What is the best approach to prioritize and manage infectious diseases like COVID-19, pneumonia, influenza, norovirus, C.diff (Clostridioides difficile), and urinary tract infections in a behavioral health facility?

From the Guidelines

The best approach to prioritize and manage infectious diseases in a behavioral health facility is to implement a comprehensive infection prevention and control program with clear protocols for each specific condition, prioritizing COVID-19 and C. difficile due to their high transmissibility and potential severity.

Prioritization of Infectious Diseases

When scoring the probability of occurrence, risk level of failure, potential change in care, and preparedness for each infectious disease in a behavioral health facility, the following considerations should be taken into account:

• COVID-19: Probability of occurrence - 3 (high), Risk level of failure - 3 (life-threatening), Potential change in care - 3 (high), Preparedness - 1 (good) 1
• Pneumonia: Probability of occurrence - 2 (medium), Risk level of failure - 2 (permanent harm), Potential change in care - 2 (medium), Preparedness - 1 (good)
• Influenza: Probability of occurrence - 2 (medium), Risk level of failure - 2 (permanent harm), Potential change in care - 2 (medium), Preparedness - 1 (good)
• Norovirus: Probability of occurrence - 2 (medium), Risk level of failure - 1 (temporary harm), Potential change in care - 2 (medium), Preparedness - 1 (good)
• C. difficile: Probability of occurrence - 3 (high), Risk level of failure - 3 (life-threatening), Potential change in care - 3 (high), Preparedness - 1 (good)
• Urinary Tract Infection: Probability of occurrence - 2 (medium), Risk level of failure - 1 (temporary harm), Potential change in care - 2 (medium), Preparedness - 1 (good)

Management of Infectious Diseases

To manage these infectious diseases effectively, the following strategies should be employed:

• COVID-19: Establish screening protocols, isolation procedures for positive cases, and vaccination requirements 1
• Pneumonia: Implement prompt antibiotic therapy and respiratory isolation
• Influenza: Use oseltamivir for treatment and prophylaxis, and implement droplet precautions
• Norovirus: Implement strict contact precautions, enhanced environmental cleaning, and isolation until 48 hours after symptom resolution
• C. difficile: Implement contact precautions, hand washing with soap and water, and treatment with oral vancomycin or fidaxomicin
• Urinary Tract Infection: Manage with empiric antibiotics like nitrofurantoin, while ensuring proper hydration

Key Considerations

It is essential to maintain surveillance and reporting for healthcare workers and residents, and to discourage healthcare workers from working in multiple facilities to avoid inter-facility infection 1. By prioritizing COVID-19 and C. difficile, and implementing targeted interventions for each pathogen, along with universal infection control measures, the transmission risk can be reduced, and the unique challenges of a behavioral health setting can be addressed.

From the Research

Infectious Disease Management in Behavioral Health Facilities

The management of infectious diseases like COVID-19, pneumonia, influenza, norovirus, C.diff (Clostridioides difficile), and urinary tract infections in behavioral health facilities requires a comprehensive approach. The following sections outline the probability of occurrence, risk level of failure, potential change in care, and preparedness for each disease.

Disease-Specific Information

• Pneumonia:
  • Probability of occurrence: 3 (high) 2
  • Risk level of failure: 3 (life-threatening) 2
  • Potential change in care: 3 (high) 2
  • Preparedness: 2 (fair)
• LRTI (Bronchitis):
  • Probability of occurrence: 2 (medium)
  • Risk level of failure: 2 (permanent harm)
  • Potential change in care: 2 (medium)
  • Preparedness: 2 (fair)
• Influenza:
  • Probability of occurrence: 3 (high) 3, 4
  • Risk level of failure: 3 (life-threatening) 3
  • Potential change in care: 3 (high) 3
  • Preparedness: 2 (fair)
• COVID-19:
  • Probability of occurrence: 3 (high) 5, 3, 6
  • Risk level of failure: 3 (life-threatening) 5, 3
  • Potential change in care: 3 (high) 5, 3
  • Preparedness: 2 (fair)
• Norovirus:
  • Probability of occurrence: 2 (medium)
  • Risk level of failure: 1 (temporary harm)
  • Potential change in care: 2 (medium)
  • Preparedness: 2 (fair)
• C.diff (Clostridioides difficile):
  • Probability of occurrence: 2 (medium)
  • Risk level of failure: 2 (permanent harm)
  • Potential change in care: 2 (medium)
  • Preparedness: 2 (fair)
• Urinary Tract Infection:
  • Probability of occurrence: 2 (medium)
  • Risk level of failure: 2 (permanent harm)
  • Potential change in care: 2 (medium)
  • Preparedness: 2 (fair)
• SSDI:
  • Probability of occurrence: 1 (low)
  • Risk level of failure: 1 (temporary harm)
  • Potential change in care: 1 (low)
  • Preparedness: 3 (poor)
• Dental:
  • Probability of occurrence: 1 (low)
  • Risk level of failure: 1 (temporary harm)
  • Potential change in care: 1 (low)
  • Preparedness: 3 (poor)
• Foodborne:
  • Probability of occurrence: 1 (low)
  • Risk level of failure: 1 (temporary harm)
  • Potential change in care: 1 (low)
  • Preparedness: 3 (poor)

Key Considerations

• The probability of occurrence and risk level of failure for COVID-19, pneumonia, and influenza are high, emphasizing the need for effective management and prevention strategies 2, 5, 3.
• The potential change in care for these diseases is also high, highlighting the importance of prompt and appropriate treatment 2, 5, 3.
• Preparedness for these diseases is generally fair, indicating that facilities have some measures in place but may need to improve their response to emerging infectious diseases 2, 5, 3.