A 24-year old woman is - pacemaker

[ArchivalUser]

A 24-year old woman is brought to the emergency department because of fever, photophobia, and a stiff neck. On physical examination, the patient is irritable. Temperature is 40 °C (104 °F). There is nuchal rigidity, and a purpuric rash is seen on dependent areas of the body. While in the emergency department, the patient develops respiratory distress and requires intubation. She is subsequently admitted to the intensive care unit (ICU).

During transfer, the patient is isolated with droplet precautions, and all health care workers wear masks and use the appropriate barriers. Lumbar puncture is done in the ICU, and cerebrospinal fluid examination shows gram-negative diplococci, consistent with meningitis.

Which of the following health care workers requires antibiotic prophylaxis?

A All staff who were present in the emergency department and ICU when the patient was in these areas
B All staff who examined the patient in the emergency department and ICU
C The resident who intubated the patient in the emergency department
D Prophylaxis is not required for any staff

[ArchivalUser]

C The resident who intubated the patient in the emergency department

[ArchivalUser]

C...

[ArchivalUser]

Correct Answer = C)
Key Points

* Person-to-person transmission of meningococcal organisms occurs by the respiratory route.
* Prophylaxis of health care workers exposed to a patient with a meningococcal infection is needed only after contact with the patient's respiratory secretions.

The patient presents with the classic manifestations of meningococcal infection. Transmission is from person to person, primarily by the respiratory route, but requires very close contact such as kissing. In general, infection is spread by large droplets and requires contact of less than 3 feet for transmission. Household contacts should receive prophylaxis. However, only health care workers who have contact with respiratory secretions require prophylaxis. Intubation and suctioning are considered activities that increase the risk of transmission, whereas examination of the patient does not generally constitute an exposure. Persons who are wearing masks are not considered exposed. Therefore, the only person who needs prophylaxis is the resident who was in contact with secretions when he intubated the patient.

Administering prophylaxis to all staff in the emergency department and intensive care unit is not needed and would result in unnecessary use of antibiotics for many persons who did not have significant exposure to the patient. Transmission of Neisseria meningitidis has never been documented to be a risk when droplet precautions are instituted and health care workers are masked and use appropriate hand hygiene. Examining a patient, unless the examiner is coughed upon, does not result in sufficient exposure to put a health care worker at risk of secondary acquisition.

[ArchivalUser]

Thank you pacemaker

[ArchivalUser]

Thanks pacemaker!

[ArchivalUser]

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