Harbor:Infectious Disease Threats - Revision history

Bchap23: /* Measles */

2025-03-14T18:50:32Z

Measles

← Older revision		Revision as of 18:50, 14 March 2025
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	*Plan:		*Plan:
	** ~~Airborne Isolation -~~ https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/Measles-HCFacilityICRecs.pdf		** [https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/Measles-HCFacilityICRecs.pdf CDPH Guidelines for Isolation and Testing]
			** Airborne Isolation
	*** Standard terminal clean - 1 hour timeframe		*** Standard terminal clean - 1 hour timeframe
	** Patient mask		** Patient mask

Bchap23: /* Measles */

2025-03-14T18:48:26Z

Measles

← Older revision		Revision as of 18:48, 14 March 2025
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	**** "Measles Real-Time PCR-PHL" - throat swab - use the Eswab (verify the swab container has sufficient transport medium)		**** "Measles Real-Time PCR-PHL" - throat swab - use the Eswab (verify the swab container has sufficient transport medium)
	** '''For all suspected cases'''		** '''For all suspected cases'''
	*** Call IDPC M-F 8-5 x66532; IPC ~~homepage~~		*** Call IDPC M-F 8-5 x66532; [https://lacounty.sharepoint.com/sites/dhs-harbor-inf_prev_ctrl/Test%20Documents%20To%20Upload/Forms/AllItems.aspx?id=%2Fsites%2Fdhs%2Dharbor%2Dinf%5Fprev%5Fctrl%2FTest%20Documents%20To%20Upload%2FContact%20List%20for%20SharePoint%20Page%20%E2%80%93%206%2E IPC Homepage for on-call physician]
	*** Call Public health for any suspected cases		*** Call Public health for any suspected cases
	**** Weekdays: 8:30 AM – 5 PM call 888-397-3993		**** Weekdays: 8:30 AM – 5 PM call 888-397-3993

Bchap23: /* Measles */

2025-03-14T18:46:58Z

Measles

← Older revision		Revision as of 18:46, 14 March 2025
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	**** "Measles Real-Time PCR-PHL" - throat swab - use the Eswab (verify the swab container has sufficient transport medium)		**** "Measles Real-Time PCR-PHL" - throat swab - use the Eswab (verify the swab container has sufficient transport medium)
	** '''For all suspected cases'''		** '''For all suspected cases'''
	*** Call IDPC M-F 8-5 x66532;		*** Call IDPC M-F 8-5 x66532; IPC homepage
	*** Call Public health for any suspected cases		*** Call Public health for any suspected cases
	**** Weekdays: 8:30 AM – 5 PM call 888-397-3993		**** Weekdays: 8:30 AM – 5 PM call 888-397-3993
	**** After-hours: call 213-974-1234 and ask for the physician on call.		**** After-hours: call 213-974-1234 and ask for the physician on call.

			* Education/Guidance:
	** ~~If advised to test for measles by DPH, submit a specimen for polymerase chain reaction (PCR) testing~~		** [[Measles\|WikEM Measles]]
	*** Full clinical guidance from the California Department of Public Health https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/Measles-ClinicalGuidance.pdf		** [https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/Measles-ClinicalGuidance.pdf CDPH Measles Information]
	*** Guidance from CDC for healthcare professionals:https://www.cdc.gov/measles/hcp/index.html		** [https://www.cdc.gov/measles/hcp/index.html CDC Measles Information]

	==Hepatitis A==		==Hepatitis A==

Bchap23: /* Measles */

2025-03-14T18:40:30Z

Measles

← Older revision		Revision as of 18:40, 14 March 2025
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	==Measles==		==Measles==
	* ~~Report suspected measles immediately to DPH~~		* 95% of CA population vaccinated
	** ~~Weekdays 8:30 AM~~ – ~~5 PM: call 888-397-3993~~		* Risk factors: international travel, never immunized of born after 1956
	** ~~After-hours: call 213-974-1234~~ and ~~ask for~~ the ~~physician on call~~.		* Symptoms
			** Fever (generally high), including subjective fever.
			** Usually 1 or 2 of the “3 Cs” – cough, coryza, conjunctivitis, Koplik spots.
			** Rash begins a few days after fever and URI symptoms; starts on the head and descends.


	*Plan:		*Plan:
	** ~~Isolate pt~~ - https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/Measles-HCFacilityICRecs.pdf		** Airborne Isolation - https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/Measles-HCFacilityICRecs.pdf
			*** Standard terminal clean - 1 hour timeframe
			** Patient mask
			** Provider N95 or PAPR
			** "Measles Outbreak Testing" order set
			*** '''Order all the boxes in the order set''':
			**** "Measles IgG Antibody - PHL" - blood
			**** Patient Isolation Precautions - Airborne
			**** "Measles IgM Antibody IFA - PHL" - blood
			**** "Measles Real Time PCR-PHL" - urine
			**** "Measles Real-Time PCR-PHL" - throat swab - use the Eswab (verify the swab container has sufficient transport medium)
			** '''For all suspected cases'''
			*** Call IDPC M-F 8-5 x66532;
			*** Call Public health for any suspected cases
			**** Weekdays: 8:30 AM – 5 PM call 888-397-3993
			**** After-hours: call 213-974-1234 and ask for the physician on call.


	** If advised to test for measles by DPH, submit a specimen for polymerase chain reaction (PCR) testing		** If advised to test for measles by DPH, submit a specimen for polymerase chain reaction (PCR) testing
	*** Full clinical guidance from the California Department of Public Health https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/Measles-ClinicalGuidance.pdf		*** Full clinical guidance from the California Department of Public Health https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/Measles-ClinicalGuidance.pdf
	*** Guidance from CDC for healthcare professionals:https://www.cdc.gov/measles/hcp/index.html		*** Guidance from CDC for healthcare professionals:https://www.cdc.gov/measles/hcp/index.html

	* Risk factors: international travel, never immunized of born after 1956
	* Symptoms
	** Fever, including subjective fever.
	** Rash that starts on the head and descends.
	** Usually 1 or 2 of the “3 Cs” – cough, coryza and conjunctivitis.

	==Hepatitis A==		==Hepatitis A==

Bchap23: /* Flu/ILI */

2025-02-05T20:01:30Z

Flu/ILI

@@ Line 832: / Line 832: @@
 ==Flu/ILI==
 *Influenza-like-illness (ILI) is defined as fever >100.0 F / 37.8 C AND cough or sore throat.
-*Per our DHS policy, please consider treatment for high-risk populations.
+**Per our DHS policy, please consider treatment for high-risk populations.
 **Antivirals for influenza are most effective when administered when symptoms have been present for <48 hours.
-**May benefit for severely ill patients who have had >48 hours of symptoms.
+***May benefit for severely ill patients who have had >48 hours of symptoms.
 ==Measles==

Bchap23: /* DHS Visitor Policy */

2023-01-11T22:51:03Z

DHS Visitor Policy

← Older revision		Revision as of 22:51, 11 January 2023
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	* Patients visiting the ED may have up to two visitors at the discretion of care team		* Patients visiting the ED may have up to two visitors at the discretion of care team
	* Limiting visitors to inpatient areas up to two visitors per day and no more than one visitor is permitted at a time.		* Limiting visitors to inpatient areas up to two visitors per day and no more than one visitor is permitted at a time.
	[https://~~lnks~~.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDAsInVyaSI6ImJwMjpjbGljayIsImJ1bGxldGluX2lkIjoiMjAyMjAxMTEuNTE2Mzk5MTEiLCJ1cmwiOiJodHRwczovL2xhY291bnR5LnNoYXJlcG9pbnQuY29tL3NpdGVzL0RIUy1DT1ZJRDE5L0V4cGVjdGVkUHJhY3RpY2VzL0Zvcm1zL05ld2VzdCUyMG9uJTIwVG9wLmFzcHg_aWQ9JTJGc2l0ZXMlMkZESFMtQ09WSUQxOSUyRkV4cGVjdGVkUHJhY3RpY2VzJTJGSG9zcGl0YWwrTWVkaWNpbmUlMkZESFMrQ09WSUQrVmlzaXRhdGlvbi5wZGYmcGFyZW50PSUyRnNpdGVzJTJGREhTLUNPVklEMTklMkZFeHBlY3RlZFByYWN0aWNlcyZ1dG1fY29udGVudD0mdXRtX21lZGl1bT1lbWFpbCZ1dG1fbmFtZT0mdXRtX3NvdXJjZT1nb3ZkZWxpdmVyeSZ1dG1fdGVybT0ifQ.gA88PgU4cNBUuLSlfHh0fdNHoC8iKF5HFmIdmNWlu-E/s/~~859983445~~/~~br/124618773330-l~~ DHS visitation policy 1-2022]		[https://lacounty.sharepoint.com/sites/DHS-COVID19/ExpectedPractices/Hospital%20Medicine/DHS%20COVID%20Visitation.pdf DHS visitation policy 10-2022]

	====Vaccines====		====Vaccines====

Bchap23: /* Workforce Member Exposures */

2022-12-13T08:27:37Z

Workforce Member Exposures

← Older revision		Revision as of 08:27, 13 December 2022
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	** '''Asymptomatic or mild disease''':		** '''Asymptomatic or mild disease''':
	*** DAY 0 = first day of symptom onset		*** DAY 0 = first day of symptom onset
	*** May return on Day 6 (from onset of symptoms or positive test), IF afebrile for 24 hours AND neg antigen test within 24 hours of return (on day 5 or 6)		*** '''May return on Day 6 (from onset of symptoms or positive test), IF afebrile for 24 hours AND neg antigen test within 24 hours of return (on day 5 or 6)'''
	*** if positive antigen test at day 6-7, can return on DAY 11 (10 days from symptom onset/positive test) AND 24hr fever free		*** if positive antigen test at day 6-7, can return on DAY 11 (10 days from symptom onset/positive test) AND 24hr fever free
	** Severe illness or immunocompromise, 20d from symptom onset/positive test AND 24hr fever free		** Severe illness or immunocompromise, 20d from symptom onset/positive test AND 24hr fever free

Bchap23: /* Workforce Member Exposures */

2022-12-13T08:26:55Z

Workforce Member Exposures

← Older revision		Revision as of 08:26, 13 December 2022
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	** '''Asymptomatic or mild disease''':		** '''Asymptomatic or mild disease''':
	*** DAY 0 = first day of symptom onset		*** DAY 0 = first day of symptom onset
	*** May return on Day 8 (~~7 days~~ from onset of symptoms or positive test), IF afebrile for 24 hours AND neg antigen test within 24 hours of return		*** May return on Day 6 (from onset of symptoms or positive test), IF afebrile for 24 hours AND neg antigen test within 24 hours of return (on day 5 or 6)
	*** if positive antigen test at day 6-7, can return on DAY 11 (10 days from symptom onset/positive test) AND 24hr fever free		*** if positive antigen test at day 6-7, can return on DAY 11 (10 days from symptom onset/positive test) AND 24hr fever free
	** Severe illness or immunocompromise, 20d from symptom onset/positive test AND 24hr fever free		** Severe illness or immunocompromise, 20d from symptom onset/positive test AND 24hr fever free

Bchap23: /* Treatment */

2022-10-16T18:48:03Z

Treatment

← Older revision		Revision as of 18:48, 16 October 2022
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	** renally dosed eGFR 30-60 then 150 mg/100 mg dosing		** renally dosed eGFR 30-60 then 150 mg/100 mg dosing
	** '''89% reduction in hospitalization or death in high risk population, and 70% reduction in hospitalizations with no deaths in standard risk population'''		** '''89% reduction in hospitalization or death in high risk population, and 70% reduction in hospitalizations with no deaths in standard risk population'''
			** '''Among vaccinated population, only reduces hospitalization if >65 y/o''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9454652/ Paxlovid in Vaccinated Patients]
	** COVID-19 rebound is characterized by a recurrence of symptoms or a new positive viral test after having tested negative. People with recurrence of COVID-19 symptoms or a new positive viral test after having tested negative should restart isolation and isolate again for at least 5 days. Per CDC guidance, they can end their re-isolation period after 5 full days if fever has resolved for 24 hours (without the use of fever-reducing medication) and symptoms are improving. The individual should wear a mask for a total of 10 days after rebound symptoms started. Currently, there are no reports of severe disease among persons with COVID-19 rebound.		** COVID-19 rebound is characterized by a recurrence of symptoms or a new positive viral test after having tested negative. People with recurrence of COVID-19 symptoms or a new positive viral test after having tested negative should restart isolation and isolate again for at least 5 days. Per CDC guidance, they can end their re-isolation period after 5 full days if fever has resolved for 24 hours (without the use of fever-reducing medication) and symptoms are improving. The individual should wear a mask for a total of 10 days after rebound symptoms started. Currently, there are no reports of severe disease among persons with COVID-19 rebound.

Bchap23: /* Treatment */

2022-06-30T23:49:17Z

Treatment

← Older revision		Revision as of 23:49, 30 June 2022
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	* '''Paxlovid''' (nirmatrelvir 300mg + ritonavir 100mg, twice daily for 5 days)		* '''Paxlovid''' (nirmatrelvir 300mg + ritonavir 100mg, twice daily for 5 days)
	** Treatment of mild-to-moderate coronavirus disease (COVID-19) in adults and pediatric patients (12 years of age and older weighing at least 40 kilograms) that are high risk		** Treatment of mild-to-moderate SYMPTOMATIC coronavirus disease (COVID-19) in adults and pediatric patients (12 years of age and older weighing at least 40 kilograms) that are high risk
	** '''initiate within 5 days of symptom onset'''		** '''initiate within 5 days of symptom onset'''
	** Many [https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-paxlovid-drug-drug-interactions/ drug interactions]		** Many [https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-paxlovid-drug-drug-interactions/ drug interactions]