Giving the flu a dose of its own medicine

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Giving the flu a dose of its own medicine

Toronto, January 14, 2014

By Leslie Shepherd

GeneXpert machine tests for flu virus.
GeneXpert machine tests for flu virus. (Photo by Yuri Markarov)

It’s flu season, and St. Michael’s is better prepared than ever before.

Dr. Matthew Muller, medical director of infection prevention and control, said his team worked with the pharmacy, microbiology, quality and performance and corporate health and safety this year to make sure they had coordinated action and contingency plans in place --before flu season started.

The biggest change this year is that flu tests can now be done in 90 minutes, instead of a matter of days.

The impact of this on patient care, flow and satisfaction is huge: faster confirmation that a patient does or does not have the flu means patients will spend less time in isolation, freeing up those beds for people waiting in the Emergency Department, and hopefully reducing ED wait times and the use of antiviral drugs.

The hospital is now running flu tests on a machine called GeneXpert, which it acquired about a year ago for testing for C-difficile, said Dr. Larissa Matukas, head of the Division of Microbiology. When infection control asked how St. Michael’s could improve turnaround times for flu tests, Dr. Matukas said they worked to make sure GeneXpert’s sensitivity for identifying the flu virus was as good as the manual tests the hospital was using and they put forward a business case.

Testing nasal swabs manually is both time-consuming and labour intensive. It requires careful handling of the specimen by specially trained staff in special facilities. The fastest a test could be done is between six and eight hours, but in practice tests were conducted in batches only two to three times a week.

GeneXpert performs the test completely automatically. The swab goes into a vial with a transport medium. A sample of the medium is placed in a cartridge already loaded with the reagents to detect the flu virus and determine whether it is Influenza A or B or subtype H1N1. Up to four cartridges can be tested at once in the machine, which is literally about the size of a breadbox.

Laura Scopa, a patient flow redesign specialist, said GeneXpert was “just one of the arrows in our flu-planning quiver” this year.

There’s also a contingency plan to open extra beds if other units are forced to close beds to accommodate isolation patients.

And at the beginning of flu season in November, patient flow reintroduced the Flu Tracker, a daily snapshot of how the flu is impacting the hospital. The tool, developed midway through last flu season, provides all the medical, surgical and critical care units with the latest info on such things as bed closures and number of staff who have called in sick.

A weekly flu report, showing the number of confirmed in-patient flu cases for this year and last year, is also available to staff on the Infection Prevention and Control page on the intranet.

“We hope this will help clinicians understand the epidemiology of the flu as it appears locally at St. Michael’s,” Dr. Muller said. “When we are in the peak of flu season, if it looks like flu, it probably is, and we should treat it as such.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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