Nosocomial flu infection: An unresolved patient death
'Why would they have flu — they're in a hospital?'
In reviewing the risk of seasonal influenza and the controversial question of health care worker immunization, Thomas Talbot, MD, MPH, paused on a mysterious case study — an 'N of 1," if you will, that suggests patients come into hospitals and die of influenza contracted during treatment.
A 56-year-old patient needing a hip replacement had a history complicated by myocardial infarction, bypass surgery, and lower extremity ischemia, recalled Talbot, a hospital epidemiologist at Vanderbilt University Medical Center in Nashville, TN. The patient developed a postoperative fever 12 days after admission and had a new infiltrate on chest X-ray, thought to be a vent-associated pneumonia.
"[We recommended] a test for flu," he recently said in Fort Lauderdale, FL, at the annual meeting of the Association for Professionals in Infection Control and Epidemiology. "People thought, that's crazy, they haven't been around anybody. Why would they have flu — they're in a hospital? This is a VAP; flu doesn't cause VAP."
The patient had influenza, though all signs indicated it was not present on admission. "As we began to investigate, we found there were a lot of staff coming into work sick with sniffles and cold or coughing," Talbot said. "We looked at the [worker] vaccination rate, and it was about what national averages are — that over half of the people weren't getting vaccinated."
Was the infection caused by a health care worker, a visitor? "After a prolonged course [the patient] developed a bacterial VAP and died on Day 38," he reported. "Would he have gotten to that point if he didn't acquire influenza? Who did he acquire it from? We don't know."
Another unanswered question is how many similar cases occur each flu season, since surveillance of nosocomial flu is virtually nonexistent in the absence of an institutional outbreak.
"Health care-associated flu is not something that we routinely track very well," Talbot said. "I would argue that potentially after people are exposed, they may be discharged and go on to get sick at home, and then be seen in their doctor's office. We don't really track this."
In reviewing the risk of seasonal influenza and the controversial question of health care worker immunization, Thomas Talbot, MD, MPH, paused on a mysterious case study an 'N of 1," if you will, that suggests patients come into hospitals and die of influenza contracted during treatment.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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