Question

From: Brian Sanders, Hospital CEO

Sent: Tuesday, February 12, 2015 12:20

To: Laura Hernandez

Subject: Thank You

Thank you, Laura, for continuing to investigate our unfortunate situation of illnesses within our patient load here at the hospital. I want to let you know we are willing to do whatever is necessary to assist your investigation to help determine the agent and cause of this event. Per your recommendation, we are setting up times and contacts with your staff to perform the three recommended lines of investigation:

1. Laboratory studies to determine the causative agent,
2. Environmental health assessment of the hospital main cafeteria,
3. Epidemiologic study of patients still admitted at the hospital.

We have requested our clinicians to collect stool specimens from new cases of vomiting and diarrhea; as well as bacterial cultures from patients seen in the emergency rooms. Also, per your guidance, we have submitted stool samples of those already sick from the initial phase of the outbreak and are shipping them to the Centers for Disease Control and Prevention (CDC) for viral studies including reverse transcription-polymerase chain reaction (RT-PCR). What else can we do to assist you in this investigation?

Answer these questions based on your observations

At this point of the investigation, what instructions would you give to health care providers for the collection of stool specimens from patients? Include instructions on how specimens should be collected, stored, and transported. Given that investigators suspect a virus as the causative agent, what contributing factors are likely to have played a role in this outbreak? What activities would you undertake during the environmental health assessment? What key areas should be explored during interviews with the cafeteria food workers? As the health department epidemiologist, please list your next priorities and discuss them in relation to the steps of this outbreak investigation.

Answer 1

1 Sample collection: Instructions for collection of stool specimen: it should be collected and sealed in containers and immediately refrigerated or packed between ice packs in the cold box, undue delay or exposure to heat can damage the virus, to be transported to the laboratory within 72hours of collection.

2. Virus have a great ability of changing their genetic material and can survive on surfaces for longer duration

3. The source of water in the washroom, also the drinking water provided in the cafeteria needs to be analysed.

4.next priorities is providing proper health check up to the effected individual, hydrate them well, proper medication, isolate them

Also the cafeteria in needs to be closed for a while with swab taken from every items like chair, table,tea machine, washroom etc and analyse for the virus.