What We Need is a Red Book for College Health: Infection Control for the College Campus

1. What We Need is a Red Book for College Health: Infection Control for the College Campus Evelyn Wiener, MD University of Pennsylvania

2. Public Health Image Library United States Environmental Protection Agency

3. SESSION OBJECTIVES • List communicable diseases for which infection control measures are indicated • Identify modes of transmission for communicable diseases • Identify appropriate infection control measures for common and/or serious contagious diseases • Know the campus and community resources involved with implementing infection control measures

4. LA 2/23/12 • History: • Sore throat & cough x 1 day • PMH pneumonia one year ago • Physical exam • BP 138/85 HR 115 T 98.5 • Pharynx red, TM normal • Lungs clear • Symptomatic treatment advised

5. LA, continued Returns 2/28/12 • CXR (obtained 2/23) was negative • Symptoms have continued, cough worse • Physical exam • BP 147/91 HR 113 T 99.0 • Pharynx red, cervical adenopathy • Lungs clear, but frequent dry coughing fits, speaking in full sentences • Symptomatic measures continued

6. LA, continued 2/29/12 • Goes to ER - cough incessant, uncontrolled by codeine • What is the differential diagnosis? • What else do you need to know? • What do you need to do?

7. WHAT NOW? What are the infection control issues? Which issues are unique to college setting? Who needs to be involved/informed? Where do you find the answers?

8. FAMILY Family PARTNERS HEALTH SERVICE ADMINISTRATION STUDENT FRIENDS STUDENT AFFAIRS ROOMMATES Risk Management FACULTY RES LIFE STAFF CLASSMATES Environmental Health FACILITIES HUMAN RESOURCES

9. WHAT DO STUDENTS NEED TO KNOW?**Also parents, staff, media • Who is at risk for exposure? • What should students do if they were exposed? • What should students do if they have symptoms?

10. WHAT DO ADMINISTRATORS NEED TO KNOW? • Same as students PLUS • Extent of outbreak • Measures needed to control outbreak • Need to provide support to affected students • Need for resources • Talking points

11. WHAT DO CLINICAL STAFF NEED TO KNOW? • Same as students and administrators PLUS • On-site infection control measures • Clinical presentation • Diagnostic tests • Management • Reporting

12. CAMPUS INFECTION CONTROL ISSUES • How do basic infection control principles apply in a campus environment? • Populations • Facilities • Significant functions • What resources are needed? • What resources are available?

13. STUDENT POPULATIONS Residential students Commuters Part-time students Greek system Athletes Health care students International students Visiting/exchange students

14. OTHER POPULATIONS Faculty Staff Visitors Special program participants Contractors

15. FACILITIES Student housing Residence halls Fraternities and sororities Off-campus housing Dining halls Classrooms Research laboratories Libraries Athletic facilities Other buildings

16. SIGNIFICANT FUNCTIONS

17. TYPES OF INFECTIOUS DISEASES • Viral • Bacterial • Fungal • Parasitic • Nematodes and helminths • Critters

18. TRANSMISSION BASICS • Airborne • Droplet • Contact • Ingestion • Blood and body fluid

19. AIRBORNE TRANSMISSION • Airborne droplet nuclei • Small particles <5 μm of evaporated droplet • Widely dispersed • Remain suspended in air for long periods • Indication for N95 respirator

20. TB Online CDC CDC

21. DROPLET TRANSMISSION • Droplets generated primarily by coughing, sneezing, talking • Droplets relatively large • Propelled short distance (< 3 feet) • Deposited on conjunctiva, nasal mucosa, mouth • Do not remain suspended in air • Indication for surgical masking

22. CDC CDC CDC scarletfeverpictures.com

23. CONTACT TRANSMISSION • Direct contact with infected area • Fomites • Most common route of health care-associated infections

24. Wikipdedia/Robert Morley CDC/Dr. Thomas Sellers MiteBitespictures.com CDC

25. INGESTION Chicago Star Tribune

26. BLOOD AND BODY FLUID CDC CDC

27. CONTROL AND PREVENTION • Pre-exposure immunization (for vaccine-preventable diseases) • Screening • Hand hygiene • Food and water safety • Universal precautions • Isolation and quarantine • Post-exposure immunization • Post-exposure chemoprophylaxis

28. RECOGNIZING AND MANAGING OUTBREAKS • Disease surveillance • Contact identification and tracing • Pre- and post-exposure prophylaxis • Notification • Public health emergencies

29. INFECTION CONTROL ISSUES • Transmission characteristics • Diagnosis • Treatment • Evaluation of the exposed individual • Control measures • Isolation/exclusion – who, what, how long • Post-exposure measures • Environmental measures

30. PERTUSSIS {Total duration 6 – 10 weeks}

31. PERTUSSIS, continued

32. MEASLES

33. MEASLES, continued

34. MRSA

35. MRSA, continued

36. NOROVIRUS

37. NOROVIRUS, continued

39. OTHER ISSUES • Global health concerns • Global patterns of disease • Issues for students traveling abroad • Issues for international students • Health care students • Animal-borne diseases • Faculty and staff

40. ENVIRONMENTAL CLEANING • Standards for cleaning • Cleaning in response to disease outbreak • Special circumstances/setting • Protective equipment

41. CAMPUS RESOURCES • SHS • Dean of students • Environmental Health • Public safety • Facilities • Human Resources • Risk Management

42. COMMUNICATIONS • Communication with administration • Communications to students (and parents) • Communications to faculty • Media releases • Notification to public health officials

43. ACKNOWLEDGEMENTS Sharon McMullen RN BSN BA   University of Pennsylvania Esther Chernak, MD, MPH, FACP Drexel University School of Public Health