Thursday, October 27, 2016

CDC: Healthcare Exposure to Zika and Infection Control


A little over a month ago, in MMWR: Investigation Into the `Unique' Utah Zika Case, we looked at the CDC's investigation into the infection of a family member caring for a relative with Zika, without any of the known risk exposures (mosquito vector, sexual contact, blood transfusion).

The elderly family member - who had serious comorbidities - died of organ failure on June 25th, while the caregiver developed symptoms on July 1st.

Of particular note, the MMWR reported that `The index patient’s blood specimen obtained 2 days before his death had a level of viremia approximately 100,000 times higher than the average level reported in persons infected with Zika virus (2).'   

Despite a detailed investigation, exactly how this caregiver contracted the Zika virus remains unclear, causing the CDC to warn: ` . . .  family contacts should be aware that blood and body fluids of severely ill patients might be infectious.'

Hyperbolic tabloid headlines aside, the evidence suggests this to be a very rare occurrence with Zika.

Nevertheless, this scenario is assumed a possibility by all healthcare workers who adhere to the `Standard Precautions' principle, but is less often considered by family members or lay people.

The CDC defines `Standard Precautions' as:
Standard Precautions represent the minimum infection prevention measures that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. These evidence-based practices are designed to both protect healthcare personnel and prevent the spread of infections among patients.
Standard Precautions replaces earlier guidance relating to Universal Precautions and Body Substance Isolation. Standard Precautions include:  1) hand hygiene, 2) use of personal protective equipment (e.g., gloves, gowns, facemasks), depending on the anticipated exposure, 3) respiratory hygiene and cough etiquette, 4) safe injection practices, and 5) safe handling of potentially contaminated equipment or surfaces in the patient environment.
The CDC has published an updated Healthcare Exposure To Zika and Infection Control document, which addresses both HCW, and lay caregivers and visitors, who may be exposed to a Zika patient.

The document has 8 main sections:

The gist being:

Preventing Exposure in Healthcare Settings
Standard Precautions should be used to protect healthcare personnel from all infectious disease transmission, including Zika virus. Standard Precautions are based on the fact that all blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes might contain transmissible infectious agents. Body fluids, including blood, vaginal secretions, and semen, have been implicated in transmission of Zika virus. Current information about Zika virus transmission and risks can be found on CDC’s Zika Transmission webpage.

HCWs will want to read the full document for specific scenarios, room disinfection procedures, and testing recommendations.  For the general public, the CDC has the following advice:

Advising Caretakers and Visitors of People with Zika

As with any other infectious illness, family members and other caregivers should take the following precautions

  • Do not touch blood or body fluids and surfaces contaminated with these fluids with exposed skin.
  • Wash hands with soap and water immediately after providing care to the patient. If hands are not visibly dirty, an alcohol-based hand rub can be used instead of soap and water.
  • Immediately remove and wash clothes if they get blood or body fluids on them. Use laundry detergent and the water temperature specified in the garment care instructions to wash clothes soiled with blood or body fluids. Using bleach is not necessary.
  • Immediately clean and disinfect surfaces that have blood or other body fluids on them, minimizing direct contact, using household detergent/disinfectant according to manufacturer’s instructions. The sick person’s immediate environment should be cleaned daily using household cleaners according to manufacturer’s instructions.
Pregnant women should follow the same precautions as other family members caring for a person with Zika, including avoiding activities that would expose them to blood or other potentially infectious body fluids.

When visiting a patient in a hospital setting, visitors should not engage in activities that could possibly expose them to blood or body fluids from a hospitalized patient. Helping a patient with sitting up in bed or walking should not expose someone to blood or body fluids; however, family members and caregivers should pay attention to hygiene, not touch blood or body fluids or surfaces soiled with them, and wash hands before and after touching the patient.

Common sense precautions that should apply whenever you are providing care to another person, regardless of whether they have a Zika infection, Influenza, or the common cold. 

And a pretty good reason to keep a modest supply of exam gloves, surgical masks, and hand sanitizer in your home (and auto) first aid kit (see #NatlPrep : One For The Home, And One More For The Road).


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