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Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review

Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review. Review Participants IP , ID, Lab, Micro, QA, Materials Management, Lean, DHHS Presented by Lynda Caine, Infection Prevention Officer. Agenda. Background Reviews Conducted Line Listing

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Pseudo Outbreak of Group A Strep (GAS) at Concord Hospital A Collaborative Review

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  1. 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

  2. Agenda • Background • Reviews Conducted • Line Listing • Process and Observation • Product Review • Case Studies and Lab Data Correlation with Timeline • DHHS Reports

  3. 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

  4. 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?

  5. Pseudo outbreak • Type: TermPronunciation:sū-dō-out′brākDefinitions:1. Episode of increased disease incidence due to enhanced surveillance or other factor not related to the disease under study

  6. 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

  7. 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

  8. Product Review • Micro conducted testing on all lots of current blood culture bottles as well as chlorhexidineswabs – 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

  9. CH Case Timeline • Plotted: • Blood Culture Collection Time • Antibiotic Administration • Blood Culture Result Time • Finding: blood cultures were obtained prior to antibiotic administration

  10. 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

  11. Community Data from CH Micro: Positive Group A StrepThroat Cultures

  12. DHHS: Group A Strep by Age Group

  13. DHHS: Group A Strep Rate and Cases by Age Group

  14. DHHS: Group A Strep Cases by Sex and Year

  15. DHHS: Group A Strep Cases by County and Year

  16. DHHS: Group A Strep Rate by County and Year

  17. DHHS: Group A Strep Rate by County and Year

  18. DHHS: Group A Strep Rate by County

  19. DHHS: Group A Strep Rate by Month

  20. DHHS: Group A Strep Rate and Cases by Year

  21. 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

  22. Special THANKS to DHHS!!!

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