Sue Dolan, RN, an infection preventionist at Colorado Children’s Hospital in Denver, has extensive experience dealing with acute flaccid myelitis (AFM) and the viruses that can trigger the paralytic condition.
Dolan provided the following comments and tips for IPs to Hospital Infection Control & Prevention.
Droplet Precautions for EV-D68, EV-A71
Dolan: Many enteroviruses (EV) are primarily spread via the fecal-oral route, and contact precautions are sufficient. However, EV-D68 and EV-A71 act more like respiratory viruses. They are likely to spread person-to-person like other respiratory viruses through droplets via coughing and sneezing or by manual transfer of fomites from contaminated surfaces.
The virus enters the nasopharynx and attaches to epithelial cells on mucosal surfaces and then initially spreads locally. In some patients, it becomes more invasive and can travel to other parts of the body like the central nervous system — causing neurological symptoms. It is unclear why this additional or severe invasive step occurs in some patients and not others.
Dolan: Specific [infection control] exceptions were developed for long-term patients needing therapy/rehabilitation outside their room to work toward improving their neurological deficits. Procedures were developed to allow for physical/occupational/speech therapy sessions at identified times and locations outside of the patient room. Practices were used by staff to protect themselves and other patients by proper use of PPE, patient transfer methods, and environmental disinfection.
Dolan: EPA-approved hospital disinfectants with label indications against nonenveloped viruses [such as EV-D68] have broad efficacy and therefore also work against enveloped viruses.
However, the label may not specifically designate activity against enveloped or nonenveloped viruses, so look for a claim of efficacy against at least one common nonenveloped virus. If present, then you are assured it will work for EV. These include norovirus, rotavirus, adenovirus, poliovirus, and rhinovirus.
Dolan: We consider this an important step year-round to prevent visitors from bringing in contagious illnesses and to protect our vulnerable patients, as well as staff and other visitors.
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At our hospitals, we routinely screen all visitors once a day for contagious illness symptoms or recent history prior to them entering the inpatient units. We ask about fever, rash, sore throat, cold, cough, runny nose, vomiting, diarrhea. We also ask about eye infection and active infection or recent exposure to chickenpox, measles, mumps, and tuberculosis. If they pass as not having any symptoms or exposures, they receive a sticker to wear showing they have been screened.
Dolan: During peak respiratory season, we have historically limited the number of visitors who can visit patients. This is an effort to decrease the burden of transmission risk during a time of multiple respiratory illnesses in the community.
In 2014, we started these restrictions earlier than usual when we began seeing the unusual outbreak of EV-68 and the severity of the illness in some patients. Because the outbreak was new and the neurological findings on these patients very concerning, we limited visitation a few months earlier than the usual Dec. 1 start date.
Also during this time in 2014, we limited and/or modified many of our community activities at the hospital in an effort to minimize transmission risk. Based on the knowledge gained in 2014, we did not need to implement additional visitor restrictions or limit community activities during the [current] outbreak and did not have any internal transmission at our facilities.