Pandemic Influenza

Infection Control Measures Prepared by Akrum Hamdy Pandemic Influenza

Objectives By the end of this unit, you will be familiar with : • infection control precautions for Flu Pandemic • specific infection control precautions in clinic, outreach situations and Non-Emergency Ambulance Transfer Services • HA infection control policy on Flu Pandemic

Cover the nose/mouth when coughing or sneezing Perform hand hygiene if contact respiratory secretions and contaminated objects Put on a surgical mask Recommendation for all individuals with respiratory symptoms Respiratory hygiene and cough etiquette • Use tissue paper to contain respiratory secretions and dispose in the waste receptacle

Modes of transmission of Influenza • Human influenza • Large respiratory droplets • Avian Influenza: • Transmission route ??

Isolation precautions for Human influenza • Standard • Droplet

HA Infection Control Plan for Avian Influenza • Respiratory hygiene and cough etiquette • Standard precautions • Contact precautions • Droplet precautions 5. Eye protection 6. Airborne precautions

Isolation Precautions Hand hygiene Patient placement PPE Isolation Precautions Patient Transport Decontamination Linen & laundry Waste Management

Hand hygiene • Perform hand hygiene: • Before and after patient contact • After removing gloves or any other PPE item • After touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn • After contact with patient surroundings • Routine hand hygiene by alcohol hand rub (preferably) or by washing hands with soap and water • Perform hand hygiene after touching surgical mask/ N 95 respirator or before touching the face

When expose to blood, body fluids, secretions, excretions, mucous membranes and non-intact skin, and contaminated items Perform hand hygiene immediately after glove removal PPE - Gloves • Change gloves when heavily contaminated 4. Disposable glove should not be reused

1. When splashes or sprays of blood and body fluids, secretions and excretions to skin and working clothes are likely 2.When working clothes has substantial contact with patient, environmental surfaces or patient items PPE - Gown 3. Select an appropriate gown for the procedure

PPE – Respiratory & eye protection Surgical masks and eye protection: • When splashes or sprays of blood and body fluid, secretions and excretions are likely - Droplet precautions N95 Respirator • Airborne isolation precautions Change PPE promptly if heavily contaminated during the procedure

Recommended Staff PPEs in HA Hospitals during Avian Flu Alert and Serious (S1) Response Level

Recommended Staff PPE in HA Hospitals during Avian Flu Serious (S2) & Emergency (E1 and E2) Response Level

PPE removal De-growing Area • Designated de-gowning area is preferred. • Gowning down carefully • Avoid touching the external surface of PPE. • Perform hand hygiene immediately after PPE removal and whenever contaminated. • PPE should not be worn / taken out of the workplace into non-clinical areas • Disinfect reusable items and store properly to avoid recontamination • Single used items should be properly disposed

Strategy ofPatient Placement • Isolate suspected or confirmed cases in a negative pressure isolation room • When single rooms are fully occupied • Cohort patients with same confirmed diagnosis in same cubicles, maintaining a minimum of 1 metre distance from each other • Confirmed and suspected cases should be nursed in separate cubicle

Transport of Suspected or confirmed patient • Limit patient transport unless clinically indicated • Encourage patients to wear surgical mask if no contraindication • Inform the receiving service/department of concern beforehand • Clean / disinfect transport vehicles after use

Decontamination - Patient Care Items • Dedicated non-critical patient care items for suspected and confirmed cases • Clean and disinfect reusable equipment before used on other patients. • Use 1,000 ppm of hypochlorite solution (i.e. add 1 part of 5.25% hypochlorite in 49 parts of water) to disinfect non-critical items • Use 70% alcohol on metallic surfaces • Reusable respiratory equipment should undergo high level disinfection before reused on other patients

Decontamination - Environmental Control Disinfect isolation and procedure rooms after use by a high risk patient • Clean and disinfect the environment regularly and additional session for frequently touched surfaces • Contaminated area should be disinfected by one part of hypochlorite solution add in 49 parts of water • If blood spills occur: • Use one part of hypochlorite solution add in 49 parts of water for non-metallic and 70% alcohol for metallic items. • If spills involve large amount of blood, the blood should be removed by disposable material soaked with one part of hypochlorite solution add in 4 parts of water before further cleaning and disinfection

Linen and laundry management • Proper handling of soiled linen: • Avoid sorting • Minimum agitation and shaking • Well pack soiled linen to prevent leakage • Wear appropriate PPE when handling soiled linen • Clean linen should be transported and stored separately to prevent recontamination • Follow hospital policy

All waste generated from room/ area housing suspected or confirmed avian influenza patients should be treated as clinical waste Biohazard labeling Wear appropriate PPE when handling clinical waste Waste Management

Principles of precautions for high-risk procedures • In high risk patients • Limit indications of use • Limit extent of procedure • Limit number of persons involved • Use recommended PPE

Staff Early Sickness Alert System (SESAS)

Visiting policy under Serious (S2) & Emergency Response Level • In general: • Children under 12 are generally not permitted • Pregnant women are strongly discouraged • Volunteer activities will be arranged differently according to corresponding response levels. 2. High-risk areas: • No visiting except on compassionate grounds: • Register on visitor’s record • Adopt infection control precautions • Non face to face visiting : Mobile phone, video conferencing 3. Other patient areas: • Keep number of visitors to minimum • Keep track on the number of visitors • Wear surgical mask and encourage hand hygiene • Arrange PPE and hand hygiene facilities • Supply health information on proper infection control precautions

Infection Control for Outreach Staff • PPE, hand hygiene facilities including towelette made readily available before outreach duty • Assess the risk of infection of patient • Be vigilant on abnormal clustering • Implement appropriate infection control measures

Infection Control for Outreach staff Cardiac Life Support: • Avoid direct mucosal exposure, e.g. mouth to mouth resuscitation • Use alternative ventilation device: e.g. resuscitation bags, pocket masks • Wear appropriate PPE

Infection control measures in A&E and clinic • Follow Respiratory Hygiene and Cough Etiquette precautions • Triage: Fever, Travel history, Occupational exposure, Contact history and Cluster of persons with fever and pneumonia symptoms. • Designated areas for suspected patients while waiting for referral and arrange speedy consultation and management • Wear appropriate PPE • Environment and equipment cleaning and disinfection

Non Emergency Ambulance Transfer Services (NEATS) • Suspected and confirmed patients should be separated from other patients • Patient to wear surgical masks unless contraindicated • PPE, hand hygiene facilities and towelette made readily available • Staff to wear appropriate PPE • Transport compartment and equipment should be cleaned and disinfected when spills or splashes of blood, body fluid, excretions, secretions occur and after transport infectious patient

Handling of dead bodywith known Avian Influenza • Implement standard precautions when caring for the deceased patients • Wear appropriate PPE when handling dead body • Ensure proper covering and packing to prevent leaking • Attach warning tag indicating risk category 2 (Yellow label) on outside of the body bag • Cremation is not mandatory

Thank You

Pandemic Influenza