Outbreak investagation

Outbreak in” rel=”nofollow”>investagation

Order Description

assignment will take you through the ten steps of an outbreak in” rel=”nofollow”>investigation. There is a media component for this assignment, lin” rel=”nofollow”>inked in” rel=”nofollow”>in Resources. You will in” rel=”nofollow”>introduce yourself within” rel=”nofollow”>in the hospital as the in” rel=”nofollow”>infection control manager, and there are reports that a number of patients are gettin” rel=”nofollow”>ing sick with a gastroin” rel=”nofollow”>intestin” rel=”nofollow”>inal illnesses.
As you are in” rel=”nofollow”>introduced to each update from various members of the healthcare facility, jot down your notes, perform your research, and then report on the steps taken within” rel=”nofollow”>in the outbreak in” rel=”nofollow”>investigation. Each step should be approximately one page in” rel=”nofollow”>in length, but some steps may take multiple pages to capture a comprehensive response.
As you progress through the media simulation, your answers to key questions and thoughts will be recorded and will be made available to you at the end of the simulation. You may wish to save the PDF file as a word document to make changes or updates to it prior to submittin” rel=”nofollow”>ing it as your assignment for this unit.

Riverbend City: Outbreak Investigation

Introduction
Laura Hernandez’s Office
Outbreak Detection and Notification
Generatin” rel=”nofollow”>ing the Hypothesis
Generatin” rel=”nofollow”>ing the Hypothesis
Testin” rel=”nofollow”>ing the Hypothesis
Investigation Results
Control and Preventative Measures

Conclusion

Introduction

For this assignment, you will be guided through a fictitious scenario where an outbreak occurs at a simulated healthcare facility. You will work through the various media components and throughout the six parts of the case study, there will be stop poin” rel=”nofollow”>ints where you will need to answer questions posed to you. Your responses will consist of the body of the Unit 7 assignment. You will label the questions and responses on a Word document and submit all the questions answered for this assignment.

After completin” rel=”nofollow”>ing this case study, you should be able to:

Describe the appropriate response to a potential foodborne illness complain” rel=”nofollow”>int.
List disease categories to in” rel=”nofollow”>include in” rel=”nofollow”>in the differential diagnosis of an acute gastroin” rel=”nofollow”>intestin” rel=”nofollow”>inal illness, given clin” rel=”nofollow”>inical in” rel=”nofollow”>information.
Outlin” rel=”nofollow”>ine a hypothesis on the source of an outbreak
Interpret epidemiologic study fin” rel=”nofollow”>indin” rel=”nofollow”>ings.
Identify in” rel=”nofollow”>information to in” rel=”nofollow”>include in” rel=”nofollow”>in an outbreak in” rel=”nofollow”>investigation report.
Describe the epidemiology e.g., occurrence, transmission, and control of an in” rel=”nofollow”>infectious disease
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Outbreak Detection and Notification

One Page

Voicemail from Keith Olson Hospital Infection Control

Hello, Laura. I wanted to reach out to you and let you know that yesterday our long term care unit as well as our labor and delivery unit reported an unusually high number of gastroin” rel=”nofollow”>intestin” rel=”nofollow”>inal symptoms. Nearly all of the 26 persons in” rel=”nofollow”>in both wards (16 in” rel=”nofollow”>in long term and 10 in” rel=”nofollow”>in labor and delivery) reported they were sufferin” rel=”nofollow”>ing from nausea, vomitin” rel=”nofollow”>ing, and diarrhea. All reported they had become ill durin” rel=”nofollow”>ing the night. I just wanted to make you aware of this situation as the epidemiologist for our local health department.

Answer these questions based on your observations

At this poin” rel=”nofollow”>int, what types of questions are you, the epidemiologist, begin” rel=”nofollow”>innin” rel=”nofollow”>ing to thin” rel=”nofollow”>ink about askin” rel=”nofollow”>ing the in” rel=”nofollow”>infection control nurse at the hospital? IN the first part of the assignment, please prepare an exhaustive list of questions you are lookin” rel=”nofollow”>ing to ask to ascertain” rel=”nofollow”>in additional in” rel=”nofollow”>information to assist you in” rel=”nofollow”>in your in” rel=”nofollow”>investigation, if one is needed at all. Should this complain” rel=”nofollow”>int/concern be in” rel=”nofollow”>investigated further? Why or why not?

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Generatin” rel=”nofollow”>ing the Hypothesis

One Page

Email from State Health Department.

From: Sarah Perkin” rel=”nofollow”>ins, State Health Department

Sent: Tuesday, February 12, 2015 12:20

To: Laura Hernandez

Subject: Follow-Up

Staff from both the hospital and your epidemiological section were skeptical of the in” rel=”nofollow”>infection control nurse’s report but felt that a min” rel=”nofollow”>inimal amount of exploration was necessary. You contacted the State Health Department to determin” rel=”nofollow”>ine if their staff was aware of a problem. State Health Department staff reviewed the foodborne illness complain” rel=”nofollow”>int log to see if others from the hospital had reported similar illnesses or exposures. Although a few reports of vomitin” rel=”nofollow”>ing and diarrhea had been received, no other recent complain” rel=”nofollow”>ints mentioned the hospital or in” rel=”nofollow”>involved references to patients at the hospital.

State Health Staff then made a few telephone calls. The hospital, where the sick complain” rel=”nofollow”>ints came from, noted on this day the cafeteria had been closed until 11:00 A.M., outsourcin” rel=”nofollow”>ing breakfast and snacks to patients from a licensed caterer. A subsequent call to the emergency room learned they had been flooded with a waitin” rel=”nofollow”>ing room full (15 patients and countin” rel=”nofollow”>ing!) of persons complain” rel=”nofollow”>inin” rel=”nofollow”>ing of acute gastroenteritis in” rel=”nofollow”>in the last 24 hours. You pull the emergency room surveillance log for the past month and only four patients had been seen for similar symptoms, none associated with the hospital. Stool specimens from in” rel=”nofollow”>initial 26 patients in” rel=”nofollow”>in the two hospital wards had been taken and submitted to the in” rel=”nofollow”>in-house hospital laboratory for enteric analysis. Results were not available at this time.
Voicemail from Dr. Henry Johnson East Side Outpatient Clin” rel=”nofollow”>inic

Hello Laura, it’s about 2:30 P.M. This is Dr. Henry Johnson from East Side Outpatient Clin” rel=”nofollow”>inic- I just wanted to in” rel=”nofollow”>inform you that I have 7 patients in” rel=”nofollow”>in my waitin” rel=”nofollow”>ing room complain” rel=”nofollow”>inin” rel=”nofollow”>ing of nausea, diarrhea, and vomitin” rel=”nofollow”>ing. I fin” rel=”nofollow”>ind it bizarre because I’ve only seen 1 case like this in” rel=”nofollow”>in the past month and every sin” rel=”nofollow”>ingle patient I’ve seen has stated they have been to the hospital to visit family or friends or were employees of the hospital.

Answer these questions based on your observations

At this poin” rel=”nofollow”>int, do you thin” rel=”nofollow”>ink these cases of gastroin” rel=”nofollow”>intestin” rel=”nofollow”>inal illness represent an outbreak at the hospital? Why or why not? Please discuss. What is the criterion for defin” rel=”nofollow”>inition of an outbreak? What are the critical components of this defin” rel=”nofollow”>inition? As the health department epidemiologist, please list your next priorities and discuss them in” rel=”nofollow”>in relation to the steps of this outbreak in” rel=”nofollow”>investigation.

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Generatin” rel=”nofollow”>ing the Hypothesis

Three to Five Pages

Email from the Hospital Infection Control Nurse.

From: Susan Jones, Hospital Infection Control Nurse

Sent: Tuesday, February 12, 2015 12:20

To: Laura Hernandez

Subject: Patient Interview Results

Per your recommendation and request, I in” rel=”nofollow”>interviewed the 26 patients from the two wards here usin” rel=”nofollow”>ing the forms you gave me and I’ve done some prelimin” rel=”nofollow”>inary analysis of the symptomology presentation. I will share those with you now:

24 persons (91%) reported vomitin” rel=”nofollow”>ing
22 persons (85%) reported diarrhea
18 persons (70%) reported abdomin” rel=”nofollow”>inal crampin” rel=”nofollow”>ing
15 persons (60%) reported headache
13 persons (50%) reported muscle aches
1 person (5%) reported bloody diarrhea

The range of temperatures recorded was from 98.8°F to 102.4°F. We only have about half (12 persons) of the complete blood counts, but I thought it was in” rel=”nofollow”>interestin” rel=”nofollow”>ing to note that all 12 of those tested so far had an elevated white blood cell count of 13.7 units {normal: 4.8 – 10.8 units}.

The laboratory is still tryin” rel=”nofollow”>ing to type the organism but it has been able to rule out Salmonella, Shigella, Campylobacter, Vibrio, Listeria, Yersin” rel=”nofollow”>ina, E. coli O0157:H7, Bacillus cereus, or Staphylococcus aureus. Parasitology screens were also negative. A few of the stool specimens tested demonstrate fecal leukocytes and occult blood.

I will keep you updated as I get more in” rel=”nofollow”>informaiton. Do you have anythin” rel=”nofollow”>ing to share with me?

Answer these questions based on your observations

At this poin” rel=”nofollow”>int, how might you respond to the in” rel=”nofollow”>infection control nurse with the in” rel=”nofollow”>information you have so far? How would you in” rel=”nofollow”>interpret these prelimin” rel=”nofollow”>inary laboratory results? Where would you be focusin” rel=”nofollow”>ing your next round of laboratory analyses on (bacteria, virus, parasite, toxin” rel=”nofollow”>in/chemical)? What agencies need to be notified at this poin” rel=”nofollow”>int? As the health department epidemiologist, please list your next priorities and discuss them in” rel=”nofollow”>in relation to the steps of this outbreak in” rel=”nofollow”>investigation.

Feedback

After some brief casework, you develop the epidemic curve for this outbreak at the hospital and it looks like this in” rel=”nofollow”>in a graph format:

Number of Cases.

Based on the epidemic curve and likely causative agent, what is the likely mode of transmission and the period of in” rel=”nofollow”>interest for possible exposures related to this outbreak? What was the likely in” rel=”nofollow”>incubation length and day? What type of outbreak is this called?

Feedback

The hospital uses municipal water and sewage services. There had been no work on water or sewage lin” rel=”nofollow”>ines in” rel=”nofollow”>in the past year nor recent roadwork or diggin” rel=”nofollow”>ing around the hospital. The hospital din” rel=”nofollow”>inin” rel=”nofollow”>ing service in” rel=”nofollow”>included two cafeterias. The main” rel=”nofollow”>in cafeteria served as the primary arena for all food storage, preparation, cookin” rel=”nofollow”>ing and delivery to 100% of patients in” rel=”nofollow”>in the hospital. Visitors also ate at this main” rel=”nofollow”>in cafeteria. The specific facilities within” rel=”nofollow”>in the main” rel=”nofollow”>in cafeteria served hot entrees, a grill, deli bar, and salad bar. A second smaller cafeteria at the hospital offers menu selections with a per item cost and predomin” rel=”nofollow”>inantly is used by hospital staff.

Under the advisement of your State epidemiologist, you begin” rel=”nofollow”>in in” rel=”nofollow”>interviewin” rel=”nofollow”>ing the sick hospital patients to better understand the likely source of the outbreak. Among the 20 patients in” rel=”nofollow”>interviewed (6 had been discharged and were no longer at the hospital), 25 had eaten food from the deli bar; 9 had eaten food from the salad bar, and 3 from the grill. Seven-day food histories revealed no particular food item that was common to all or most of the patients. It was also noted in” rel=”nofollow”>in the labor and delivery ward that none of the newborns were exhibitin” rel=”nofollow”>ing symptoms.

Given this in” rel=”nofollow”>information, what is your leadin” rel=”nofollow”>ing hypothesis on the mode of transmission in” rel=”nofollow”>in this outbreak? What studies or other in” rel=”nofollow”>investigations would you in” rel=”nofollow”>initiate to explore this hypothesis. Provide some descriptive epidemiology on the nature of this outbreak and the likely culprit in” rel=”nofollow”>in terms of the epidemiological triangle. As the health department epidemiologist, please list your next priorities and discuss them in” rel=”nofollow”>in relation to the steps of this outbreak in” rel=”nofollow”>investigation.

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Testin” rel=”nofollow”>ing the Hypothesis

Three to Five Pages

Email from the Hospital Infection Control Nurse.

From: Brian Sanders, Hospital CEO

Sent: Tuesday, February 12, 2015 12:20

To: Laura Hernandez

Subject: Thank You

Thank you, Laura, for contin” rel=”nofollow”>inuin” rel=”nofollow”>ing to in” rel=”nofollow”>investigate our unfortunate situation of illnesses within” rel=”nofollow”>in our patient load here at the hospital. I want to let you know we are willin” rel=”nofollow”>ing to do whatever is necessary to assist your in” rel=”nofollow”>investigation to help determin” rel=”nofollow”>ine the agent and cause of this event. Per your recommendation, we are settin” rel=”nofollow”>ing up times and contacts with your staff to perform the three recommended lin” rel=”nofollow”>ines of in” rel=”nofollow”>investigation:

Laboratory studies to determin” rel=”nofollow”>ine the causative agent,
Environmental health assessment of the hospital main” rel=”nofollow”>in cafeteria,
Epidemiologic study of patients still admitted at the hospital.

We have requested our clin” rel=”nofollow”>inicians to collect stool specimens from new cases of vomitin” rel=”nofollow”>ing and diarrhea; as well as bacterial cultures from patients seen in” rel=”nofollow”>in the emergency rooms. Also, per your guidance, we have submitted stool samples of those already sick from the in” rel=”nofollow”>initial phase of the outbreak and are shippin” rel=”nofollow”>ing them to the Centers for Disease Control and Prevention (CDC) for viral studies in” rel=”nofollow”>includin” rel=”nofollow”>ing reverse transcription-polymerase chain” rel=”nofollow”>in reaction (RT-PCR). What else can we do to assist you in” rel=”nofollow”>in this in” rel=”nofollow”>investigation?

Answer these questions based on your observations

At this poin” rel=”nofollow”>int of the in” rel=”nofollow”>investigation, what in” rel=”nofollow”>instructions would you give to health care providers for the collection of stool specimens from patients? Include in” rel=”nofollow”>instructions on how specimens should be collected, stored, and transported. Given that in” rel=”nofollow”>investigators suspect a virus as the causative agent, what contributin” rel=”nofollow”>ing factors are likely to have played a role in” rel=”nofollow”>in this outbreak? What activities would you undertake durin” rel=”nofollow”>ing the environmental health assessment? What key areas should be explored durin” rel=”nofollow”>ing in” rel=”nofollow”>interviews with the cafeteria food workers? As the health department epidemiologist, please list your next priorities and discuss them in” rel=”nofollow”>in relation to the steps of this outbreak in” rel=”nofollow”>investigation.

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Investin” rel=”nofollow”>ingation Results

Two Pages

Voicemail from Karen Walker Staff Epidemiologist and Environmental Health Specialists

Investigators toured the facility and obtain” rel=”nofollow”>ined a list of the foods served at the main” rel=”nofollow”>in cafeteria durin” rel=”nofollow”>ing the implicated period. Cafeteria staff was questioned about their responsibilities such as the foods they handled, which meals they served, and where they usually worked (e.g., deli bar, grill). They also were asked about use of gloves, hand washin” rel=”nofollow”>ing practices, work schedule durin” rel=”nofollow”>ing the week before the outbreak, and if they had been ill. None of the food workers reported bein” rel=”nofollow”>ing ill in” rel=”nofollow”>in the last two weeks. The cafeteria did not have a sick food workers policy.

An in” rel=”nofollow”>inspection of the main” rel=”nofollow”>in cafeteria food preparation area, equipment, and servin” rel=”nofollow”>ing lin” rel=”nofollow”>ine was unremarkable. Walk-in” rel=”nofollow”>in refrigerators and freezers were organized to prevent cross contamin” rel=”nofollow”>ination and main” rel=”nofollow”>intain” rel=”nofollow”>ined at appropriate temperatures. Food preparation surfaces were clean and appropriately situated with respect to flow of kitchen traffic. Steam tables on the servin” rel=”nofollow”>ing lin” rel=”nofollow”>ine heated to proper temperatures. Other equipment (e.g., meat slicer) was clean and in” rel=”nofollow”>in good workin” rel=”nofollow”>ing order.

The deli bar had its own refrigerator and preparation area. Durin” rel=”nofollow”>ing mealtimes, sandwiches were made to order by a food worker. Each day, newly prepared deli meats, cheeses, and condiments were added to partially depleted deli bar items from the day before (i.e., without discardin” rel=”nofollow”>ing leftover food items). While the deli bar was open for service, sandwich in” rel=”nofollow”>ingredients were not kept refrigerated or on ice. The deli bar contain” rel=”nofollow”>iners were not routin” rel=”nofollow”>inely cleaned. The refrigerator cooled only to 47°F. Water and ice from the cafeteria were collected to test for fecal coliforms. Samples of leftover food were collected from the deli bar for bacterial cultures and special viral studies at CDC. Stool specimens were requested from all cafeteria staff. Sir/Ma’am, what do you recommend for action at this time?

Answer these questions based on your observations

At this poin” rel=”nofollow”>int in” rel=”nofollow”>in the outbreak in” rel=”nofollow”>investigation, do you recommend shuttin” rel=”nofollow”>ing down the deli bar? What about the cafeteria? What type of epidemiological study design would you employ to assist in” rel=”nofollow”>in narrowin” rel=”nofollow”>ing down the list of likely agents that may be the culprit for food-borne illness? What steps in” rel=”nofollow”>in the outbreak in” rel=”nofollow”>investigation are utilized in” rel=”nofollow”>in this phase of the in” rel=”nofollow”>investigation? Please report on this development.

Feedback

We have completed the surveys of all ill persons and matched them with control (case-control) study to assist in” rel=”nofollow”>in determin” rel=”nofollow”>inin” rel=”nofollow”>ing the food source causin” rel=”nofollow”>ing the illness. This data is reflective of patients and persons consumin” rel=”nofollow”>ing meals at the hospital from Day 0-1, which falls in” rel=”nofollow”>in lin” rel=”nofollow”>ine with the in” rel=”nofollow”>incubation period. Sir/ma’am, please in” rel=”nofollow”>instruct me what we (as a health department) need to do next?

Exposure Ill Exposed/
Total Ill(%) Well Exposed/
Total Well(%) Odds Ratio 95% Confidence
Interval p-value
American Cheese 13/28 (46) 4/20 (20) 3.4 0.80-17.5 0.06
Swiss Cheese 8/28 (29) 8/20 (40) 0.61 0.15-2.4 0.30
Ham 11/28 (39) 6/20 (30) 1.5 0.38-6.3 0.36
Turkey 15/28 (54) 11/20 (55) 0.95 0.26-3.5 0.57
Shredded Lettuce 13/28 (46) 10/20 (50) 0.87 0.24-3.2 0.52
Tomato 7/28 (25) 6/20 (30) 0.78 0.18-3.5 0.50
Pickles 7/28 (25) 7/20 (35) 0.63 0.15-2.6 0.63
Mayonnaise 20/28 (71) 9/20 (45) 3.1 0.78-12.4 0.06
Mustard 10/28 (36) 9/20 (45) 0.68 0.18-2.6 0.52

Interpret the table. Please provide a brief discussion on implicated foods vs. non-implicated foods, the benefits of this study design and what the confidence in” rel=”nofollow”>interval and p-value mean in” rel=”nofollow”>in relation to this data. What steps in” rel=”nofollow”>in the outbreak in” rel=”nofollow”>investigation are utilized in” rel=”nofollow”>in this phase of the in” rel=”nofollow”>investigation? Please report on this development.

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Control and Preventative Measures

One Page

Voicemail from Kristin” rel=”nofollow”>in Malecha Hospital Food and Beverage Director

Good afternoon. It’s been 3 days sin” rel=”nofollow”>ince our cafeterias have been closed and I am gettin” rel=”nofollow”>ing pressure from the higher-ups at the hospital system to reopen the cafeterias. Can you give me a sign-off please, or let me know what I can do to get our cafeterias back open again” rel=”nofollow”>in? I look forward to hearin” rel=”nofollow”>ing from you.

Voicemail from Keith Olson Hospital Infection Control Nurse

Hello! I know you were hopin” rel=”nofollow”>ing to never hear from us again” rel=”nofollow”>in but I have some very in” rel=”nofollow”>interestin” rel=”nofollow”>ing news to share with you. Did you know of all the hospital cafeteria staff you stool sampled, 28 of the 29 (97%) came back negative for any norovirus presence. But I couldn’t figure out the reason why there wasn’t 100%. So, I did some diggin” rel=”nofollow”>ing and found out Ms. Mary Mallon was the mornin” rel=”nofollow”>ing shift deli prep cook who did not submit a stool sample due to her religious beliefs. She has not been sick but did take off 2 days before Day 0 to care for her ill daughter (who ironically had a diarrheal illness). Ms. Mallon again” rel=”nofollow”>in vehemently denied she has been sick and further states she wore gloves while doin” rel=”nofollow”>ing all the slicin” rel=”nofollow”>ing of the cheese, meat, etc, but didn’t wash her hands because she had gloves on. What is your take on this? Do you thin” rel=”nofollow”>ink she is the source of transmission?

Answer these questions based on your observations

Given your conversation with the in” rel=”nofollow”>infection control nurse and the food and beverage direction, what actions and next steps do you require/recommend? Once the cafeterias are reopened, what is the epidemiologist’s next step in” rel=”nofollow”>in the outbreak in” rel=”nofollow”>investigation?

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Conclusion

In this scenario you were guided through a fictitious outbreak at a local health care facility. You were asked to answer questions along the way that allowed you to build a hypothesis on the origin” rel=”nofollow”>in of the outbreak, in” rel=”nofollow”>interpret epidemiologic study fin” rel=”nofollow”>indin” rel=”nofollow”>ings, and determin” rel=”nofollow”>ine and describe the appropriate response to the complain” rel=”nofollow”>int.

Your assignment is to answer the questions posed durin” rel=”nofollow”>ing this scenario, and:

Describe the appropriate response to a potential foodborne illness complain” rel=”nofollow”>int.
List disease categories to in” rel=”nofollow”>include in” rel=”nofollow”>in the differential diagnosis of an acute gastroin” rel=”nofollow”>intestin” rel=”nofollow”>inal illness, given clin” rel=”nofollow”>inical in” rel=”nofollow”>information.
Outlin” rel=”nofollow”>ine a hypothesis on the source of an outbreak
Interpret epidemiologic study fin” rel=”nofollow”>indin” rel=”nofollow”>ings.
Identify in” rel=”nofollow”>information to in” rel=”nofollow”>include in” rel=”nofollow”>in an outbreak in” rel=”nofollow”>investigation report.
Describe the epidemiology e.g., occurrence, transmission, and control of an in” rel=”nofollow”>infectious disease

Post your answers to the questions posed in” rel=”nofollow”>in this scenario, your outlin” rel=”nofollow”>ine results and description of the appropriate response to this complain” rel=”nofollow”>int in” rel=”nofollow”>in the Unit 7 Assignment Board in” rel=”nofollow”>in the course room.
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