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Hi Kelly
I certainly can share my experience on the respiratory human Metapneumovirus as one that I have not seen in the 10 years I have been in infection control. We also recovered from a HMPV virus outbreak on one of our wards and all I can say is that the activity of all viruses regardless has had a shift in the last year or two.
Most of our patients had low grade temperatures and cough. Based on the past activity of HMPV it was not notified to IP&C as it was considered an organism that was not required to be routinely notified to IP&C but rather to the wards. I find this a problem as not all IC processes are followed by the book regardless of how you beat down in trying to getting them done as this is not usually considered a priority in patient care on most cases. However, from its current activity and who knows what else happens in the future it probably should be considered a notifiable organism to IP&C just like any other respiratory virus i.e. influenza. There should be more standardised and clear cut guidelines on how these organisms should be managed as an outbreak is a clear indicator of person to person transmission. Sometimes even a change in activity by the lab should be enough to bring out that trigger to the IPU.
What we noted when dealing with this virus that is usually self-limiting and has never resulted in an outbreak until now in our facility is that it was also very debilitating to the patients that it affected and took a longer time to clear. Mind you most of these patients were non-acute rehabilitating patients so the impact on their recovery and limiting services like utilising a shared gym and keeping them secluded were a challenge in itself.
What we also noticed and I am sure others have too is that the viruses including RSV are on the increase resulting in more healthcare associated transmission than I have ever seen before should we ignore this or should these be the types of emerging organisms of significance that we should be taking note of as I am sure we are all recovering from this debilitating flu season we certainly wouldn’t have the capacity to control when they got out of hand. What is currently not clear is how long we could isolate the patients and safely de-isolate as there are no clear guidelines for this so all we relied on was fever and cough which we know can go on for a while. However, apart from this and not understanding how long transmission can go on for we kept affected patients in the same area did not admit any new patients to the cohort rooms for a while(this was achievable as they were long stay patients)-this could be a challenge where there is a high turnover of patients.
I would also appreciate if there is anyone out there with clear evidence based protocols to manage such patients that they would share the information with us as well. We finally got over the outbreak after 6 confirmed cases and monitoring of all patients within the unit who became may have developed symptoms. It took us close to 2 weeks of monitoring, screening, isolation, education and cleaning to finally stop having any confirmed cases for HMPV as most of the confirmation was some days apart- and also taking into consideration the maximum recommended incubation period of 7days.What I also found and have read is some of these viruses can complicate any opportunistic infections particularly patients colonised with MRO’s would be interesting to see if there is any conclusive evidence out there relating to this claim.
In other words, keep an eye out for these organisms that are emerging and proving to be greater in the IP&C world.
Kind Regards
Verily Thomas
Clinical Nurse Consultant | Infection Prevention and Control
SWSLHD-Bankstown/Lidcombe Hospital
Eldridge Road, Bansktown.NSW 2200
Tel 02 97228000 pager 28230
Tel 02 9722 8633 | Fax 02 9722 7822 | verily.thomas@sswahs.nsw.gov.au
http://www.health.nsw.gov.au
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Hi Collective Brains Trust,
We currently have a respiratory outbreak in one of our residential aged care facilities and one of our staff has come back positive for Human metapneumovirus infection. I am wondering if anyone has had experience with this that could share your wisdom. Rest of the PCR’s are still pending. Any help would be greatly appreciated.
Regards,
Kelly
Kelly Barton
Infection Prevention & Control Officer
Monday- Friday
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