Readmissions to Ebola Centres/ False negatives.

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   http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20924

Eurosurveillance, Volume 19, Issue 40, 09 October 2014

DESCRIBING READMISSIONS TO AN EBOLA CASE MANAGEMENT CENTRE (CMC), SIERRA LEONE, 2014.      G Fitzpatrick et al.

Quick breakdown of an article I thought interesting. 

This was a study done at one of the  Ebola clinics in Sierra Leone ( KCMC).  It demonstrated that 7% of patients who were originally assessed and discharged as non ebola-cases were later readmitted as EVD PCR positive cases. Notably all readmissions occurred within 21 days of the initial discharge. 

This readmission’s timeframe raised 2 possibilities.

1) Had nosocomial infection occurred during the primary admission assessment
  ie had the patient been infected at the clinic during their initial assessment.

Or

2) False negative result by PCR test.

        Looking at the first option, i.e. hospial infection.

The study ruled out this and details the infection control undertaken in this clinic segregating confirmed and suspected cases.  This includes the following

Quote : The patients were admitted to either the suspect or the probable ward of the CMC. Infection control measures are strictly enforced in assessment areas. Patients in the suspect/probable wards are encouraged to maintain a minimum distance from other patients at all times and not to touch or use items belonging to other patients. The number of cases per ward is capped to prevent overcrowding. Chlorine solution hand washing facilities are located at multiple points for patient and staff use. Patients can only be transferred from suspect/probable into confirmed wards and not vice versa to prevent spread of infection within the CMC. Hygienist staff regularly disinfects all areas within both the low and high risk zones. The implementation of strict infection control protocol in the suspect/probable wards.

The second option was false negative testings.

The study supports this.  Quote: The interval between discharge from primary admission and follow-up readmission to the KCMC  was an average of 9.4 days with a range from four to 21 days  Cases had a documented epidemiological contact with a suspected or confirmed case of Ebola (excluding their primary admission to the KCMC) within the prior 21 days to their readmission to the KCMC   

15 patients history is then given.  Quote : The majority (10/15) of these epidemiological contact types were household followed by occupational (3/15) and funeral (2/15)

The study concludes new guidelines should be implemented.

Quote :
A proportion of newly admitted patients will require a repeat EVD PCR test if symptom duration has been less than 72 hours to rule out a false negative result . In such cases the symptomatic patient will have to spend additional time in the suspect or probable ward until cleared.

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Hazelpad Members Profile Send Private Message Find Members Posts Add to Buddy List Adviser Group Joined: September 09 2014 Status: Offline Points: 6910	Post Options Post Reply Quote Hazelpad Report Post Thanks(0) Quote Reply Topic: Readmissions to Ebola Centres/ False negatives. Posted: October 20 2014 at 4:11am
	http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20924 Eurosurveillance, Volume 19, Issue 40, 09 October 2014 DESCRIBING READMISSIONS TO AN EBOLA CASE MANAGEMENT CENTRE (CMC), SIERRA LEONE, 2014. G Fitzpatrick et al. Quick breakdown of an article I thought interesting. This was a study done at one of the Ebola clinics in Sierra Leone ( KCMC). It demonstrated that 7% of patients who were originally assessed and discharged as non ebola-cases were later readmitted as EVD PCR positive cases. Notably all readmissions occurred within 21 days of the initial discharge. This readmission’s timeframe raised 2 possibilities. 1) Had nosocomial infection occurred during the primary admission assessment ie had the patient been infected at the clinic during their initial assessment. Or 2) False negative result by PCR test. Looking at the first option, i.e. hospial infection. The study ruled out this and details the infection control undertaken in this clinic segregating confirmed and suspected cases. This includes the following Quote : The patients were admitted to either the suspect or the probable ward of the CMC. Infection control measures are strictly enforced in assessment areas. Patients in the suspect/probable wards are encouraged to maintain a minimum distance from other patients at all times and not to touch or use items belonging to other patients. The number of cases per ward is capped to prevent overcrowding. Chlorine solution hand washing facilities are located at multiple points for patient and staff use. Patients can only be transferred from suspect/probable into confirmed wards and not vice versa to prevent spread of infection within the CMC. Hygienist staff regularly disinfects all areas within both the low and high risk zones. The implementation of strict infection control protocol in the suspect/probable wards. The second option was false negative testings. The study supports this. Quote: The interval between discharge from primary admission and follow-up readmission to the KCMC was an average of 9.4 days with a range from four to 21 days Cases had a documented epidemiological contact with a suspected or confirmed case of Ebola (excluding their primary admission to the KCMC) within the prior 21 days to their readmission to the KCMC 15 patients history is then given. Quote : The majority (10/15) of these epidemiological contact types were household followed by occupational (3/15) and funeral (2/15) The study concludes new guidelines should be implemented. Quote : A proportion of newly admitted patients will require a repeat EVD PCR test if symptom duration has been less than 72 hours to rule out a false negative result . In such cases the symptomatic patient will have to spend additional time in the suspect or probable ward until cleared.