Major Course Topics First Receivers typically include personnel in

First Receivers typically include personnel in the following roles: Clinicians
and other staff who have a role in receiving and treating contaminated victims
and those whose roles support these functions.
Major Course Topics
 OSHA and EPA regulations
 An understanding of what hazardous
substances are, and the risks
associated with them in an incident
 Knowledge of the basic hazard and
risk assessment techniques
 Know how to select and use proper
personal protective equipment
provided to the First Receiver
 An understanding of basic hazardous
materials terms
 Know how to implement basic
decontamination procedures
 An understanding of the relevant
standard operating procedures and
termination procedures
This class is designed to provide First
Receivers with practical information to
assist them in the receipt of contaminated
victims.
Sanford Health
Scandia Hotel
th
717 4 St. N
Fargo, ND
Wednesday, March 26, 2014
No Registration Fee
Funding Source:
Hospital Preparedness Program – US
Dept. of Health and Human Services
18th Annual Western Regional Trustee Symposium
AGENDA AT-A-GLANCE
WEDNESDAY, JUNE 11, 2014
8
The Perfect Patient Experience: Bringing High Reliability to the Bedside
Craig Deao, MHA, Senior Leader, Studer Group
Delivering Results in a Changing Healthcare Environment:
The Trustee’s Role
Bernice J. Washington, President/CEO, BJW Consulting
Group
9
How is the Hospital Doing Financially?
Dennis Stillman, Senior Lecturer, Dept. of Health Services, School of Public Health, University of Washington
Concurrent Sessions
10
Keynote Address
1
2
The Trustee Toolkit
Karma Bass, Principal, Via Healthcare Consulting
3
Quality, Patient Safety & the EHR
Melissa Cole, CEO, Cole Consulting
4
Rethinking Executive Compensation
Alexander C. Yaffe, President, Yaffe & Company, Inc.
5
Making Difficult Decisions About Services & Programs
Gordon Clark, President, iProtean
Affiliations: The Journey
Lanny Kope & Margaret Hepburn, CEO, Legacy Foundation of Southeast Arizona
Creating Value Through Lean Leadership:
The Business Case for Lean
Mike Halstead, VP, Eastern Operations, QHR
Special Session
Moving Forward: Building Authentic Population
Management Requires More Than a Bridge
Brian Silverstein, M.D., President, HC Wisdom
FRIDAY, JUNE 13, 2014
AHA Federal Update
Mike Rock, Senior Associate Director, Federal Relations,
American Hospital Association - Washington, DC
THURSDAY, JUNE 12, 2014
Keynote Session
Keynote Address
New Times, New Directions: Strategies for Trustees in the
Era of Healthcare Reform
Daniel Sinnott, Founder & President, Sinnott Executive
Consulting
Perspective on Hospital Mergers & Acquisitions
Rex Burgdorfer, Vice President, Juniper Advisory
Jordan Shields, Vice President, Juniper Advisory
Concurrent Sessions
6
Hot Topics in Legal Issues Facing Hospitals & Boards
Kelly S. McIntosh, Esq., Holland & Hart LLP
7
Governance in Value-Based Healthcare
Martin Hickey, M.D., CEO, New Mexico Health
For detailed information
and to register, visit
www.trusteesymposium.org
Health Alert Network
Feb. 14, 2014
Health Advisory
Guidance for Providers on
Syphilis Diagnosis and Treatment
Syphilis remains an important public health problem in the United States and in North Dakota.
This infection can be difficult to diagnose and manage from both a clinical and a public health
perspective. Clinical management depends on the stage of syphilis diagnosed. Syphilis may
present as primary, secondary, tertiary (gummatous) or cardiac and/or neurologic disease.
Syphilis also has periods of latency characterized by the absence of any signs or symptoms.
Epidemiology
The number of cases of syphilis being reported in North Dakota has increased since 2011. In
2011, two cases of primary or secondary syphilis were reported to the North Dakota Department
of Health. In 2012 the number of cases of primary or secondary cases increased to four.
Preliminary numbers for 2013 for primary, secondary or early latent syphilis cases is 13. An
additional 13 cases of latent syphilis were reported in 2013.
In 2013, 38 percent of early syphilis cases were located in Sioux County. Of all the cases
reported in 2013, 42 percent were American Indian, 35 percent were white and 19 percent were
black. Eighteen (69 percent) of the cases were male. Four individuals had been co-infected with
syphilis and HIV. In the United States, 75 percent of all primary and secondary cases occur in
men who have sex with men. In North Dakota, the majority of cases were reported in
heterosexual individuals. Seven (27 percent) of the cases were reported to be men who have sex
with men.
Staging of Syphilis
Based on clinical findings, syphilis has been divided into a series of stages that are used to guide
treatment and follow-up. Primary syphilis usually presents itself as an ano-genital sore (primary
chancre) with a raised border that is often reported as painless. This chancre is contagious, as it
will have treponema pallidum on its surface. Secondary syphilis usually presents as a rash that
may take on several different appearances. The rash may appear as rough, red or reddish brown
spots that may be found on the palms of the hand or the soles of the feet and usually do not cause
itching. However, rashes with different appearances may occur on other parts of the body and
may resemble rashes caused by other diseases. Secondary syphilis may also present as large,
raised, gray or white lesions in moist areas; these lesions are contagious.
In addition to rashes and lesions, symptoms presented might also include fever, swollen lymph
glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigue. The
symptoms of primary and secondary syphilis will go away with or without treatment, but without
treatment, the infection will progress to the late stages of disease. Latent infections are defined
by the lack of clinical manifestations. Early latent syphilis is defined as having acquired syphilis
within the past year but there are no symptoms of the disease. Tertiary syphilis can either
present as gummatous lesions or as cardiovascular infections. Neurosyphilis can occur at any
time during a syphilis infection.
The period of latency between primary and secondary may not exist or may be measured in
weeks. The latency period after secondary syphilis may be long, often measured in years.
Testing
Today’s syphilis diagnostics largely depend on serum tests to detect nontreponemal and
treponemal antibodies. Historically, the syphilis diagnostic algorithm started with a
nontreponemal test such as the RPR or the VDRL. If reactive, the results would be quantified
through dilutions and reported out as a titer. The reactive nontreponemal test would then be
followed by a treponemal test such as the FTA-ABS or the TP-PA. If the treponemal test is
reactive, a syphilis diagnosis is confirmed.
EIAs and CIA that detect treponemal antibodies have become popular because they are sensitive,
specific and can be done on an automated platform. However, a single EIA or CIA result is not
adequate for the diagnosis of syphilis. Because of the low prevalence of syphilis in North
Dakota, the positive predictive value of EIAs and CIAs is low. Persons who have a reactive or
positive EIA or CIA test should be tested with a nontreponemal test and if reactive, should be
considered to have a syphilis infection. If the nontreponemal test is non-reactive, a second
treponemal test such as the FTA-ABS or TP-PA should be performed. If the second treponemal
test is positive, untreated persons should be offered treatment. Please see the diagrams below for
traditional and reverse sequence (EIA/CIA) testing algorithms.
Traditional Screening
Reverse Sequence
EIA or CIA
Quantitative
RPR
EIA/CIA +
RPR +
EIA/CIA -
RPR Quantitative
RPR
FTA
FTA +
Syphilis (Past or
Present)
FTA Syphilis
Unlikely
RPR +
Syphilis (Past
or Present)
RPR -
FTA or
TPPA
FTA/TPPA
+Syphilis (Past or
Present)
FTA/TPPA Syphilis
Unlikely
The value of quantified nontreponemal tests is often associated with disease activity. Titers
generally increase through primary and early latent syphilis and often peak in secondary syphilis.
Titers may decrease during periods of latency, even when cases have not been treated.
Treatment early in the incubation period or in early primary syphilis may prevent a nontreponemal test from becoming reactive. Treatment late in infection often results in a serofast
condition with low level titers such as 1:1 or 1:2 remaining throughout life. Treatment can be
monitored using non-treponemal titers. Successful treatment should result in a four-fold (two
dilution) decrease in titer (ie: 1:8 to 1:2 or 1:256 to 1:64). Ideally, nontreponemal tests should be
performed by the same laboratory using the same methods to provide the most consistent and
comparable results. If your laboratory does not routinely quantify reactive nontreponemal tests,
you may have to specify you want such tests quantified and the titer reported.
Treatment
Benzathine penicillin G (ie. Bicillin, LA™) remains the preferred treatment for syphilis. Early
syphilis (less than one year duration), without evidence of neurological involvement, requires a
single dose of 2.4 million units of benzathine penicillin G. Late syphilis, including late latent
and latent infections of unknown duration, requires three doses, each dose being 2.4 million units
of benzathine penicillin G, spaced at one week intervals. Neurosyphilis may require inpatient
treatment with aqueous crystalline penicillin G.
Stage of Syphilis
Primary, Secondary & Early
Latent
Latent Syphilis
Tertiary Syphilis
Neurosyphilis
Recommended Treatment
1 dose of Benzathine Penicillin G, 2.4 million units IM
Benzathine Penicillin G, 7.2 million units total,
administered as three doses of 2.4 million units IM each at
one-week intervals
Benzathine Penicillin G, 7.2 million units total, administered
as three doses of 2.4 million units IM each at one-week
intervals
Aqueous crystalline penicillin G 18-24 million units per day,
administered as 3-4 million units IV every four hours or
continuous infusion for 10 to14 days
Persons infected with syphilis in whom penicillin is contradicted can be treated with alternative
regimens, depending on the stage of syphilis diagnosed. Alternative regimens consist of oral
doxycycline or tetracycline and require two to four weeks of treatment. Compliance with these
regimens must be monitored. In pregnant women who are allergic to penicillin, desensitization
and treatment with benzathine penicillin G is recommended. There is no proven alternative to
penicillin in treating pregnant women with syphilis.
For the management of sex partners of infected individuals, testing and treatment depends on the
stage of the index case. Presumptive treatment, along with testing, should be given to persons
exposed to primary, secondary, early latent syphilis or to those exposed to individuals with latent
syphilis of unknown duration with high titers (i.e. 1:32). Partners exposed to an unknown stage
of syphilis should be tested and treated presumptively. Long-term sex partners of patients who
have latent syphilis should be evaluated clinically and serologically for syphilis and treated on
the basis of the evaluation findings.
Reporting
Syphilis is a reportable condition in North Dakota. Providers are encouraged to report all cases
of infectious syphilis by phone. Providers making a clinical diagnosis of primary or
secondary syphilis should report these diagnoses to the North Dakota Department of
Health immediately instead of waiting for test results and laboratory reporting to occur.
Reports can be made by calling 701.328.2378 or 800.472.2180.
Additional Information
Providers seeking more information are encouraged call the North Dakota Department of Health
at 701.328.2378 or refer to the Centers for Disease Control and Prevention 2010 Sexually
Transmitted Diseases Treatment Guidelines available at
www.cdc.gov/std/treatment/2010/default.htm. There is a self-study module for syphilis targeted
towards providers available at: www2a.cdc.gov/stdtraining/self-study/syphilis/default.htm.
Categories of Health Alert messages:
 Health Alert conveys the highest level of importance; warrants immediate action or attention.
 Health Advisory provides important information for a specific incident or situation; may not require immediate
action.
 Health Update provides updated information regarding an incident or situation; no immediate action
necessary.
 Health Information provides general information that is not necessarily considered to be of an emergent nature.
This message is being sent to local public health units, clinics, hospitals, physicians, tribal health, North Dakota
Nurses Association, North Dakota Long Term Care Association, North Dakota Healthcare Association, North
Dakota Medical Association, and hospital public information officers.