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Crises 03 - Acinetobacter Baumanni in Royal Victoria Hospital, Belfast watch

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    Crisis 03 - Acinetobacter Baumanni in Royal Victoria Hospital, Belfast - Conclusion
    1) Mr Wing DOES NOT meet the minimum requirements to be transferred to a high intensity unit, such as at the Royal Free Hospital. According to the EUNID guidelines, to be recommended for transfer, you must have;

    EUNID consensus list of pathogens or diseases that fulfil the definition of a HID
    • Human-to-human transmissible viral haemorrhagic fevers (VHFs) Ebola
    • Avian influenza infection which has transmitted from human to human bird flu
    • An emerging highly pathogenic influenza or other respiratory infection AB is not primarily a respiratory infection
    • Smallpox and other highly pathogenic Orthopox infections
    • Cases of an unknown emerging pathogen or suspected bioterrorist agent there is no indication of a terror attack, and nor is actually an "emerging pathogen" since 2 cases have been diagnosed in the UK 10 years ago. It's also reasonably documented in China/India
    • XDR-TB and some highly resistant strains of MDRTB multi drug resistant tuberculosis

    Thus, in my opinion, he shouldn't be transferred, and should simply be isolated in Belfast, although this decision is decided by clinicians and PHE, who should be contacted regardless.

    2) With AB fitting the criteria of "highly infectious" the 10 at proximal risk should indeed be screened, a conservative isolated approach is agreeable, with likely one of them at least being "at risk" especially. Again, by contacting PHE you have highlighted that the elderly/IC may need transfer, on this I agree, however it is doubtful that any "healthy" individual found to test positive should need transfer

    3) This is correct, like a similar case of Carabapenemase-Producing Enterococci, Public Health England established the "Carbapenemase-producing Enterobacteriaceae toolkit working group" tasked with targeting this specific disease, so creating a similar toolkit for AB, with multinational input would be recommended.

    4) This is slightly a trick question, surveillance programs for AB are debatable, to justify the cost-effectiveness of the expensive accurate testing (sensitivity 63-89%) as opposed to (21-50%) requires that you are in an endemic area or during an epidemic, that >2% of those screened are in fact infected. With only one person affected, this can be viewed as a one-off, should someone come back positive, then I would raise the Alert level and consider transfer. Even if we declare an epidemic, it is VERY unlikely that >2% of people arriving from China are in fact infected, thus I feel this action is similar to Gordon Brown overstocking on Tamiflu at the bird flu peak.

    5) I also omitted one key piece of information, just curious to see if the Govt noticed that another at risk group existed here, soldiers returning from the Middle East. This wasn't mentioned but I didn't specifically ask for it either. I was interested to see if the Govt or the Opposition spotted this, but maybe that was a tad cheeky.

    So ends Crisis 03. Thoughts everyone?

    http://www.ncbi.nlm.nih.gov/pubmed/20980559
    http://www.ncbi.nlm.nih.gov/pubmed/24581017
    http://www.apic.org/resource_/elimin...c-ab-guide.pdf
    http://ec.europa.eu/health/ph_projec...frep_a9_en.pdf (EU guidelines)
    http://cid.oxfordjournals.org/content/51/1/79.full
    https://www.gov.uk/government/upload...olkit_CORE.pdf (CPE toolkit)
    http://ecdc.europa.eu/en/eaad/antibi...ence-Brief.pdf EPC EuSCAPE program for CPE
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    Well-written crisis, but a bit boring really.
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    On a point of order, Mr Speaker RayApparently. There is, fortunately, just one Crisis 03.
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    (Original post by cranbrook_aspie)
    On a point of order, Mr Speaker RayApparently. There is, fortunately, just one Crisis 03.
    This is a conclusion to Crisis 03 rather than a new crisis.
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    (Original post by RayApparently)
    This is a conclusion to Crisis 03 rather than a new crisis.
    He's referring to the thread title ('Crises').
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    (Original post by RayApparently)
    This is a conclusion to Crisis 03 rather than a new crisis.
    You misunderstand me, I am in a pedantic mood and was filling in for JD by attempting to point out the mistake in the title in a parliamentary manner
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    (Original post by TheDefiniteArticle)
    He's referring to the thread title ('Crises'.
    (Original post by cranbrook_aspie)
    You misunderstand me, I am in a pedantic mood and was filling in for JD by attempting to point out the mistake in the title in a parliamentary manner
    Oh I see. That's a vestigial tale of the previous ones - if you were a true pedant you'd have noticed that it's said 'crises' in every update since it was first posted so long ago now.
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    (Original post by RayApparently)
    vestigial
    good word
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    (Original post by TheDefiniteArticle)
    good word
    Thank you. Speakers should speak well.
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    (Original post by TheDefiniteArticle)
    Well-written crisis, but a bit boring really.
    In fairness, one of the criticisms was that the scenario wasn't realistic. Hence I've made this realistic.
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    I think the concept of crises is good, even if this one was slightly boring. I defijitely would like to see some more in the future.
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    This session of debate has ended.
    Crisis 03 is considered concluded.
 
 
 
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