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What We Need is a Red Book for College Health: Infection Control for the College Campus
Evelyn Wiener, MDUniversity of Pennsylvania
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United States Environmental Protection AgencyPublic Health Image Library
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SESSION OBJECTIVES• List communicable diseases for which
infection control measures are indicated
• Identify modes of transmission for communicable diseases
• Identify appropriate infection control measures for common and/or serious contagious diseases
• Know the campus and community resources involved with implementing infection control measures 3
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LA2/23/12•History:– Sore throat & cough x 1 day– PMH pneumonia one year ago
•Physical exam– BP 138/85 HR 115 T 98.5– Pharynx red, TM normal– Lungs clear
•Symptomatic treatment advised
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LA, continuedReturns 2/28/12•CXR (obtained 2/23) was negative•Symptoms have continued, cough worse•Physical exam– BP 147/91 HR 113 T 99.0– Pharynx red, cervical adenopathy– Lungs clear, but frequent dry coughing fits,
speaking in full sentences
•Symptomatic measures continued
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LA, continued2/29/12•Goes to ER - cough incessant, uncontrolled by codeine
•What is the differential diagnosis?
•What else do you need to know?
•What do you need to do?
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What are the infection control issues?
Which issues are unique to college setting?
Who needs to be involved/informed?
Where do you find the answers?
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WHAT NOW?
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STUDENT
PARTNERS
PARTNERS
FRIENDSFRIENDS
ROOMMATES
ROOMMATES
CLASSMATE
S
CLASSMATE
S
FamilyFamily
STUDENT AFFAIRS
STUDENT AFFAIRS
FACULTYFACULTYRES LIFE
STAFF
RES LIFE
STAFF
FACILITIESFACILITIES
HEALTH SERVICEHEALTH SERVICE
FAMILY
HUMAN RESOURCES
HUMAN RESOURCES
Risk Management
Risk Management
ADMINISTRATIONADMINISTRATION
Environmental Health
Environmental Health
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WHAT DO STUDENTS NEED TO KNOW?**Also parents, staff, media
• Who is at risk for exposure?
• What should students do if they were exposed?
• What should students do if they have symptoms?
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WHAT DO ADMINISTRATORS NEED TO KNOW?
• Same as students
PLUS• Extent of outbreak• Measures needed to control outbreak• Need to provide support to affected students• Need for resources• Talking points
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WHAT DO CLINICAL STAFF NEED TO KNOW?
• Same as students and administrators
PLUS• On-site infection control measures• Clinical presentation• Diagnostic tests• Management• Reporting
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CAMPUS INFECTION CONTROL ISSUES
• How do basic infection control principles apply in a campus environment?– Populations– Facilities– Significant functions
• What resources are needed?
• What resources are available?
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STUDENT POPULATIONS
Residential studentsCommutersPart-time studentsGreek systemAthletesHealth care studentsInternational studentsVisiting/exchange students
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OTHER POPULATIONS
FacultyStaffVisitorsSpecial program participantsContractors
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FACILITIESStudent housing
Residence hallsFraternities and sororitiesOff-campus housing
Dining hallsClassroomsResearch laboratoriesLibrariesAthletic facilitiesOther buildings
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SIGNIFICANT FUNCTIONSStudents Faculty Administration
Classes Classes HR/personnel
Research Research Finance/payroll
Housing Advising Facilities
Dining Information systems
Activities Business services
Work Public safety16
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TYPES OF INFECTIOUS DISEASES
ViralBacterialFungalParasiticNematodes and helminthsCritters
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TRANSMISSION BASICS
• Airborne• Droplet• Contact• Ingestion• Blood and body fluid
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AIRBORNE TRANSMISSION
• Airborne droplet nuclei – Small particles <5 μm of evaporated droplet
• Widely dispersed• Remain suspended in air for long periods• Indication for N95 respirator
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20CDCCDC
TB Online
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DROPLET TRANSMISSION
• Droplets generated primarily by coughing, sneezing, talking
• Droplets relatively large– Propelled short distance (< 3 feet)– Deposited on conjunctiva, nasal mucosa, mouth– Do not remain suspended in air
• Indication for surgical masking
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CDC CDC
scarletfeverpictures.comCDC
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CONTACT TRANSMISSION
• Direct contact with infected area• Fomites• Most common route of health care-associated
infections
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CDC/Dr. Thomas SellersWikipdedia/Robert Morley
CDCMiteBitespictures.com
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INGESTION
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Chicago Star Tribune
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BLOOD AND BODY FLUID
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CDC CDC
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CONTROL AND PREVENTION• Pre-exposure immunization
(for vaccine-preventable diseases)• Screening • Hand hygiene• Food and water safety• Universal precautions• Isolation and quarantine• Post-exposure immunization • Post-exposure chemoprophylaxis 27
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RECOGNIZING AND MANAGING OUTBREAKS
• Disease surveillance• Contact identification and tracing• Pre- and post-exposure prophylaxis• Notification• Public health emergencies
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INFECTION CONTROL ISSUES
• Transmission characteristics• Diagnosis• Treatment• Evaluation of the exposed individual• Control measures• Isolation/exclusion – who, what, how long• Post-exposure measures• Environmental measures
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PERTUSSIS
ManifestationsCatarrhal stageCoughParoxysmal stage
Transmission Droplet
Incubation period Typically 7 – 10 days (range 6 -21 days)
Diagnostic testsCulturePCRDFA
Treatment Macrolide antibiotic (azithromycin)
Infectivity From onset of symptoms* to 2 weeks after onset of paroxysms
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{Total duration 6 – 10 weeks}
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PERTUSSIS, continued
Control measures
Isolate student until first five days antibiotics completed or until 21 days after onset of symptomsIsolate symptomatic contacts
Candidates for post-exposure measures
Prophylaxis indicated for household and other close contactsMonitor for 21 days after last contact
Post-exposure measures
Macrolide antibiotic (azithromycin)Update Tdap when indicated, but not effective as post-exposure measure
Cleaning and disinfecting Routine cleaning only
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MEASLES
Manifestations
Fever, followed by cough, coryza, conjunctivitis and Koplik spotsErythematous maculopapular rash, starts on head and spreads downward
Transmission Airborne spread, as well as direct contact with infectious droplets
Incubation period 8 to 12 days
Diagnostic tests Culture, serology, RT-PCR
Treatment No specific antiviral therapy
InfectivityHighly infectiousContagious from four days before onset of rash to four days after rash appears
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MEASLES, continued
Control measures
Isolate for 4 days after onset of rash (airborne precautions)Isolate symptomatic contactsConsider excluding asymptomatic contacts who cannot demonstrate immunity
Candidates for post-exposure measures
Anyone who cannot demonstrate immunity
Post-exposure measures
Post-exposure immunization may be effective if given within 72 hours of exposure
Cleaning and disinfecting Routine cleaning only
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MRSA
Manifestations Pustule or boil, commonly at site of visible skin trauma
Transmission Contact
Diagnostic tests Culture and sensitivity
Treatment
Incision and drainage Empiric antibiotics may be warrantedWhen possible, obtain specimens for C&S to guide continued antibiotic choice
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MRSA, continued
Control measures
Cover infectionsExclude athletes if wounds cannot be properly coveredHand hygieneClean shared equipmentDo not share personal items
Post-exposure measures No specific measures
Cleaning and disinfecting
Usually routine cleaning sufficientFocus on surfaces that might come in contact with uncovered infectionsClean shared equipmentRoutine laundry procedures
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NOROVIRUS
Manifestations Diarrhea and vomitingSymptoms last 1 – 14 days
TransmissionIngestion Person-to-person (fecal-oral)Contaminated food or water
Incubation period 12 to 72 hours
Diagnostic tests PCR assays not commercially available
Treatment Symptomatic – antiemetics, rehydration
Infectivity Most contagious during symptoms and first 3 days of recovery
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NOROVIRUS, continued
Control measures
Standard measures for control of diarrheaScrupulous hand hygieneExclude infected individuals from food preparation, health care, child careConsider isolation for 48 hours
Candidates for post-exposure measures
Reinforce hand hygiene to anyone with potential exposure
Post-exposure measures No specific measures available
Cleaning and disinfecting
Disinfect contaminated surfaces with bleach solution or other disinfectantWash contaminated clothes and linens
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AIRBORNE DROPLET CONTACT INGESTION BLOOD/FLUID
Measles Pertussis MRSA Norovirus HIV
Chickenpox Mumps Impetigo Hep A Hep B
Zoster Meningococcus Scabies Campylobacter Hep C
Tuberculosis Influenza HSV Salmonella
SARS Strep pyogenes C. diff Shigella
Smallpox Rubella Fungi E. coli
Monkeypox Adenovirus Adenovirus
Mycoplasma Zoster
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OTHER ISSUES
• Global health concerns• Global patterns of disease• Issues for students traveling abroad• Issues for international students
• Health care students• Animal-borne diseases• Faculty and staff
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ENVIRONMENTAL CLEANING
Standards for cleaningCleaning in response to disease outbreakSpecial circumstances/settingProtective equipment
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CAMPUS RESOURCES
• SHS• Dean of students• Environmental Health• Public safety• Facilities• Human Resources• Risk Management
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COMMUNICATIONS
• Communication with administration• Communications to students (and parents)• Communications to faculty• Media releases• Notification to public health officials
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ACKNOWLEDGEMENTS
Sharon McMullen RN BSN BA University of Pennsylvania
Esther Chernak, MD, MPH, FACPDrexel University School of Public Health
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