Resources
GAS worksheet, Case/Contact Notification Letters, Contact Line list, Swab Line list, Factsheets
What are tools to manage iGAS?
Elevated creatinine (> 177)
(Appendix B)
What is a sign of renal insufficiency?
Type of child care centre, size of physical structure, number and ages of children, type of interaction of children (PHAC 2006 pg 8)
What are important aspects of an IGAS case investigation in a child care centre?
Conduct a retrospective chart review to identify an "excess" of confirmed or suggested GAS in the preceding 4 to 6 weeks (PHO Recommendations)
What is the appropriate PH action if a confirmed case of invasive GAS disease is identified in a LTCF?.
-Excess determines next actions eg. screening for GAS in residents and patient care staff.
Master number – Outbreak Location – Report Date
What is the Outbreak Name
Process Map for Managing Group A Strep
What is an iGAS decision making tool located in the Disease Specific folder on the N drive
AST, ALT or total bilirubin greater than or equal to 2 X the upper limit of normal for age
(Appendix B)
What are signs of liver function abnormalities?
Assess for any other cases of suggested non-invasive or invasive GAS infections within the CCC (pharyngitis, impetigo) PHAC pg 8
What are actions to identify the potential source specifically from within the CCC?
Skin and soft tissue infections eg. pharyngitis, cellulitis
What are suggested cases of invasive or non-invasive Group A Streptococcus?
Can be created in the summary mode when "detailed" tracking is off
Exposures
"Respiratory User Guide, Section V, Sporadic Group A Streptococcus Disease, Invasive Cases"
What is an iPHIS documentation tool?
Low platelets (less than or equal to 100,000) or DIC
(Appendix B)
What are coagulopathies associated with shock?
Cephalosporins
(CPS April 2019)
What is the recommended first line category of drugs for chemoprophylaxis in children?
Same for adults
>1 case of confirmed invasive GAS per 100 residents per month
OR
> 2 cases of confirmed invasive GAS per month in facilities with less than 200 residents
(PHO Recommendations)
What is a definition of “excess” cases in a LTCF.?
Last name, First name – Case ID – Earliest Exposure Date
Example: Smith, Bob – 12345-2021-01-01
What is a "Person" type exposure
Provides guidelines for managing/screening during outbreaks of IGAS in long term care facilities
What is the Public Health Agency of Canada (PHAC)
Chronic soft-tissue necrosis/gangrene or acute or chronic cellulitis
(Appendix B)
What are NOT signs of soft tissue necrosis for an iGAS case?
When there is an additional occurrence of invasive GAS in children or staff within 1 month or there is a concurrent varicella outbreak
(PHAC pg 9)
What is the appropriate time to consider recommending chemoprophylaxis for all children at a CCC?
> 4 cases of suggested or non-invasive GAS per 100 residents per month
(PHO Recommendations)
What is the definition of "excess" for non-confirmed and/or non-severe cases of GAS
Recommended this exposure be created from the Exposure menu
What is a "Person" type of exposure
Also provides guidelines for managing/screening during outbreaks of IGAS in a LTCF
What is Public Health Ontario (PHO)
Should be acute in nature and deeper than the skin (necrosis in fascia, muscle, gangrene in deeper tissues) (Appendix B)
What IS soft tissue necrosis for an iGAS case?
Varicella
What is a frequent antecedent of iGAS in children?
-risk is significantly increased during the 2 week period after the onset of varicella infection
(PHAC 2006 pg 8)
All patient care staff should be screened for GAS (throat, nose and skin lesions)
In LTCF with < 100 beds, all residents should be screened for iGAS
In LTCF with 100 beds or greater -screen all residents on the same care unit and index case contacts. Consider patient and care movement patterns for any additional screening that's needed
(PHO Recommendations pg 13)
What are the appropriate screening guidelines if an excess of cases is determined?
You don’t have the ability to link cases and contacts to exposures when I am OFF
Detailed tracking