CDC updates guidance on interpretation of Zika testing results for pregnant women

CDC updates guidance on interpretation of Zika testing results for pregnant women The Centers for Disease Control and Prevention (CDC) has updated guidance for healthcare professionals to interpret Zika test results for women who live in, or frequently travel (daily or weekly) to areas with a CDC Zika travel notice. Emerging data suggests that Zika virus IgM can persist beyond 12 weeks after infection in some individuals making it difficult to determine the timing of infection, especially in testing of asymptomatic people. It may not be easy to determine whether women were infected before or after they became pregnant. Hence, the CDC has recommended the following guidance for healthcare professionals evaluating women without symptoms who had potential Zika exposure—particularly women who live in or frequently travel (daily or weekly) to areas with CDC Zika travel notices. • Screen pregnant women for risk of Zika exposure and symptoms of Zika. Test pregnant women promptly, using nucleic acid testing (NAT), if they develop symptoms at any point during pregnancy or if their sexual partner tests positive for Zika virus infection • Consider NAT testing at least once during each trimester of pregnancy to detect evidence of Zika virus, unless a previous test has been positive • Consider testing specimens obtained during amniocentesis to detect evidence of Zika virus if amniocentesis is performed for other reasons • Counsel all pregnant women each trimester about the limitations of Zika testing (Source: CDC Press Release, May 5, 2017) Dr KK Aggarwal National President IMA & HCFI

Updated CDC guidelines to prevent surgical site infections

Updated CDC guidelines to prevent surgical site infections Surgical site infections (SSIs) are preventable healthcare-associated infections, also called nosocomial infections. They rank among the top five healthcare-associated infections, besides ventilator-associated pneumonia, central line–associated bloodstream infections, Clostridium difficile infections and catheter–associated urinary tract infections. SSIs not only increase costs of health care, but also the associated morbidity and mortality for the patient. Preventing SSIs is therefore important. For the first time since 1999, the Centers for Disease Control and Prevention (CDC) has issued updated evidence-based recommendations for preventing surgical site infections (SSIs),. These recommendations are published online May 3, 2017 in JAMA Surgery. Some key new and updated recommendations include: • Patients should be advised to shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before the day of the surgery. • Antimicrobial prophylaxis should be administered only when indicated. The timing of the antimicrobial should ensure a bactericidal concentration in the serum and tissues at the time of the incision. • Administer antimicrobial prophylaxis in cesarean section just before skin incision. • Use an alcohol-based agent for skin preparation in the operating room, unless contraindicated. • For clean and clean-contaminated procedures, additional prophylactic antimicrobial agent doses is not recommended after closing the surgical incision should not be administered in the OR after the surgical incision is closed, even if a drain has been put. • Do not apply topical antimicrobial agents to the surgical incision. • Target a blood glucose level less than 200 mg/dL during surgery. • Maintain normothermia in all patients. • A higher fraction of inspired oxygen during surgery and after extubation in the immediate postoperative period should be administered in patients with normal pulmonary function undergoing general anesthesia with endotracheal intubation. • Do not withhold transfusion of blood products sin order to prevent SSI. (Source: JAMA Surgery) Dr KK Aggarwal National President IMA & HCFI

CDC & AAP update recommendations for infants with Zika virus infection

CDC & AAP update recommendations for infants with Zika virus infection

Dr K K Aggarwal

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) and have updated recommendations for the clinical evaluation and management of infants suspected of having Zika infection and those who have congenital Zika virus infection. These recommendations followed an expert level meet on July 21 to discuss revisions to the last CDC recommendations, released in February 2016.

The three main areas touched were evaluation of infants with suspected or confirmed congenital Zika virus infection, outpatient care and follow-up for symptomatic infants with congenital Zika virus infection, and outpatient care and follow-up for infants without apparent abnormalities at birth.

Infants suspected to have congenital Zika infection

·         Infection is considered to be possible or confirmed if infant PCR or IgM testing results are positive (final recommendations on this awaited).

·         A comprehensive physical examination should include careful head circumference measurement and assessment of length, weight, and gestational age; and evaluation for neurologic abnormalities, dysmorphic features, liver or spleen enlargement and the presence of rash or other skin lesions.

·         A hearing screen per universal screening and a cranial ultrasound should be done before discharge.

·         The infant should be examined within a month of birth by a pediatric ophthalmologist.

·         A complete blood count to check for thrombocytopenia should be done.

Symptomatic infants with congenital Zika infection

·         Standard precautions should be followed when handling body fluids.

·         Lab work should include CBC and a complete metabolic panel including liver function tests (LFTs).

·         Careful assessment of head circumference, length, and weight at birth, monthly until age 6 months, and then as required. Head circumference in infants with severe microcephaly should be measured from the glabella to the point of the occipital bone. But, one must remember that the head size may be normal in infants with congenital Zika infection.

·         Ophthalmology and hearing screen before discharge; repeat hearing screen at 4 to 6 months of age if normal at birth. If normal ophthalmology screening at birth, it should be repeated at age 3 months, including retinal exam.

·         Head USG before discharge; CT and MRI as needed.

·         Follow up every month; these infants should receive regularly scheduled immunizations. Pertussis-containing immunizations are not contraindicated in children with central nervous system malformations, but uncontrolled seizures may be a precaution for vaccines containing pertussis.

·         Developmental screening at each visit; complete neurological exam to be done at 1 and 2 months and as necessary thereafter.

·         Screen for central hypopituitarism/hypothalamic dysfunction

·         These infants should be under the care of multidisciplinary team.

 (Source: Medscape)