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Respiratory Viruses in Healthcare:

Nothing to Sneeze At

Sara Podczervinski, RN, MPH, CIC

Washington State Department of Health

Healthcare Associated Infections Program Manager

sara.podczervinski@doh.wa.gov

Learning Objectives

1. Develop an awareness of the seasonal trends of several

respiratory viruses (RV)

2. Identify the period of peak infectivity for most RV infections

3. Describe the impact of increased community RV have on

healthcare

4. List two prevention strategies that are critical to fostering a

culture of RV prevention in a healthcare setting

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Healthy

1 Year Old

Tonic Clonic

Seizures

106.2

Admitted

Cyanotic

Nystagmus

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Now...

A Healthy

6 Year Old

Adenovirus

Outbreaks

• World War II

• Acute Respiratory

Disease

• Crowding

• Hardy Virus

Koirala B and Wang JP. Adenovirus Chapter in

Viruses and the Lung: Infections and Non-Infectious

Viral-Linked Lung Disorders. 2014. Pg. 35-42.

Adenovirus Infection Timeline

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I just have a cold

Coronavirus

Bocavirus

Rhinovirus

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Symptoms

Sneezing

Hoarseness

Chills

High fever

Muscle aches

Sore throat

Runny nose

CoughSinus Pain

Ear Pain

Congestion

RSVLeading Cause of Infant Hospitalization

Hall CB et al. Pediatrics 2013;132:e341–e348,

Hall CB et al. N Engl J Med 2009; 360:588-598

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Nishiyama M. Eurosurveillance, Volume 15, Issue 36, 09 September 2010

Incubation PeriodsVirus Incubation Period in Days

Influenza 1-4

Coronavirus 2-5

Rhinovirus 2-4

Parainfluenza 2-6

Adenovirus 2-14

Metapneumovirus 3-5

RSV 3-7

Lancet Infect Dis. 2009 May; 9(5): 291–300

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Source: nps.org.au

Multiphase

Turbulent

Buoyant

Cloud

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Enterovirus: Mid-August 2014

http://www.rollaecondev.org/geo-location.shtml

Enterovirus: October 2014

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Parainfluenza: Interactive Viruses

Super-spreaders!

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32.7

Million Children in

Child Care2011 Data: http://www.census.gov/library/infographics/child_care.html

How Long Kids in Childcare Shed Virus?

Martin ET et al. J Infect Dis. 2013;207:982-989

Community Healthcare

Community Respiratory Viruses:

The Impact on Healthcare

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Community Healthcare

Community Respiratory Viruses:

The Impact on Healthcare

Community Healthcare

HAIs

Sick Staff

Deaths

$

Community Respiratory Viruses:

The Impact on Healthcare

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Parainfluenza 3

Nosocomial

Leukemia

Summer

Berrueco R et al. Infection. 2013 Dec;41(6):1171-5.

Pinksy B. Emerging Infectious Diseases. Vol. 16, No. 7, July 2010

January 2008

4 ½ year old male

Immunocompromised

Influenza A in

respiratory & GI tract

Premature

Infants

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Reid A. Brief Report. Pediatric ID Journal. Vol 30. No. 12. Dec 2011

2010 Outbreak in NICUOxygen or Ventilator Support

Elderly

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Lon

g-T

erm

Ca

re 154 Outbreaks

>50% Influenza

92% Residents

Vaccinated

38% Staff Vaccinated

Decreased Mortality–

If Reported < 3 Days

Mahmud et al. (2013) Influenza and Other Respiratory Viruses 7(6), 1055–1061

Tre

atm

en

t

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A Tale of Two RSV Outbreaks

Chu H, et al. Biol Blood Marrow Transplant. 2014 Jun;20(6):844-51.

2007-0850+ Cases

1 Death

3+ Months

Shut down

Transplant Program

Tested 250+

Employees

2012

24 Cases

0 Deaths

1 Month

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http://intermountainhealthcare.org/

Benefits

of Testing

Antibiotic

Use Early

Detection

Isolation

Treatment

Customize

Prevention

Chu H, et al. Biol Blood

Marrow Transplant. 2014

Mahony J et al. J. Clin. Microbiol. September 2009 vol. 47 no. 9 2812-2817

70 72

94

0

20

40

60

80

100

Direct Fluorescent

Antibody (DFA)

DFA + Culture Polymerase Chain

Reaction (PCR)

Sensitivity (%)

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Monday

Scr

ee

nin

g

Your appointment is tomorrow

at 2pm. Also, flu season is

here. If you have cold or flu

symptoms, please let your

doctor or nurse know BEFORE

you come to your appointment

by calling xxx-xxxx.

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http://www.fredhutch.org/en/news/center-news/2014/10/cancer-patients-at-risk-for-colds.html

Give

Patients

a Voice

Fever?

New

Symptoms?

More than 1

Symptom?

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Top 5 Take Aways

1

2

3

4

5

Viral respiratory infections occur year-round

Community RV activity drives impact on healthcare

Immunocompromised, infants, & elderly are most

vulnerable

Treatment is limited

Prevention is key and must be bundled, visible, and

part of the healthcare culture

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Acknowledgements

Seattle Cancer Care Alliance &

Fred Hutchinson Cancer Research Center:

• Steve Pergam

• Lois Helbert

• Corey Casper

• Kim MacLeod

• Judith Davies

• Zach Stednick

• Stephanie Price

• Cheri Constantino-ShorLois Helbert, Steve Pergam,

Sara Podczervinski (me), Kim MacLeod

Questions

Sara Podczervinski, RN, MPH, CIC

Washington State Department of Health

206-418-5519

sara.podczervinski@doh.wa.gov