“Real Time” Syndromic Surveillance for ED Patients with Community Respiratory Virus (CRV) at a University Medical Center

Abstract

ISSUE: During CRV season, pts requiring hospital care can impact our bed capacity and our ability to provide services to all pts. PROJECT: <b>1. Syndromic surveillance:</b> ICP reviewed ED logs daily, recording total number of ED pts seen and number of pts with CRV symptoms. <b>2. Recommended Rapid Testing:</b> for RSV, Influenza (A and B), and viral culture for pts being admitted with CRV symptoms. <b>3. Respiratory Hygiene/Empiric Precautions:</b> At ED entrance Volunteer observes patients/visitors for Flu Like Illnesses (FLI) asks them to put on a mask. ED Staff discharge pts not requiring admission asap. Pts for admission with a positive rapid test, admit to private room or in with another confirmed case of like illness. Pts with CRV symptoms and a negative rapid test remain on precautions/private room until CRV is excluded by culture. <b>4. Special High Census Provision:</b> is activated if 5 or more ED pts are waiting for admission. <b>5. Dissemination of Information:</b> Weekly graphs on IC Web Site. RESULTS: From Dec04 - Mar 05, there were 39,947 ED pt visits, average 333 and range [180 to 399] per day, of those 7,463 pts had FLI. average was 62 range was [31 to 135]. ED pt volume increased several times but didn't necessitate special high census provisions. Specimens for direct influenza testing (QFLU) and respiratory virus cultures (RVC) were submitted for 158 pts from 12/1/04 to 3/1/05. 146 RVC were done. 161 QFLU were done. Influenza A was diagnosed in 39 pts, 12 by QFLU and 27 by RVC after negative QFLU. Influenza B was diagnosed in 4 pts, one by QFLU and 3 by RVC after negative QFLU. RSV was diagnosed in 9 pts by RSV direct assay followed by positive culture. RSV was diagnosed in 15 pts by culture. Sensitivity of QFLU was disappointing, only 13 of 43 pts with influenza were detected by the direct test (30% sensitivity). The sensitivity of the RSV direct assay was better 9 of 15 pts with positive culture for RSV were positive by the RSV direct assay. There were no nosocomial cases resulting from pts admitted directly from the ED, but 4 immunosuppressed inpatients developed nosocomial Influenza and 1 nosocomial RSV. LESSONS LEARNED: Real time CRV data helped manage pt flow during periods of high census. Rapid assays had variable sensitivity and specificity, limiting their utility in bed management. Daily screening for FLI and work restriction of sick employees/visitors is needed to prevent nosocomial CRV transmission to immunosuppressed inpatients.