HSV Encephalitis

[nurseshajwani87]

I have a student that has a herpes infection that was found when he was an infant that has caused brain damage. He is in our Special Ed room and our supervisor has said that with him we must always use universal precautions, must have his own utensils and toys, etc. My problem is with the assistants. They are freaking out!!! Every little thing with him they bring him to me and I explain that it isn't an outbreak. It has become very exhausting! Do any of you have a student with this???????

[Farawyn]

I don't, but I'm liking it and bumping it because I would love to see the replies.

Maybe our Peds nurses can weigh in?

Have you contacted your local DOH?

[OldDude]

How old is this guy, level of awareness, self care participation, mobile vs immobile, etc?

[ruby_jane, BSN, RN]

I don't, and my brief scan of the CDC provided very little in the way of assistance. But I second Farawyn's "check with public health". As a former public health nurse, I can say we like the interesting cases. Also, what are doctor's orders for this kiddo? Is that any help?

[BeckyESRN]

I haven't had a case exactly like this, but I have dealt with paras that freak out over every little thing. I started a morning check in. The student and para would come in the morning, I'd give the kiddo a quick once over, ask if he was having any pain or issues(he mostly no verbal, but good with a touch to talk), we'd secure the seat belts on his chair and off he'd go. After a few days of this, the "extra" visits really dropped of, then slowly the morning check ins dropped off to 2-3 times a week instead of daily.

I 2nd(or 3rd) the suggestion to talk to the your DOH. "The department of health recommends" is great way to take a stand on unfounded visits!

[NutmeggeRN, BSN]

A little off topic but one of the kids who has a full time para has the cruds. Phlemy, irritable and overall not feeling well. I have done the usual interventions but I guess he spent 1st block in the bathroom after I dismissed him from the clinic. He arrived here and siad he was told go home! Uhhh NOPE! Mom wants hm here, he is not that sick, (afebrile, clear throat etc). I remeinded the para that these decisions need to be made in the health office, not the classroom.

Oye.

[River Song, RN]

We sadly do see those kids in the NICU and unless they have lesions (I can only recall one child that had herpetic lesions on their skin in addition to the encephalitis), we don't even isolate them (or at least I haven't seen that at the two facilities where I had patients with it) as it's generally confined to the blood or CSF so standard precautions is all that is necessary. It can be very devastating and I've seen more than one preemie die from it.

I guess another thing to ask the staff is whether they freak out that much anytime someone gets a cold sore? That is transmittable as well and I bet there is a student or two that gets them.

I will be honest that I haven't followed those kids long term but they would get a course of IV acyclovir and that was their only treatment. We didn't treat them as if they had cooties if they came out of the acute phase.

Here is the CDC guide on precautions which might be helpful: Precautions | Appendix A | Isolation Precautions | Guidelines Library | Infection Control | CDC

I know of at least one case where there was no genital herpes involved so they were fairly confident it had to do with a cold sore type of contact and infection with that strain of herpes is becoming super common.

I'm sorry the staff are being so alarmed

[NutmeggeRN, BSN]

If there is any exposure to body fluids anticipated or reasonably expected, they should be wearing gloves and excercising univeral precautions. ALways. Look at EMS, they dont even take a BP or pulse without them, for EVERYONE!