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Department of Infection Prevention

About the Department

As part of Vanderbilt’s mission to create a safe patient care through education, research, and quality care, the department of Infection Prevention provides evidence-based, scientific, and proven resources to Vanderbilt faculty and staff as well as our patients and families.  Through surveillance activities we detect potential healthcare-associated infections and develop action plans in collaboration with our quality and unit based partners to mitigate those risks.  We are a liaison to the Tennessee Department of Health and report the communicable disease for the institution as well as establishing a link to public health infrastructure in an effort to provide quality care to our patients.  We are the content experts for infection prevention research and educational activities, a position that we exercise regularly through our numerous publications and abstract presentations both inside and outside of the institution. 

Please use the menu at left to learn more about our department's functions and activities.


In the News:

New Urine Culture Testing Algorithm to Start June 21st

for Adult and Pediatric ED and Inpatient Units

In order to reduce the risk of false positive/contaminated urine cultures and to help better guide clinicians in the interpretation of positive urine cultures, VUMC will be implementing a new urine culture testing process (known as U/A with reflexive culture) starting June 21st as part of a multi-part program to reduce variability around urine cultures.   This program also includes guidance on the indications for urine culture ordering that will be presented on order entry, standardized specimen collection protocols, and tracking of urine culture contamination rates. 

For the new U/A with reflexive culture process, a U/A will be sent with every culture specimen order.  Clinicians will be asked on order entry if the patient has a recognized condition that could either impact the U/A interpretation or where national guidelines recommend treating positive cultures even in the absence of positive U/A results.  These are 1) pregnant patients, 2) patients undergoing urologic surgery, 3) neutropenic patients, and 4) children under 25 months of age.  In the absence of any of these conditions, if the U/A is negative (defined as negative nitrites, less than small leukocyte esterase, and <5 WBC/hpf), then the urine culture will not be processed.  If the U/A is positive, the urine culture will be processed without requiring any additional action from the ordering clinicians.  If the clinician notes the presence of any of the 4 conditions listed above, they will have the option of ordering either a U/A with urine culture or urine culture alone. 

The new test can be ordered by selecting “U/A” or “urine culture” and selecting the “U/A with reflexive culture” option.  You do not need to order the U/A as a separate test, as it is part of the reflexive testing.  For more information about the urine culture standardization, please click on the links below:

Urine Culture Standardization Summary (6/14/2016)

Indications for Urine Cultures (7/12/2016)

U/A with Reflexive Culture Flowchart (7/12/2016)


MEASLES UPDATE (4/27/2016)

Airborne Precautions

The Tennessee Department of Health has issued a health advisory due to the detection of multiple cases of measles in Memphis.   We remind all of our clinicians to have a heightened awareness about measles and its symptoms.  Measles is a highly contagious, acute viral illness that is transmitted by contact with an infected person through coughing and sneezing.  Measles presents as an acute viral respiratory illness and is characterized by a prodrome of fever and malaise, followed by cough, coryza (nasal discharge), and conjunctivitis (the three “C”s), a pathognomonic enanthema (Koplik spots), and a maculopapular rash (see pictures of rash HERE). The virus can survive for up to two hours on surfaces and in the air.  Measles can cause severe health complications including pneumonia, encephalitis, and death.  Importantly, approximately 9 out of 10 susceptible persons with close contact to a measles patient will develop measles

In light of this outbreak, the VUMC Department of Infection Prevention and Occupational Health Clinic remind you of some important steps to prevent measles transmission at VUMC.

All VUMC healthcare providers should

  • Consider measles as a diagnosis in anyone with a febrile rash illness lasting 3 or more days, fever, and clinical symptoms (cough, coryza, conjunctivitis) who has recently traveled to affected areas or who has had contact with someone with a rash illness.The Tennessee Department of Health specifically recommends that all clinicians consider the possibility of measles when evaluating susceptible patients with an acute febrile rash illness, especially if the person has been in Shelby County in the past 3 weeks.

  • Ask about their patient's vaccine status, recent travel history, and contact with individuals who have febrile rash illness
  • For any suspected measles case:
  1. Place patient on Airborne Precautions and into a negative pressure room IMMEDIATELY.  All persons who enter the room must wear an N95 respiratory or PAPR.  Limit room entry to only essential personnel
  2. Notify the VUMC Department of Infection Prevention at 835-1205 (24/7) immediately

Please be advised that these issues are evolving and advice may change as new information arises.  For questions or additional information, please contact the VUMC Department of Infection Prevention.

MEASLES FAQs

TN DOH HAN ALERT 4/22/2016


ZIKA VIRUS GUIDANCE & RESOURCES (UPDATED 8/1/2016)

                            Zika

ZIKA GENERAL INFORMATION: 

CDC Guidelines 

TN Dept of Health Update (5/10/2016)

TN Dept of Health Update (6/2/2016)

TN Dept of Health Update (8/1/2016)

ZIKA & PREGNANCY:  CDC Guidelines

TESTING FORM (Specimens sent to CDC via TN State Lab):  Please note the lab client services number, 5-LABS (615-875-3227) on the test requisition as contacts for questions from the receiving lab. TDH will perform PCR and serology (IgM, IgG) for CHIK and forward specimens to CDC for Zika testing, which may involve a combination of serology, PCR, and culture-based demonstration of Zika-specific neutralizing antibodies. Note: per CDC, “Because Zika virus testing is not listed in the drop-down menu for the Test Order Name field of form 50.34 (located on 1st page, top left), you will need to select “ARBOVIRUS SEROLOGY” and then type “Zika testing” in the Brief Clinical Summary field located at the top of the second page of the form.”  According to the CDC web site, results are usually available 4-14 days after specimen receipt, longer during summer months. A positive initial serologic screen for Zika will trigger confirmatory testing, which may delay final results. A report hardcopy will be available ≥2 weeks after test completion and communicated directly to TDH Lab.


Ebola Update

                                          Ebola

Dr. Talbot's Town Hall Presentation:

Ebola and VUMC Preparedness (click here to watch)

Ebola Advisory (8/8/2014)

National and international health authorities are currently working to control a large, ongoing outbreak of Ebola involving areas in West Africa. There are currently no reports of endemic cases of Ebola infection in the United States. There is no vaccine to prevent Ebola infection, and treatment is supportive.

Despite recent media reports that suggest the contrary, Ebola patients can be safely managed in any acute care hospital if CDC recommended precautions are strictly followed.  The Department of Infection Prevention is working closely with many key stakeholders across the medical center to ensure we are prepared to care for patients with suspected or confirmed Ebola infection.  More details on the recommended infection prevention practices can be found below.

Contact 875-4000 and activate the EBOLA RESPONSE TEAM if you encounter a patient in which Ebola infection is suspected. 

Click HERE for more information.


 Middle-East Respiratory Syndrome Coronavirus (MERS-CoV) 

MERS-CoV

  • As of April 30, 2014, the European Centre for Disease Prevention and Control (ECDC) reported 424 cases of MERS-CoV globally, including 131 deaths. All cases have either occurred in the Middle East or have direct links to a primary case infected in the Middle East.
  • The number of reported cases increased markedly in April 2014 with 217 cases and 38 deaths. Between March 2013 and March 2014 the monthly average number of reported cases was 15.   A majority of cases from April 2014 occurred in healthcare workers.
  • While the first US case of MERS-CoV was reported May 2 in a traveler from Saudi Arabia, no cases have been reported in TN.
  • Human-to-human transmission has occurred to close contacts and healthcare workers, but no evidence of sustained human-to-human transmission has been documented.
  • With such an increase in cases, it is much more likely that the US will see travelers who have been exposed and infected with MERS Co-V.
  • VUMC has extensive plans to identify and mitigate transmission in the event a case of MERS-CoV is suspected or identified.  These were developed following the SARS outbreak of 2003 and are directly applicable to MERS-CoV, a similar virus.
  • Recent developments highlight the need to be vigilant and continue to screen patients for risk factors. Healthcare providers should be alert to patients who develop severe acute lower respiratory illness within 14 days after traveling from countries in the Arabian Peninsula, or neighboring countries. This includes screening of patients for risk factors; airborne and contact precautions should be added standard and droplet precautions for patients with symptoms of acute respiratory infection if MERS Co-V is being considered.

 More information can be found below (click on topic):

Tennessee Department of Health Alert (May 1, 2014)

Centers for Disease Control and Prevention

CDC MERS-CoV FAQs

VU Emergency Preparedness

Specimen Testing:   

MERS testing at TN DoH and/or CDC should begin with consultation by a state epidemiologist, prior to specimen collection. Please contact a member of the microbiology service if MERS is under consideration and prior to specimen to collection. One of the microbiologists will coordinate with the clinical team and specimen-receiving lab to support safe and efficient specimen handling for eventual routing to the state laboratory. If/when the state epidemiologist approves testing, the specimen(s) should be collected per instructions at http://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html
and submitted to our central receiving lab with the following documentation: VUMC test requisition, state specimen submission form (https://tn.gov/assets/entities/health/attachments/PH-4182.pdf), and CDC specimen submission form (http://www.cdc.gov/laboratory/specimen-submission/pdf/form-50-34.pdf). Please VERY CLEARLY indicate the suspicion for MERS on the test requisition to help avoid unintentional testing or opening of the specimen in the VUMC laboratory. If the DDx expands to include MERS after respiratory specimens have been collected and submitted to the laboratory for other testing, please immediately contact the microbiology service so that we can assist in the safe management of those materials pending a determination of whether the patient meets PUI criteria.

  1. Clinical Specimen Guidelines
  2. Biosafety Guidelines   
  3. MERS-CoV Submission Form


VUMC Urinary Catheter Management Guidelines: 

Urinary Catheters

In order to reduce infections due to urinary catheters in adult inpatients, all adult patients admitted to VUH will be placed on the nurse-directed Foley discontinuation protocol unless specifically excluded by a provider order.  Pilot testing of this policy has been met with very positive reviews from both nursing personal and physician and NP providers.

 To help with this policy change, all providers should

  1. Be aware of the indications for urinary catheters
  2. Be aware that patients with a Foley catheter must have an order for that catheter
  3. Perform an assessment daily regarding the necessity for the urinary catheter and if not needed, have it removed
  4. Understand and support the catheter discontinuation protocol

Click for more information:

VUMC Urinary Catheter Guidelines

Nurse-Directed Urinary Catheter Discontinuation Protocol


Influenza Vaccination Education

PREVENT THE SPREAD OF INFLUENZA!!

Flu

 

 VUMC policy now requires annual influenza vaccination or exemption. Exemptions may be for religious or personal/philosophical beliefs or for medical contraindications. Those who wish to be exempted from receiving the flu vaccine must complete an exemption form, available on the OHC website beginning in September.   

 

Do you never get an annual influenza vaccination?

Do you come to work with a "cold?"

If you answered "yes," you could be spreading infleunza to

your patients and colleagues (even when you don't feel sick!)

 

It's influenza season again -- find out how you can protect yourself,

your colleagues, and your patients from influenza.

 

CLICK HERE FOR MORE INFO


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