INFECTION CONTROL NEWSLETTER

February 1998
written by and for Long Term Care Infection Control Nurses

Broad Street Solutions
James Marx, RN, MS, CIC Editor
PO Box 16557
San Diego, CA 92176
(619)656-7887 Voice/FAX
jmarx@concentric.net

Respiratory Syncytical Virus (RSV)

Two strains: Type A and B, both seen in epidemics
Associated in lower respiratory tract infections in the elderly
Nearly everyone is infected by age 2 years with reinfections throughout life
Causes damage to the airway epithelium resulting in edema and mucus production
Humans are the only source
Transmission is by direct or close contact
Virus can last on surfaces for hours
Incubation period is 2 to 8 days
Initial infection shows as low-grade fever, runny nose and cough
Wheezing or rales can be heard on auscultation
Chest x-ray may show infiltrates
Adult high risk factors are advanced age and COPD
Infection increases risk of pneumonia
Diagnosis can be by obtaining nasal secretions
There is no recommended treatment for adults
Contact Precautions are recommended by the CDC
Outbreak strategies are to cohort infected residents and staff, temporarily suspend group activities and dining, exclude symptomatic visitors, and excuse staff with fever and/or productive cough

References

APIC Infection Control and Applied Epidemiology-Principles and Practice. Mosby:St. Louis, 1996, Chapter 75-1.
Benenson, AS. Control of Communicable Diseases Manual. American Public Health Association. Sixteenth Edition, 1995.

Hepatitis C

CLINICAL FEATURES
Jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting

ETIOLOGIC AGENT
Hepatitis C virus

INCIDENCE
35,000-180,000 total infections/yr in United States 3,000-54,000 (30%) symptomatic infections/yr

SEQUELAE
Chronic infection > 85% of infected persons
Chronic liver disease: 24,500-126,000 (70%)/yr
Deaths from chronic liver disease: 8,000-10,000/yr

PREVALENCE
Estimated 3.9 million chronically infected Americans

COSTS
Estimated $600 million (1991 dollars)/yr (medical and work loss)

TRANSMISSION
Bloodborne; sexual; perinatal

RISK GROUPS

Injecting drug

Sexual/household contacts users of infected persons

Health care workers

Sexually active heterosexuals

Hemodialysis

Transfusion recipients patients

Low socioeconomic level

TRENDS
Incidence stable in 1980s; decline in 1990s
Earlier increase among injection drug users now on the decline
Decrease of transfusion-associated cases due to donor screening

PREVENTION
Screening of blood/organ/tissue donors
Programs to encourage high-risk behavior modification

ISOLATION
No special precautions are necessary

More information about Hepatitis C can be obtained from the American Liver Foundation, 1425 Pompton Avenue, Cedar Grove, NJ, 07009, 201-256-2550.

Evaluating hepatitis C

If the anti-HCV (antibody for hepatitis C) test is positive, an ALT (formerly called SGOT) should be done.
If the ALT is elevated or normal, it should be repeated every 8 weeks for 6 months.
If the ALT is persistantly normal, then the patient has either recovered or is in a dormant carrier state.
If the ALT is persistently elevated, then persume chronic hepatitis C, and consider doing a liver biospy.
If the ALT is transient and returns to normal, the ALT should be reevaluated in 6 months to 1 year.

Source: San Diego BloodBank, Physician's Newsletter April 1993 Vol 2 No 1