Detection And Control Of Epidemics

Epidemics of infection due to a variety of pathogens have been noted in the long-term care setting (11-25) (see Table 4). An epidemic should be suspected if there is an increase in the rate of infection due to a single pathogen or clinical syndrome. Cases of infections with a specific pathogen should be reviewed to see if all the isolates seem to be the same (similar antimicrobial susceptibility pattern) and if there is evidence of transmission between patients, e.g., the infections occurred at a similar time, in the same location, or patients shared the same staff. If there appears to be evidence that transmission is occurring, knowledge of how that pathogen is spread will allow the practitioner to hypothesize how the outbreak occurred and how to prevent further spread. Infected residents should be placed in appropriate isolation and employees should be re-educated about infection control principles. Monitoring should be ongoing for new cases of infection. If new cases of infection continue to develop despite institution of appropriate isolation procedures and education, then alternative hypotheses may need consideration. For some organisms, e.g., S. aureus, group A streptococci, multidrug-resistant Streptococcus pneumoniae, and C. difficile, an asymptomatic carrier state, may exist among nursing facility residents or staff that perpetuate an out-

Table 4

Causes of Epidemic Infection and Associated Clinical Syndromes in the Long-Term Care Setting

Table 4

Causes of Epidemic Infection and Associated Clinical Syndromes in the Long-Term Care Setting

Clinical syndrome

Bacterial

Viral Parasitic

Respiratory tract

Chlamydia pneumoniae

Influenza

M. pneumoniae

Respiratory syncytial virus

Group A streptococci

Parainfluenza

Haemophilus influenzae

Adenovirus

M. tuberculosis

Rhinovirus

C. psittaci

S. pneumoniae

Soft-tissue infections

Group A streptococci

Adenovirus

Group A streptococci

Rash

Scabies

Gastroenteritis

Shigella

Campylobacter

Entamoeba histolytica

Noninvasive

Rotavirus Norwalk agent

Giardia lamblia

Toxin-mediated

Food-borne

E. coli 0157:H7 S. aureus C. perfringens Bacillus cereus

Non-food-borne

C. difficile

break. In the event of increased rates of infection, it may be appropriate to identify asymptomatic carriers and isolate them in an attempt to disrupt the chain of transmission. For some infections (MRSA, multidrug-resistant S. pneumoniae, group A streptococci) decolonization with systemic or topical antimicrobial agents has been attempted to disrupt transmission and stop an outbreak. Consultation with an expert in epidemiology should be considered if reasonable measures are not effective. Failure to detect new cases indicates that the epidemic has abated and a return to routine infection control procedures can be considered.

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