Influenza management in a secondary care setting during 2010-11 winter: North Bristol Experience

Mahableshwar S Albur, Rupali Rajpurohit, Imad Ibrahim, S.K. Jacobson

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Abstract

Introduction:
Both influenza A/H1N1 (2009) and influenza B circulated at the same time in winter 2010/2011. Influenza was reported more often in young and middle-aged adults in the 2010/11 season than seen in the previous pandemic period in 2009/10. Increased ICU admissions, primarily in under 65 year old Mortality, in terms of excess deaths and individual fatal cases, was also higher in 010/11 than the 2009/10 pandemic [Total no. of deaths = 602]. Of the Influenza A/H1N1 (2009) viruses tested in the UK, 3.1% were found to carry the mutation commonly associated with resistance to Oseltamivir. CBI associated with influenza infection during the 2010/11 season, prompting an alert for clinicians issued by the Chief Medical Officer.
Methodology: We conducted a clinical audit of management of Influenza during 2010-11 winter. The aim was to ensure that patients who presented with Influenza-like-symptoms received appropriate care as per NBT trust guidelines (Fig. 1.). We collected the data by retrospective review of case notes, drug charts, laboratory and radiological findings. All laboratory confirmed cases of Influenza from NBT during 2010-11 winter season were included.
We focussed on following key Areas:
Laboratory diagnosis: Timeliness of specimen collection & Lab (virology) turnaround time.
Infection control practices: Isolation to side room/cohort ward & personal protection
Antiviral therapy:
Results: Demography:
Total no of laboratory confirmed influenza cases = 71
Male:Female = 30:41
Age = Mean 46.5±19.8years
Patients older than 65years = 11(16%)
High risk group = 44/71(62%)
Community acquired = 88%

Clinical features:
ILI symptoms: 63/71(89%)
CURB-65 score: Mean 0.91±0.96 (median 1.0)
CXR findings: 62/71 (6/62 with changes)

Clinical outcome:
Length of stay: Mean = 12.1 ± 16 days, Median=6 days
ITU admission: 12
Deaths= 9 [Mortality=13%]
ECMO transfers: 2

Laboratory Diagnosis:
The mean turn around time by the SW regional HPA Virology lab. = 1.32 ± 0.95 days. A variety of samples were collected from patients.

Anti-viral therapy:
Number of patients started on antiviral therapy = 56(80%).
The mean time lag between suspecting flu & starting therapy = 0.87±1.44 days
Mean duration = 6 ± 2 days [Median = 5 days].

Infection control
The time interval from admission to ICP:
Mean = 0.61 ± 0.95 days, Median = 1 day
Number of patients transferred to side room = 61/71(85%)
Time lag for isolation into side room = Mean 0.57±1.68 days Median 1 day
Number of patients admitted to Flu cohort ward = 12(17%)

Discussions:
The North Bristol picture of influenza season 2010-11 was similar to national picture.( i.e. Young age, high proportion of admission to ICU, epidemic wave. Chronology). Clinical teams across the trust showed good compliance with NBT Flu guidelines in terms of lab diagnosis, use of anti-virals & Infection control procedures. Only 17% of patients were admitted to cohort ward, because it was created late into the epidemic wave. Earlier creation of cohort ward may have eased the pressure on side rooms during busy winter period. Also better communication with regional HPA virology reference laboratory (especially in the initial period) may have made management bit smoother.
Original languageEnglish
Publication statusPublished - 19 Nov 2011
EventFederation of Infection Socieities 2011 - Manchester, United Kingdom
Duration: 16 Nov 201118 Nov 2011

Conference

ConferenceFederation of Infection Socieities 2011
CountryUnited Kingdom
CityManchester
Period16/11/1118/11/11

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