Complete ONE of the following discussions:
Read the following case scenario, then answer the questions.
Helpful link: CDC: Giardia
A luxury around-the-world cruise ship is full to capacity, carrying 1200 passengers (average age 66) and 500 crew. It set sail from Southampton three weeks earlier and docked in Spain, the Azores, the Caribbean Islands, and Mexico, before sailing through the Panama Canal and on to California. Passengers explored onshore at all destinations, where most dined at local restaurants and cafés. Water for drinking, personal hygiene, and making ice, as well as for a freshwater swimming pool and four spa pools, is produced on board via reverse osmosis (RO) from seawater taken on only while the ship is sailing in open water or is supplied from water of drinking standard taken on board (bunkered) in port. There is also a seawater pool that is filled daily from the open ocean. Food is a mixture of frozen and refrigerated items from the port of embarkation with some additional fresh food brought on board along the way, sourced from reputable, international suppliers subject to rigorous quality checks. Three passengers consult the ship’s doctor with symptoms of diarrhea and abdominal discomfort just before the ship docks in San Francisco.
INVESTIGATION OF THE INCIDENT
The ship’s doctor collected stool samples that are sent to a private laboratory in San Francisco. Two days later, just as the ship sets sail again for Hawaii, you receive a call on your satellite phone saying that two of the three samples have tested positive for Giardia. That day, four more people visit your office complaining of similar symptoms.
Chand, M. (2017). Case studies in infection control. Taylor & Francis Group
Using an epidemiologic approach, analyze the infection outbreak applying the step by step approach for an outbreak investigation. What infection prevention and control measures/procedures do you think could have been used to prevent the outbreak?
Or
Read the following case scenario, then answer the questions.
Helpful link: CDC: Campylobacter jejuni
A patient presented to the Emergency Room with profuse bloody diarrhea. The diarrhea occurred more than 10 times a day and had started suddenly, although the patient admitted he had been “under the weather” for a few days. An initial diagnosis of inflammatory bowel disease was made, and he was admitted to an open unit. Initial laboratory investigations included standard hematology and biochemistry and a specimen of diarrhea was sent to the microbiology laboratory for culture of fecal gastrointestinal bacterial pathogens and detection of relevant viruses by polymerase chain reaction (PCR).
Three days later the unit received a report from the laboratory that Campylobacter jejuni had been isolated from the feces. The patient was then isolated and because of the severity of the attack was started on treatment with erythromycin. Two days later two additional patients on the unit developed severe diarrhea, and they also were isolated, and specimens sent to the laboratory. There was no evidence of direct contact between the initial case and the new cases in that unit.
The following day a patient in a separate unit developed diarrhea and subsequently a patient in a third ward also developed diarrhea. In all cases, C. jejuni was isolated from the feces. All cases excluding the initial case had been admitted to the unit more than 10 days prior to the onset of disease.
All cases excluding the initial case had been admitted to the unit for ≥10 days.
INVESTIGATION OF THE CASE
When other patients on the same unit developed diarrhea, the hospital held an outbreak meeting attended by (you) the infection-control nurse, the hospital epidemiologist, the clinical microbiologist, the consultant in charge of the patient, the nurse manager, and a member of the administrative staff.
Adapted from Chand, M. (2017). Case studies in infection control. Taylor & Francis Group
Using an epidemiologic approach analyze the infection outbreak applying the step by step approach for an outbreak investigation. What infection prevention and control measures/procedures do you think could have been used to prevent the outbreak?
