PATIENT SAFETY
When is WORLD PATIENT SAFETY DAY being celebrated?
September 17, 2024
When can PCT be falsely high?
Renal dysfunction (CKD, AKI)
Neonates (Day 1 to 3 of life)
Physiologic stress (trauma, surgery,
burns)
Shock or organ perfusion
abnormalities (ie. shock from
hypovolemia, cardiogenic,
obstructive)
A diagnostic marker that is usually falsely used in PEDIA
Procalcitonin
What is being used as a screening test for mycobacterium tuberculosis in low resource settings?
Tuberculin Skin Test
_______ is the new standard for syndromic infectious disease diagnostics. It delivers accurate results in about one hour.
Biofire
Theme for world patient safety day
Improving diagnosis for patient safety
When can PCT be falsely low?
Taken too early in the course of
infection (procalcitonin peaks at
12-14 hours)
Localized infections (ie. Tonsillitis,
Abscess, Appendicitis, Ventriculitis, Cholecystitis)
3 indications to use 4plex
2 weeks to <2 years old with severe community acquired pneumonia Any age with chronic medical conditions (see Box 1) with URTI and/or non-severe pneumonia
Immunocompromised host with URTI and/or non-severe pneumonia
Advantage of TB quantiferon over TST?
BCG vaccination is not detected in TB quantiferon unlike in TST where a false positive result may be read
The test is limited to cases with clear evidence of _____________, encompassing clinical signs, symptoms, increased oxygen requirement, and new or progressive radiographic findings
Pneumonia
focuses on importance of correct and timely diagnosis in ensuring patient safety
Defer starting or stepping up
antibiotics, symptoms (ie. fever,
apnea, respiratory distress) may be
explained by a non-infectious cause
Discontinue antibiotics, when a
shorter antibiotic duration is desired
How can 4plex be collected?
laboratory measurement of interferon gamma on whole blood
Indications in the use of Biofire for NEWLY intubated patients
a. Pneumonia in the immunocompromised host
i. On active treatment for solid tumor/hematologic
ii. With primary immunodeficiency
iii. With HIV infection
iv. On immunosuppressive therapy
v. Hematopoietic stem cell transplantation recipient
b. Children with severe pneumonia exhibiting poor response to empiric antibiotic therapy.
c. Children who develop a new-onset nosocomlal pneumonia and antibiotic resistance is suspected (previously on broad-spectrum antibiotics).
promotes appropriate, timely diagnostic testing, including collection and identification and reporting of results timely
Diagnostic Stewardship
Diseases where CRP should be ordered rather than PCT?
Neonatal sepsis, Osteomyelitis
If the influenza A and/or B panel test/s positive, what antiviral should we start?
Oseltamivir
TST not available
cannot follow up 48-72 hours for TST reading
contraindication to ID administration of TST
history of BCG vaccine <5 years, more than 1 dose or BCG given after infancy
Scenarios where Biofire should not be used
1. The test should not be repeated to determine prognosis or predict treatment response.
2. In patients with non-severe pediatric community-acquired pneumonia (PCAP) under typical guideline-based therapy.
Absence of preventable harm and reduction of risk of unnecessary harm associated with health care to an acceptable minimum
Patient Safety
Clinical scenario where procalcitonin can be ordered?
signs and symptoms are equivocal or non resolving symptoms
What does 4plex comprise in terms of virus detected?
influenza a and B, flu and rsv
Which is not affected by non tuberculous mycobacteria?
The PN panel cannot be repeated within ______ day interval without prior consultation with the infectious disease service (for clinical reasons) or microbiology director (for laboratory reasons)
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