Okay, No One Panic; Working up a Case of Possible Hospital Acquired V. Cholerae

Abstract

<h3>Background</h3> Disease caused by Vibrio cholera (Cholera) is rare in the United States, due to the sanitation standards. On July 4th, 2019, a long-term patient with new onset diarrhea tested positive for Cholera and Clostridioides difficile via Polymerase Chain Reaction (PCR). Since this patient was admitted for over three months and receiving nutrition via G-tube, Infection Prevention (IP) assumed this was hospital acquired Cholera. <h3>Methods</h3> IP and Infectious Disease (ID) reviewed the electronic medical record, identified a group of subject matter experts, and sent requests for information. Facilities identified recent water testing. Nutrition Services reviewed food sources and the formula room. Pharmacy pinpointed medications the patient received via G-tube and checked for reports of contamination. ID examined the patient and discussed risk factors with the family. Laboratory leadership worked to confirm the PCR test. <h3>Results</h3> Results of individual investigations concluded in less than twenty-four hours and yielded no potential reservoirs. This positive result added five additional IP staff hours and approximately one hour to each of the departments (excluding the laboratory) consulted for their expertise, totaling nine additional holiday person-hours. Confirmatory testing by four different methods, including the state laboratory and repeat PCR, yielded negative results. There were no additional costs for state testing, but the additional in-house culture for PCR confirmation cost $288. Additional monetary costs included an ID consult for the patient. It took an additional four days to confirm the false positive. The source of the positive PCR remains unclear. <h3>Conclusions</h3> Laboratory results are often accurate, specifically with PCR. When there is a false positive, especially with a rare organism such as Cholera, hospitals may incur increased costs related to person-hours, additional testing, and patient needs. Additionally, Infection Prevention should work to foster interdepartmental relationships, as time-sensitive mobilization is more attainable in times of need when those relationships already exist.