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Fungal Meningitis: The IP’s view. On October 4 th , IHAN broadcast a CDC national alert advising clinicians to contact all patients who had received injections of contaminated Methylprednisolone. Patients were coming to the Emergency Room after receiving the call.
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On October 4th, IHAN broadcast a CDC national alert advising clinicians to contact all patients who had received injections of contaminated Methylprednisolone. Patients were coming to the Emergency Room after receiving the call. Some had symptoms, others did not. But everyone was concerned and scared. Information was scarce to non-existent as even the CDC did not know how to direct clinicians in testing or treatment. The contaminant was unknown, and the symptoms were vague except look for stroke and neurological signs. When patients asked questions, most of the answers were “we don’t know”. Infection Prevention was involved in many areas of this outbreak; not just from the Infection Prevention aspect, but as nurses and members of the community.
Those people admitted after LP results met CDC criteria were housed on a unit where the nurse to patient ratio would allow for multiple drugs to be administered by IV. The medications initially recommended by the CDC were anti-fungal and antibiotic. Side effects from these medications, for some patients caused fatigue, weakness, hallucinations, acute renal failure or drug-induced hepatitis, and other symptoms. Patients were in isolation for meningitis in the initial stages due to the unknown. Tracking those persons identified from the clinic, who entered our facility was done via a comprehensive spreadsheet. This included name, demographics, injection date, site and lot number, admission, discharge, room number, test results, and notes listing complications or death. The CDC also came to our hospital to collect information about these patients.
Order sets were created for screening and treating patients. A “cheat-sheet” was used in the ER by Physicians to use for patients who had received the contaminated injection and met the criteria (headache, nausea, fever, confusion). Non-ER Physician Order sets were created to specify tests to order and consultation. Later, these forms were modified to include meal time and snack delivery, pain and nausea medicine. Pharmacy developed education hand-outs for patients and family members about the various medications.
Criteria for diagnosis of meningitis and admission was a CSF WBC of > 5 Some examples of lab results: Patient #1 CSF: Cloudy WBC: 1,495 (0-8) Symptoms: Not sick, back pain only Patient #2 CSF: Slightly Cloudy WBC: 718 Symptoms: Stroke, negative head CT Patient #3 CSF: Clear WBC: 378 Symptoms: Slight headache Patient #4 CSF: Cloudy WBC: 7,290
Numerous department managers, nurses, doctors, materials management, pharmacy, administration, radiology, security, purchasing, marketing, social services, clergy, local and state health departments and others joined together to lend their experience to develop a process which helped to identify and then care for these patients. Some hospital staff members stayed around the clock, worked extended shifts, worked weekends, called in to check to see if anything was needed, and planned ahead. Everyone collaborated with others in the patient’s best interest. Everyone pulled together and gave willingly to help others. It’s an experience we will never forget.
“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou
