Question

Case Study - Critical Thinking You are the Environmental Services Director of a large 750-bed hospital in the Pacific Northwest. You have just been notified that Unit 10 is now in an outbreak situation with what appears to be an influenza organism. So far, twenty-nine patients have experienced a rapid onset fever, body aches, chills, sweating, dehydration, fatigue, and loss of appetite Describe the steps that are required to limit the spread of the organism to other floors or units. 1. Describe the disinfectant characteristics that are required to kill this virus.

Answer 1

Influenza viruses can spread to other people when there is direct contact with infected person, or contact with the environment surrounding such infected person or when people inhale the droplets from the infected person which contain the virus. All these different routes of transmission should be considered to prevent transmission to other people in the floor and units. The steps involved in prevention of influenza type virus to other floors and units include:

i. The surfaces of the unit, respiratory equipment’s etc that had contact with the infected people should be sanitized. Droplets are travel in areas less than 1 meter of the infected person. Suitable disinfectants should employed that will kill the virus. All areas that the person contacts should be thoroughly disinfected. The invasive equipment’s used should be discarded and then sterilized. Any procedure on the patent should be performed on negative pressure rooms with HEPA filters.

ii. Health care workers should follow standard healthcare precautions. They should use mask and protective gear that cover the nose and mouth. Gloves should be worn while handling patients and these hands should be washed after the gloves are removed. Washing of hands should be performed using medicated soaps and water for atleast 20 sec. In case of contact with blood and other tissue fluids, health care workers should wear protective gowns. The gowns should be changes while handling each patient. Preferably vaccinated personal should attend to the patients. Goggles and other protective gear should be used for medical procedures.

iii. Patients with active infections should be isolated singly in that unit. The isolation should be continued till the patient exhibits no fever or other symptoms. This period should be extended for children and immunocompromised persons as they take longer to recover. Cohort rooms can be used if single rooms are unavailable. Prophylactic and therapeutic drugs can be used to contain the spread of infection.

iv. Vaccination should be conducted in people in other units or floor if there is a vaccine available against this influenza like virus. Vaccination should be carried out for medical staff. Vaccination is especially important for long term hospitalized patients. As the people are already vaccinated, there is less chance of spread to other units. Protective masks should be provided to family members visiting the patients in the infected units. These family members should wash their hands and disinfect themselves before leaving the unit.

v. Surveillances should be carried out in patients in other units by looking out for flu like symptoms in the patients, healthcare personal and other family members. Routine samples can be tested from other units to study whether the virus has spread. People can be educated in other units for good hygienic practices to avoid spread of the infection.

1. Characteristics of disinfectant that kill the virus:

a. Effectiveness: The disinfectant should kill the virus and not just inactivate it. Inactivated viruses can easily be activated later on. Broad spectrum germicides such as alcohol can kill the virus. However alcohol is flammable compound. Broad spectrum germicides are effective against large number of viruses. The disinfectant should not be easily inactivated by soil, temperature etc. Otherwise it will lose its effectiveness. It should have high penetration power through the envelope of the virus. The disinfectant should be able to inhibit critical process in the virus.

b. Kill time: The disinfectant should be able to kill the virus fast. Influenza virus mutates very fast and hence, if exposed to suboptimal levels of disinfectant, may become resistant to it. Disinfectants should leave a residue on surface to prevent any further viruses from adhering to it.

c. Safety of Use: The disinfectant should only kill the virus but should not affect humans. They should not cause skin irritation.

d. Ease of Use: The disinfectant should not be inactivated by inorganic surfaces. Influenza like viruses can be killed using standard disinfectant like sodium hypochlorite present in bleach. However, sodium hypochlorite is easily inactivated on inorganic surfaces. The disinfectant should be compatible with the solution of soap it is added to in order to prevent its inactivation. It should be water and lipid soluble so that it can easily enter the envelope of the virus. Influenza viruses are enveloped viruses.