Category Archives: Infectious Disease

TB and ED discharges and disposition

Good morning

Patients may be referred to the TSTU (Tuberculosis Surveillance and Treatment Unit) following an ED visit for the next available non-holiday weekday.

Procedure

1.  Ask the patient to go to J1-05 Immunology Clinic from 8 AM to 3:30 PM. (the earlier the better).  After they enter the Immunology Clinic, the first door to their immediate left is the TSTU (door is marked IPaC TSTU Clinic).
2.  Provide the patient with a mask and ask him/her to wear it to the TSTU.
3.  The patient should state that he/she was seen in the ED and was asked to come to the TSTU.
4.  The referring ED need NOT write orders for sputum nor write a referral.
5.  IF, the patient is strongly suspected of having active PULMONARY tuberculous disease but is clinically stable following an evaluation in the ED during off-hours, weekends or holidays, the same process may be followed however, the medical provider should call 43077 and leave a voice message indicating that the patient is strongly suspected of having disease.
6.  The TSTU extension is 46058

Please understand that patients presenting with strongly suspected active PULMONARY tuberculosis should be carefully evaluated to reasonably assess that they will return for follow up.  Clinically unstable patients or patients that will likely not follow up with the TSTU following evaluation in the ED on a weekend or holiday should be considered for admission (e.g., homeless person).

During weekdays, cases with a low level of suspicion may be referred to the TSTU in the manner described above.

During weekdays, cases with a high level of suspicion should be called into IPaC at 43077.  The patients can be evaluated in the ED and referred to the TSTU prior to admission.  Admitted patients are evaluated in the same manner and offered the workup in the TSTU with the consent of the medical-surgical admitting team.

regards,

George Alonso, M.D.
Director, Infection Prevention and Control (IPaC)
Elmhurst Hospital Center

Zika Flow Sheet

Zika Flow Sheet

  • Symptoms: Rash, Fever (including report of fever at home), Arthralgia AND/OR Conjunctivitis
  • Travel (Locations may change so check the CDC/DOH websites): Caribbean, South and Central America
  • “Recent Travel”: 4 weeks

 1) Pregnant, no symptoms but exposure (recent travel or sexual partner who has recently travelled)

  • Refer to WHC clinic
    • FP make appointment for next clinic session
      • M-F 8:00 AM to Noon and 1:00 PM to 3:00 PM
    • Send email to Director Dr. Barry Brown brownba@nychhc.org
    • Send message to follow up nurse to check patient’s compliance

2) Pregnant with symptoms and recent travel but doesn’t need hospitalization:

  • Refer to WHC:
  • FP make appointment for next clinic session
  • Send email to Director Dr. Barry Brown brownba@nychhc.org
  • On AVS write “Referred for Zika testing” in the comment section
  • Send message to follow up nurse to check patient’s compliance

3)Pregnant with symptoms but need hospitalization for complication of pregnancy or other reasons:

  • Notify the admitting team of the Zika risk/concern so they can test and contact DOH

4)All Adults (including non-pregnant women) who are symptomatic and have positive travel history

  • Refer to Zika testing clinic on Wednesday afternoon:
    • FP clerk should schedule for this clinic specifically not Diagnostic clinic. If they have difficulty they are to call Ben Mendez.
    • On the AVS write “Referred for Zika testing” in the comment section
  • Send message to follow up nurse to check patient’s compliance

5)Symptomatic patients with NO travel history (DOH Surveillance Project)

  • Order urine for Zika PCR (not blood)
  • Call Sandy Sallustio (718) 369-6166 and if she is not available call Don Weiss (347) 386-4911

MERS Protocol

1.  Any patient with travel history (14 days) to the Arabian peninsula (Bahrain; Iraq; Iran; Israel, the West Bank, and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen).presenting with fever (>=100.5 F) and respiratory symptoms (cough, shortness of breath) OR pneumonia (chest x-ray finding)

2.  Any patient with travel history (14 days) to South Korea with fever and contact with an ambulatory or inpatient medical facility.

3.  Any patient with fever and contact with a traveler to either the Arabian peninsula or South Korea that has met or potentially fulfills the above criteria

Patients should be placed on airborne, contact and faceshield precautions; the ED should contact IPaC or the NYC DoH and report as a possible MERS PUI (person under investigation).  If, the ED contacts the DoH directly, they should still contact IPaC for subsequent reporting to the DoH.

I’m available to the ED off hours and Saturday.  there is an IPaC nurse in the hospital on Sunday.

The DoH will “advise” as to whether the patient will be worked up as a MERS PUI.

As the DoH decision to test will likely span a day(s), the patient will likely leave the ED and go to either the floor or an ICU depending on the clinical judgment of the ED attending.  If, the patient proceeds to a non-icu area, the nursing supervisor should be contacted to provide faceshields to the target admission area.

Additionally,
a log should be kept of all staff and visitors entering the room(s) where the patient is kept.
Visitors should be limited to 2, until we’ve ruled out MERS or the PUI status has been lifted
Visitors should wear surgical masks with shields NOT N95 respirators
The DoH will likely want an induced sputum, a nasopharyngeal culture and a red top for PCR.  These should be kept in accessioning for DoH pick up

Nota bene: a traveler from an affected area falling within the target time span with bacterial bronchitis may have fever and a negative x-ray in the setting of respiratory symptoms.  This case would qualify for PUI.  For the DoH, the decision to perform or not perform a test can be leisurely discussed, but for hospital staff, there is no difference between a rule-out case and a true case.

thank you

George Alonso, M.D.
Director, Infection Prevention and Control (IPaC)
Elmhurst Hospital Center
718 334-3078
email alonsog@nychhc.org