January 6, 2015

1715Flu640

This year’s flu season is in full force with about half of the country, including Texas, experiencing high levels of influenza activity. According to the Centers for Disease Control and Prevention, the flu has claimed the lives of 21 children and hospitalized almost 4,000 people in the United States.

Dr. Carol Baker, a pediatric infectious disease specialist and executive director of the Center for Vaccine Awareness and Research at Texas Children’s Hospital, says it’s not too late to get vaccinated against the potentially deadly infection and penned a column that ran in the Dec. 29 edition of the Houston Chronicle urging people to do so.

Read her column below, and if you haven’t already, get your annual flu vaccine. Employee Health is administering free seasonal influenza vaccinations to all Texas Children’s employees, Baylor College of Medicine employees working in Texas Children’s facilities, Texas Children’s medical staff and volunteers. Call the Employee Health Clinic at Ext: 4-2150 today to make an appointment to get your flu vaccine.

Recently, the news has been dominated by the dangers and deaths from Ebola virus, with thousands of Americans being deployed to West Africa to fight Ebola. Yet we need to also be concerned about another epidemic, one that hits us every year: influenza virus or the flu, which killed more Americans last year than the current total deaths from Ebola in Liberia. While the severity of the flu epidemic is unpredictable, it always hospitalizes thousands of Americans and last year killed 107 children, almost half of whom were previously healthy; so far this year, five children have died. This month ushered in this year’s epidemic in Texas. We also learned from the U.S. Centers for Disease Control and Prevention that the most frequent strain of the four influenza viruses, H3N2, is dominant so far. H3N2 flu is linked to severe influenza seasons, with high rates of hospitalization and death. Also, a little more than half of the patients with H3N2 flu disease so far have virus that has mutated slightly, making this part of the vaccine less effective.

You may think this change in one of the four flu viruses is a reason not to get vaccinated. This is simply not the case. The influenza vaccine remains the best way to protect yourself and your family from the flu, and it is better than other important strategies, like hand and cough hygiene and staying away from people with flu symptoms. Even with the mutated H3N2 flu circulating, this year’s flu vaccine protects against other strains causing flu. While this year’s vaccine could be somewhat less effective, opting for no vaccination assures no protection.

Getting the flu vaccine is especially important to protect the most vulnerable: pregnant women, children under two years of age, the elderly and those people with diseases or receiving medications that impair the immune system (e.g., cancer). Last year, only 52 percent of pregnant women and 70 percent of children under two were vaccinated. Pregnant women are five times more likely to have a complication from influenza that results in hospitalization than nonpregnant women of the same age. Vaccination not only protects the woman, but the antibodies created by the mother in response to flu vaccine pass through the umbilical cord and breast milk to the baby, protecting the baby before age 6 months when the flu vaccine can be given. Also, flu-vaccinated pregnant women have fewer premature and low-birth weight babies, and millions of flu vaccine doses given in the past have proven how safe this vaccine is for mother and baby.

While you may think that flu is no worse than other respiratory viruses common this time of year, flu is distinct. It causes high fever, severe muscle aches, fatigue, sore throat and in children sometimes vomiting and diarrhea, symptoms that last a week or more. Getting the vaccine not only protects, but if you do get the flu, the symptoms are less severe and don’t last as long.

Every year, my colleagues and I care for far too many vulnerable infants and children who suffer needlessly from an infection that can be prevented. It’s not too late to be immunized: The flu epidemic typically peaks in February and continues into the spring. Vaccine is still available; if your physician has no more supply, go to a pharmacy or the health department. It takes 14 days to be protected after vaccination, so readers who haven’t already done so should take this opportunity to seek the flu vaccine as soon as possible.

We still anticipate seeing an increase in cases at our hospitals, so there is still time to protect yourself and your loved ones. Flu vaccine is truly the best personal protective equipment you can wear during flu season.

November 18, 2014

111914antibioticresistence640

Each year more than two million people in the United States get infections that are resistant to antibiotics and at least 23,000 people die as a result.

Dr. Debra Palazzi, a pediatric infectious diseases specialist and medical director of Texas Children’s Hospital’s Antimicrobial Stewardship Program, said the hospital has a good history of keeping antibiotic resistance at bay, but that the organization isn’t immune to the worldwide problem and has seen an increase in such cases during the past few years.

“We now see children with complicated diseases for whom we have limited or no effective antimicrobial therapy,” Palazzi said. “This is a growing problem in our pediatric population and results in increased morbidity and mortality.”

To help raise awareness of antibiotic resistance and the importance of appropriate antibiotic prescribing and use, Texas Children’s Hospital is joining more than 20 children’s hospitals across the country this week to promote the Center for Disease Control and Prevention’s Get Smart About Antibiotics Week. The goals of the annual event are to raise awareness of antibiotic resistance and to educate health care providers and the public about the appropriate and safe use of antimicrobial therapy.

Palazzi and Ruston Taylor, the clinical pharmacy specialist for the Antimicrobial Stewardship Program, have been working hard to achieve both of those goals and formed earlier this year a multidisciplinary Antimicrobial Stewardship Program aimed at optimizing the selection, dose, duration and route of therapy given to patients at Texas Children’s Hospital. Since then, a member of the program’s team has reviewed microbiology reports daily to assist healthcare providers in prescribing the appropriate antimicrobial therapy.

In some cases, the stewardship team – which is composed of people from multiple departments including Pharmacy, Infection Control, Infectious Diseases, Microbiology, and Quality and Safety – makes a recommendation to improve a patient’s antimicrobial treatment plan. The recommendation might be to de-escalate therapy, use an alternative therapy or stop therapy altogether.

“When most people think of antimicrobial stewardship, they say ‘antibiotic police’,” Taylor said. “We’ve actually called providers to START a drug that’s active against a reported bacterial pathogen rather than calling for discontinuation of agents.”

Another tool the team uses to help optimize a patient’s treatment plan is a rapid diagnostic test that can identify the presence of certain antibiotic-resistant strains of bacteria in a few hours instead of days. Before the availability of the test, physicians had to wait on culture-dependent methods for identification, which could take two to three days. Now, results can be determined in about an hour, allowing physicians to prescribe more appropriate treatment sooner rather than later.

Another intervention developed by the Antimicrobial Stewardship Program team started in the Pediatric Intensive Care Unit (PICU) and has quickly spread to other parts of the hospital. This summer, members of the stewardship team began rounding with all PICU teams to introduce a care bundle for antimicrobial prescribing to their daily provider progress notes. The bundle addresses the infectious disease the team is trying to treat, the antimicrobial agents the patient is on, microbiology data obtained, and the plan for antimicrobial therapy.

“The appropriate use of antimicrobials is something that affects all of us,” Taylor said. “The choices we make today may have consequences for generations to come.”

For more information on Get Smart About Antibiotics Week and how you can help, visit http://www.cdc.gov/getsmart/week/.

November 11, 2014

111214ebolalab640

Texas Children’s Hospital is working hard to prepare its staff and its facilities for a patient with Ebola or a similar infectious disease.

Isolation units have been designated. PPE has been purchased. Staff is being trained on how to use it. And, leaders are meeting regularly to assess the organization’s preparedness as it relates to the most current information available.

Another initiative in the works will give the hospital the capability to test for the Ebola virus onsite instead of depending solely on lab results from state and federal government laboratories.

Dr. James Versalovic, who heads up the hospital’s pathology department, said he is in the process of purchasing equipment that will allow his staff to test for Ebola and similar infectious diseases at the main campus. Being able to test for such conditions at Texas Children’s Hospital will enable medical staff to quickly determine and provide appropriate care.

Currently, lab samples from suspected Ebola patients are sent to the Texas Public Health Department in Austin and the Centers for Disease Control and Prevention in Georgia. Results are typically released within 72 hours. In the meantime, the patient is isolated and his or her symptoms are treated.

Versalovic said even with onsite diagnostic capabilities, lab samples from suspected Ebola patients still would be sent to the state and the CDC for confirmatory testing. Treatment, however, could be started sooner with the initial result in hand in hours compared with days. And, by ruling out Ebola more quickly in suspected patients, the correct diagnosis can be made more rapidly.

All onsite testing will be done at the main campus by a specialized team in a negative-pressure bio-containment laboratory. A similar unit is being planned for the west campus.

The goal is to have both labs ready and equipped to test for Ebola and other such diseases next year. The upgrades and additions will provide Texas Children’s with the best tools to diagnose and treat patients with infectious diseases, Versalovic said. The tools also will position the organization’s staff for effective patient care, optimal protection and safety.

 

Return to Ebola Response site.

 

October 21, 2014

102214EbolaScreeningSignage640

Bright red signs asking patients if they have traveled to West Africa in the past 21 days were posted around Texas Children’s Hospital more than a month ago when the Ebola outbreak overseas continued to escalate.

A few weeks later, Thomas Duncan was diagnosed with Ebola at a Dallas hospital and later died. Duncan contracted the virus in Libera, one of three West African countries where Ebola has spread rapidly and killed thousands. Two of the nurses who cared for Duncan caught the infection and are being treated at hospitals in Georgia and Maryland.

No one has been diagnosed with Ebola in Houston, but Texas Children’s has been preparing for months in the event we receive such a patient. One of the first steps in that process is screening.

Staff in the Emergency Centers at both Main and West campuses and entry areas in the Pavilion for Woman are actively screening all patients for possible Ebola exposure.

Anyone who has traveled to Liberia, Sierra Leone, and Guinea in West Africa within the past 21 days is considered at risk and is immediately isolated. After isolation procedures are initiated, additional screening occurs and Infection Control is notified. The patient must be cleared by Infection Control to be removed from isolation.

Any patient with suspected Ebola will immediately be isolated in a pre-designated room, Infection Control will be notified, and additional screening will occur. Once deemed appropriate, the patient will be transported to a pre-designated room where they will remain until their treatment is completed.

At the West Campus, the patient will be transported to the Pediatric Intensive Care Unit and cared for by the nurses and physicians there. At the Main Campus, the patient will be transported to the pediatric care unit and cared for by nurses and physicians from the PICU. Since patients will only be placed and cared for in these units, other units do not need to designate isolated space for Ebola patients or receive extensive training.

All patients transported to Texas Children’s by the Houston Fire Department paramedics are screened prior to arrival in the Emergency Center.

Our clinics in the Critical Care Center and at the West Campus, pediatric and OB/GYN practices, urgent care centers and other community centers are being educated and informed on proper screening protocols and isolation methods should a suspected case of Ebola present at one of their locations. However, the care of that patient would not take place within these facilities.

As for visitors to our hospital, we are not actively screening them for travels to the affected regions in Africa, but they all are screened on a routine basis for signs and symptoms of any infectious disease. This screening occurs before visitors are allowed entry into the inpatient units. The screening includes questions about symptoms such as fever, cough, runny nose, and vomiting.

Remember, Ebola is only contagious when a patient is showing symptoms. Because symptoms associated with the virus are severe, it is highly unlikely that someone with Ebola would be visiting another patient in the hospital.

Because this is a rapidly evolving situation, all screening practices are routinely reviewed and will change if necessary.

For more information about the organization’s Ebola preparations please click on the “Ebola Response” logo on the Connect intranet site and on the parallel external Connect news site at texaschildrensnews.org, which is accessible from any computer or mobile device at any time.

If you have questions about our plan or about Ebola, please email them to connectnews@texaschildrens.org. The communications team will route questions to Dr. Kline and the leaders of our response and readiness team to get answers and provide updated information to our organization.

October 15, 2014

101514ebola640

This week, two health care workers at Texas Health Presbyterian Hospital in Dallas have tested positive for Ebola.

The Centers for Disease Control and Prevention (CDC) confirmed the first positive test on Sunday. The second positive test was confirmed by the state public health laboratory in Austin very early this morning. A confirmatory test will be conducted by the CDC today. Both health care workers helped care for Thomas Eric Duncan, the first person diagnosed with Ebola in the United States.

“This development is concerning to many, but it does not change what we are doing and have been doing at our own hospital,” said Texas Children’s President and CEO Mark A. Wallace. “We want to keep our patients and their families safe, but we’re also intensely focused on keeping our physicians, staff and employees as safe as possible as well. We remain very confident in our preparedness plan.”

To date, there are no confirmed cases of Ebola in Houston. And more specifically, there have been no confirmed cases of Ebola at Texas Children’s Hospital. Nonetheless, Texas Children’s is preparing thoroughly in the event that we do receive a patient with suspected Ebola symptoms.

Initial contact and protective equipment

The most hazardous times for a health care worker are the initial patient encounter at the Emergency Center or other entry point before the diagnosis is known, and during the removal of protective equipment used when caring for a known case.

“Our simulation training has emphasized proper protocol specifically at these time points,” said Texas Children’s Physician-in-Chief Dr. Mark Kline. “We know that the CDC protocols are effective when 100 percent of the protocols are followed 100 percent of the time.

“A single lapse in following proper procedure can lead to contamination and infection. When protocols are followed properly, every single time, the virus can be contained. That’s why we will continue to run simulations and ensure personnel in areas most likely to come into contact with an Ebola patient are properly trained to implement our protocols at all times.”

Training for targeted health care workers

Kline emphasized that training is both thorough and targeted. Staff who work in areas most likely to come into contact with a suspected Ebola patient are receiving the appropriate training to screen and/or care for these patients, according to staff specific roles. However, most staff and employees will never come in contact with an Ebola patient that may be treated here, so it is not necessary to train all clinical personnel.

And while there is deliberate preparation underway to ready the organization for a possible Ebola patient, leaders emphasize that staff and employees must remain focused on caring for all of our patients.

“Yes, it’s important to be prepared for the suspected Ebola patient who might walk into the hospital, but today, there are many other patients here who don’t have Ebola, and they need our focused care and attention,” said Executive Vice President John Nickens. “We continue to see thousands of patients every day across our system, and they need us to remain calm and focused on our mission of providing them with the best possible care.”

Leaders in Nursing, Critical Care, Emergency Medicine, Infection Control and other areas meet daily, constantly assessing the most current information available from the CDC and the World Health Organization to refine our plan appropriately. They echo Nickens’ emphasis on remaining calm and purposeful.

“There is a lot of hysteria out there right now,” Kline said. “But our staff and employees are educated. They understand science. We are health care providers, and as such, it’s our responsibility to spread facts, not hysteria. We have an opportunity here to be educated ambassadors and share correct, purposeful information.”

Where to find more information

Texas Children’s Ebola response and readiness information is updated regularly on Connect, so check back often for the latest information. Click below for previous articles

Oct. 4. – Suspected Ebola case tested at West Campus, result negative
Oct. 2. – Texas Children’s confident, prepared in face of Dallas Ebola concern
Sept. 17 – Texas Children’s prepared but not anticipating Ebola virus

Also, current, accurate information can be found online on the websites for the Centers for Disease Control and Prevention (www.cdc.gov) and the World Health Organization (www.who.int).

October 7, 2014

10814WCebola640

A suspected Ebola case that presented at Texas Children’s Hospital West Campus last Thursday tested the organization’s preparedness plan. The good news is our staff at West Campus handled the case confidently and proficiently. The better news is that the patient tested negative for Ebola.

“At this time, there are no confirmed cases of Ebola at Texas Children’s Hospital,” said Texas Children’s Physician-in-Chief Dr. Mark W. Kline. “We are currently monitoring a case at West Campus, but the patient’s initial blood test for the Ebola virus has been reported as negative by the Texas public health laboratory.”

Standard protocol requires the Centers for Disease Control and Prevention (CDC) to conduct a confirmatory parallel test. Final test results were received from the CDC on Saturday and have been reported as negative. The patient also was tested for malaria, and that test was positive. The patient currently is being treated for malaria.

The patient arrived at the West Campus Emergency Center on Thursday afternoon. Diligent screening of the patient allowed for immediate isolation as outlined in our protocol for handling suspected cases of Ebola. The organization recently elevated screening activities at all Texas Children’s facilities based on these protocols. For the past two months, we have been implementing a detailed plan to identify, isolate and treat suspected cases of Ebola if necessary.

“As you know, our physicians and staff are among the best in the world,” Kline said. “We are thoroughly prepared to safely and confidently treat any patient who exhibits symptoms of potentially contagious diseases.”

You can review specific information about Texas Children’s preparedness plan on Connect.

Be mindful of the media

There is a lot of information with varying levels of accuracy in the media about Ebola. We encourage all staff and employees to be smart about how you communicate about this information.

Remember your role and responsibility to uphold the privacy of Texas Children’s patients.

Be mindful of any comments you share on social media. Always be respectful of organizational confidentiality.

All media requests and/or social media concerns should be directed to Public Relations Director Christy Brunton at 281-684-3184. If you are contacted by any media, please redirect them to Christy.

The best way to handle any concerns you may have is to educate yourself. The most accurate and current information about Ebola is on the Centers for Disease Control and Prevention website: www.cdc.gov

October 2, 2014

On Tuesday, the Centers for Disease Control and Prevention (CDC) confirmed the Ebola diagnosed in the United States.

“An adult patient who traveled recently from Liberia to Dallas became ill and was admitted to a hospital there,” said Texas Children’s Hospital Physician-in-Chief Dr. Mark Kline.

“Having this case in Dallas, only 270 miles away, might engender fear, especially among health care workers who come in contact with patients who might have a suspected case of Ebola, but the factors that led to this epidemic in West Africa are not present here in Texas or the United States.”

Kline emphasized the U.S. will never suffer the kind of Ebola epidemic that Africa is experiencing today because of the hygienic conditions here and, in particular, because of the infection control practices in U.S. hospitals. Texas Children’s leaders remain confident about our preparedness plans should we receive a patient with Ebola at one of our sites.

“We’ve concentrated our efforts on the main portals of entry to the hospital and the system – for example, the Emergency Center and our primary care practices across the community,” Kline said. “We’ve gone from passively screening with posted signage to active screening. Every child and family is being asked specifically ‘Have you traveled in the past 21 days? If so, has any of that travel been to West Africa and, specifically, to the countries that have been impacted by Ebola?’ ”

If the answer to those questions is “yes,” Texas Children’s has a plan in every setting for moving the child and the family to an isolated area for further evaluation.

How Texas Children’s has prepared

Texas Children’s leaders in Infection Control, the Emergency Centers, Critical Care, Emergency Management, Texas Children’s Pediatrics and other areas monitor daily Ebola updates and recommendations from the CDC and the World Health Organization. They regularly assess Texas Children’s preparedness as it relates to the most current information, and there is a plan in place in the unlikely event we receive a patient with the disease.

Preparation has included:

  • Simulation exercises and thorough education in areas that may be a point of entry for a patient with Ebola symptoms.
  • Development of specific protocol outlining the steps we will take should we receive a patient with Ebola symptoms, including designated isolation rooms in the Emergency Centers and the PICUs.
  • Securing an inventory of appropriate personal protective equipment (PPE), including full-coverage protective suits, which have been deployed to Texas Children’s Main and West campuses, Pavilion for Women and transport services (Kangaroo Crew).

“We’re doing everything we can to make certain that if we see a case of Ebola we will not have secondary cases among health care workers or among the other patients and families we serve,” Kline said.

“I’m very, very confident that with all of the policies and procedures and infection control precautions we have in place we will maintain our ability to care for patients and families and to care for one another as well.”

Important facts to remember about Ebola

Most of the population in West Africa doesn’t have Ebola.
As of September 30, there had been about 6,500 cases of Ebola diagnosed in Guinea, Liberia, Senegal and Sierra Leone. However, more than 20 million people live in these countries. This means fewer than 1 percent (.03 percent) have the virus – 99.97 percent of the residents in these countries do not have Ebola.

Diagnosis occurred in Dallas, but the disease source is still in Liberia.
Tuesday’s news revolves around the first case of Ebola that was diagnosed in the U.S. However, the source of transmission originated in Liberia – not here. Nothing has changed about the epidemiology of this virus in the U.S.

Ebola is not a highly infectious disease.
Ebola is a bloodborne pathogen – it is not transmitted like the flu or other airborne viruses. It is spread only when symptoms are present.

The CDC is the best source of information, not the media.
The best way to allay any concerns is to educate yourself. The most current information about Ebola is available online from the Centers for Disease Control and Prevention.