assay
If a long term issue, need to tell them about change to our assay/method and scope of testing
Verbal actual
Absence of clinical test results due to supply chain issue
How will you review your policies after this incident?
I will learn from the event, and adapt so our service has greater resilience and flexibility
To build in resilience:
- increase stock of reagents, if storage allows
- avoid single-chain bottle necks - e.g only 1 supplier of reagent
- multi-channel supply chain contingencies
- review whether switching suppliers/ assays is warranted
- inter-tendencies with neighbouring lab networks
- review communication network for cascading information
- review current contingency plans
- communicateto UKAS
Verbal actual
39F admit to A&E
dry cough, SOB, myalgia
Inhaled steroids for asthma
No other PMHx
Respiratory viral PCR swab - A H1N1 pos
Requires admission
how would you manage this case?
History
Diagnosis
Management
IP&C
Public Health
Summarise case
- 39F on inhaled steroids, admitted with acute respiratory symptoms, and confirmed Influenza A H1N1 on testing
Clinical history
unwell contacts
travel
animal exposure e.g Avian influenza
recurrent infections - needs HIV test
sputum production - Influenza with secondary bacterial infection
Annual influenza vaccine
Diagnosis
CXR - bilateral interstitial pneumonia
Swab - check no other viral infections
Sputum culture
FBC - lymphopenia/ lymphocytosis
UE - check renal function if giving antiviral
HIV test
Management
Oseltamivir 75mg BD for 5 days
Start within 48 hours, consider up to 5 days as has lung condition
IP&C
side room - respiratory precautions
FFP3 if AGP performed
Public Health
Notify automatically by lab reporting
Verbal actual
Who 6x patient groups are indicated to have influenza PEP?
Age >65, Age <6 months
Pregnant women - up to 2 months post-partem
Chronic lung/ heart/ kidney/ liver conditions
Diabetes
Immunosuppressed
Morbid obesity - BMI >40
Asplenia
Verbal actual
What is oseltamivir PEP dosing based on?
Renal function
Weight - standard 75mg dosing based on >41kg
Verbal actual
What drugs are used as influenza PEP?
Oseltamavir
Use inhaled zanamavir if:
- local resistance reports high rates of oseltamivir resistance
- if severely immunosuppressed
Verbal actual
When does influenza treatment need to be initiated?
Within 48 hours of symptom onset
Can be up to 5 days if patients are high risk
Verbal actual
When does influenza PEP need to be initiated?
Start within 48 hours of last contact when patient was infectious
Verbal actual
Patient is influenza A contact
They had their routine annual influenza vaccine
Do they still require PEP?
Vaccine considered protective if:
- it is a good match for circulating variants
- it has been 14 days since immunisation date
If not, then give oseltamivir
Verbal actual
39F admit to A&E
dry cough, SOB, myalgia
Inhaled steroids for asthma
No other PMHx
Respiratory viral PCR swab - A H1N1 pos
Her 5 year old child presents to ED with URTI symptoms
Swab:
Influenza A H1N1 positive
Influenza A H3N2 positive
Influenza B positive
What is the most likely interpretation of these results?
Swab:
Influenza A H1N1 positive
Influenza A H3N2 positive
Influenza B positive
Likely reflects recent administration of Live intranasal vaccine
Other possibility is a triple co-infection
Verbal actual
Her 5 year old child presents to ED with URTI symptoms
Swab:
Influenza A H1N1 positive
Influenza A H3N2 positive
Influenza B positive
What is the most likely reason the child has symptoms?
Mother has H1N1 proven, and child is a contact
Therefore likely child has true H1N1 infection
Likely not protected, as it has not been 14 days since vaccine administration
Other possibility is URTI due to vaccine itself
Verbal actual
Her 5 year old child presents to ED with URTI symptoms
Swab:
Influenza A H1N1 positive
Influenza A H3N2 positive
Influenza B positive
Suspect child has H1N1 true infection, as mother has proven infection
How would you prove this?
History of timing of vaccine will hint at the diagnosis
- Check the respiratory PCR worksheet
Expect:
Influenza A H1N1 to have early take off
Influenza A H3N2/ B to have late-take off
Melt curves from wild type virus, and vaccine may be different
- Can send respiratory samples to the Respiratory Virus Unit in Colindale for sequencing
