What We Need is a Red Book for College Health:
Infection Control for the College Campus
Evelyn Wiener, MD
University of Pennsylvania
1
United States Environmental Protection Agency
Public Health Image Library
2
SESSION OBJECTIVES
• List communicable diseases for which
infection control measures are indicated
• Identify modes of transmission for
communicable diseases
• Identify appropriate infection control
measures for common and/or serious
contagious diseases
• Know the campus and community resources
involved with implementing infection control
measures
3
LA
2/23/12
• History:
– Sore throat & cough x 1 day
– PMH pneumonia one year ago
• Physical exam
– BP 138/85 HR 115 T 98.5
– Pharynx red, TM normal
– Lungs clear
• Symptomatic treatment advised
4
LA, continued
Returns 2/28/12
• CXR (obtained 2/23) was negative
• Symptoms have continued, cough worse
• Physical exam
– BP 147/91 HR 113 T 99.0
– Pharynx red, cervical adenopathy
– Lungs clear, but frequent dry coughing fits,
speaking in full sentences
• Symptomatic measures continued
5
LA, continued
2/29/12
• Goes to ER - cough incessant, uncontrolled by
codeine
• What is the differential diagnosis?
• What else do you need to know?
• What do you need to do?
6
WHAT NOW?
What are the infection control issues?
Which issues are unique to college setting?
Who needs to be involved/informed?
Where do you find the answers?
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Family
FAMILY
PARTNERS
HEALTH
SERVICE
STUDENT
ADMINISTRATION
FRIENDS
STUDENT
AFFAIRS
RES
LIFE
STAFF
FACULTY
Risk
Management
ROOM
MATES
CLASS
MATES
Environmental
Health
FACILITIES
HUMAN
RESOURCES
8
WHAT DO STUDENTS NEED TO KNOW?*
*Also parents, staff, media
• Who is at risk for exposure?
• What should students do if they were
exposed?
• What should students do if they have
symptoms?
9
WHAT DO ADMINISTRATORS NEED TO KNOW?
• Same as students
PLUS
•
•
•
•
•
Extent of outbreak
Measures needed to control outbreak
Need to provide support to affected students
Need for resources
Talking points
10
WHAT DO CLINICAL STAFF NEED TO KNOW?
• Same as students and administrators
PLUS
•
•
•
•
•
On-site infection control measures
Clinical presentation
Diagnostic tests
Management
Reporting
11
CAMPUS INFECTION CONTROL ISSUES
• How do basic infection control principles apply
in a campus environment?
– Populations
– Facilities
– Significant functions
• What resources are needed?
• What resources are available?
12
STUDENT POPULATIONS
Residential students
Commuters
Part-time students
Greek system
Athletes
Health care students
International students
Visiting/exchange students
13
OTHER POPULATIONS
Faculty
Staff
Visitors
Special program participants
Contractors
14
FACILITIES
Student housing
Residence halls
Fraternities and sororities
Off-campus housing
Dining halls
Classrooms
Research laboratories
Libraries
Athletic facilities
Other buildings
15
SIGNIFICANT FUNCTIONS
Students
Faculty
Administration
Classes
Classes
HR/personnel
Research
Research
Finance/payroll
Housing
Advising
Facilities
Dining
Information systems
Activities
Business services
Work
Public safety
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TYPES OF INFECTIOUS DISEASES
Viral
Bacterial
Fungal
Parasitic
Nematodes and helminths
Critters
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TRANSMISSION BASICS
•
•
•
•
•
Airborne
Droplet
Contact
Ingestion
Blood and body fluid
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AIRBORNE TRANSMISSION
• Airborne droplet nuclei
– Small particles <5 μm of evaporated droplet
• Widely dispersed
• Remain suspended in air for long periods
• Indication for N95 respirator
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TB Online
CDC
CDC
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DROPLET TRANSMISSION
• Droplets generated primarily by coughing,
sneezing, talking
• Droplets relatively large
– Propelled short distance (< 3 feet)
– Deposited on conjunctiva, nasal mucosa, mouth
– Do not remain suspended in air
• Indication for surgical masking
21
CDC
CDC
CDC
scarletfeverpictures.com
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CONTACT TRANSMISSION
• Direct contact with infected area
• Fomites
• Most common route of health care-associated
infections
23
Wikipdedia/Robert Morley
CDC/Dr. Thomas Sellers
CDC
MiteBitespictures.com
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INGESTION
Chicago Star Tribune
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BLOOD AND BODY FLUID
CDC
CDC
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CONTROL AND PREVENTION
• Pre-exposure immunization
(for vaccine-preventable diseases)
• Screening
• Hand hygiene
• Food and water safety
• Universal precautions
• Isolation and quarantine
• Post-exposure immunization
• Post-exposure chemoprophylaxis
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RECOGNIZING AND MANAGING OUTBREAKS
•
•
•
•
•
Disease surveillance
Contact identification and tracing
Pre- and post-exposure prophylaxis
Notification
Public health emergencies
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INFECTION CONTROL ISSUES
•
•
•
•
•
Transmission characteristics
Diagnosis
Treatment
Evaluation of the exposed individual
Control measures
• Isolation/exclusion – who, what, how long
• Post-exposure measures
• Environmental measures
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PERTUSSIS
Manifestations
Catarrhal stage
Cough
{Total duration 6 – 10 weeks}
Paroxysmal stage
Transmission
Droplet
Incubation period
Typically 7 – 10 days (range 6 -21 days)
Diagnostic tests
Culture
PCR
DFA
Treatment
Macrolide antibiotic (azithromycin)
Infectivity
From onset of symptoms* to 2 weeks
after onset of paroxysms
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PERTUSSIS, continued
Isolate student until first five days antibiotics
completed or until 21 days after onset of
Control measures
symptoms
Isolate symptomatic contacts
Candidates for
Prophylaxis indicated for household and
post-exposure
other close contacts
measures
Monitor for 21 days after last contact
Post-exposure
measures
Macrolide antibiotic (azithromycin)
Update Tdap when indicated, but not
effective as post-exposure measure
Cleaning and
disinfecting
Routine cleaning only
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MEASLES
Manifestations
Transmission
Fever, followed by cough, coryza,
conjunctivitis and Koplik spots
Erythematous maculopapular rash, starts
on head and spreads downward
Airborne spread, as well as
direct contact with infectious droplets
Incubation period
8 to 12 days
Diagnostic tests
Culture, serology, RT-PCR
Treatment
No specific antiviral therapy
Infectivity
Highly infectious
Contagious from four days before onset of
rash to four days after rash appears
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MEASLES, continued
Isolate for 4 days after onset of rash (airborne
precautions)
Control measures Isolate symptomatic contacts
Consider excluding asymptomatic contacts
who cannot demonstrate immunity
Candidates for
post-exposure
Anyone who cannot demonstrate immunity
measures
Post-exposure
measures
Post-exposure immunization may be effective
if given within 72 hours of exposure
Cleaning and
disinfecting
Routine cleaning only
33
MRSA
Manifestations
Pustule or boil, commonly at site of visible
skin trauma
Transmission
Contact
Diagnostic tests
Culture and sensitivity
Treatment
Incision and drainage
Empiric antibiotics may be warranted
When possible, obtain specimens for C&S
to guide continued antibiotic choice
34
MRSA, continued
Cover infections
Exclude athletes if wounds cannot be
properly covered
Control measures
Hand hygiene
Clean shared equipment
Do not share personal items
Post-exposure
measures
No specific measures
Cleaning and
disinfecting
Usually routine cleaning sufficient
Focus on surfaces that might come in contact
with uncovered infections
Clean shared equipment
Routine laundry procedures
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NOROVIRUS
Manifestations
Diarrhea and vomiting
Symptoms last 1 – 14 days
Transmission
Ingestion
Person-to-person (fecal-oral)
Contaminated food or water
Incubation period
12 to 72 hours
Diagnostic tests
PCR assays not commercially available
Treatment
Symptomatic – antiemetics, rehydration
Infectivity
Most contagious during symptoms and
first 3 days of recovery
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NOROVIRUS, continued
Standard measures for control of diarrhea
Scrupulous hand hygiene
Control measures Exclude infected individuals from food
preparation, health care, child care
Consider isolation for 48 hours
Candidates for
Reinforce hand hygiene to anyone with
post-exposure
potential exposure
measures
Post-exposure
measures
No specific measures available
Cleaning and
disinfecting
Disinfect contaminated surfaces with bleach
solution or other disinfectant
Wash contaminated clothes and linens
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AIRBORNE
DROPLET
CONTACT
INGESTION
BLOOD/FLUID
Measles
Pertussis
MRSA
Norovirus
HIV
Chickenpox
Mumps
Impetigo
Hep A
Hep B
Zoster
Meningococcus Scabies
Campylobacter
Hep C
Tuberculosis
Influenza
Salmonella
SARS
Strep pyogenes C. diff
Shigella
Smallpox
Rubella
Fungi
E. coli
Monkeypox
Adenovirus
Adenovirus
Mycoplasma
Zoster
HSV
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OTHER ISSUES
• Global health concerns
• Global patterns of disease
• Issues for students traveling abroad
• Issues for international students
• Health care students
• Animal-borne diseases
• Faculty and staff
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ENVIRONMENTAL CLEANING
Standards for cleaning
Cleaning in response to disease outbreak
Special circumstances/setting
Protective equipment
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CAMPUS RESOURCES
•
•
•
•
•
•
•
SHS
Dean of students
Environmental Health
Public safety
Facilities
Human Resources
Risk Management
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COMMUNICATIONS
•
•
•
•
•
Communication with administration
Communications to students (and parents)
Communications to faculty
Media releases
Notification to public health officials
42
ACKNOWLEDGEMENTS
Sharon McMullen RN BSN BA
University of Pennsylvania
Esther Chernak, MD, MPH, FACP
Drexel University School of Public Health
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