~ FRISBIE STAFF ~ Flu Exposure & Illness Management Algorithms

1. ~ FRISBIE STAFF ~ Flu Exposure & Illness Management Algorithms • Based on the guidelines from the NH DHHS • UPDATED 10/09/09 • Contact: Janice Parker, APRN – Employee Health Services ext 8463

2. ~ FRISBIE STAFF ~ Flu Exposure & Illness Algorithms ~ *DEFINITIONS* • HCW: healthcare worker whose activities include contact with patients • Unprotected exposure : • At home: exposed any time between one day before symptoms through 24 hours after contact has no fever over 100 without fever-reducing drugs • At work: being within 6 feet of suspected, probable or confirmed patient with H1N1 without wearing appropriate PPE* • ILI: influenza-like-illness • Fever (100ºF or higher) with cough and/ or sore throat • PEP: post-exposure prophylaxis • Anti-viral medication which must be taken within 48 hours of exposure & continued for 10 days after last exposure • PPE: personal protective equipment; for ILI appropriate PPE is: • surgical mask upon entering room, ALSO when within 6 feet, of patient with ILI; • Gloves; • N95 mask or PAPR for aerosol-generating procedures • High risk for complications: age 6 mos – 4 yrs or 65+ yrs; pregnant; chronic pulmonary (including asthma), cardiovascular (not high blood pressure), kidney, liver, hematological or metabolic disorders (includes diabetes); immunosuppressed (including due to medication); any condition that compromises ability to breathe or swallow • Severely ill – trouble breathing, persistent high fevers, significant chest or abdominal pain, lightheadedness, severe headache, disorientation or confusion

3. Algorithm # 1 ~ What to do if Frisbie direct patient care givers are exposed to the flu

4. Algorithm # 2 ~ When unvaccinated Frisbie direct patient care givers are exposed to the flu

5. Algorithm # 3 ~ Frisbie Direct Patient Care HCW* who develop ILI*

6. Algorithm # 4 ~ Frisbie Staff PEP, TESTING & TREATMENT HCW sent toEmployee Health or EDfor PEP, TESTING, TREATMENT Does HCW have symptoms of ILI*? YES Did HCW have patient contact* 24 hours before or after symptoms began? NO PEP only 1.Prescribe PEP* - see TABLE #1 (call Rx to employee's drug store) & instruct employee to: a.wear a surgical mask at work until PEP is started; b. have Rx filled, c. & begin PEP ASAP OR 2.instruct to wear a surgical mask while at work until 7 days after exposure YES TEST See TABLE #1 NO Is HCW in high risk category*? YES TREAT – see TABLE #1 1.Prescribe anti-viral 2.Send home & instruct: a. Stay home until no fever (100ºF or higher) for 24 hours without anti-fever medication Wear a mask after return to work until no symptoms such as cough NO Send home & instruct: 1. Stay home until no fever (100ºF or higher) for 24 hours without anti-fever medication 2. Wear a mask after return to work until no symptoms such as cough

7. Table #1FRISBIE STAFF ~ FLU TESTING & TREATMENT(* see definitions) • TESTING • the following groups ONLY • HCW* with ILI* with direct patient contact during 24 hours before symptoms began to 24 hours after symptoms started • IF recent onset fever (100ºF or higher) with cough and/ or sore throatAND • Hospitalized patients • Requested by Public Health • nasopharyngeal swab, aspirate or wash for influenza PCR testing • PEP - Post Exposure Prophylaxis • Begin within 24 hours of exposure & continue until 10 days after last unprotected exposure* • PEP* for adults • Oseltamivir 75 mg orally once daily • Zanamivir 10 mg inhaled once daily • TREATMENT • Begin within 48 hours of start of symptoms • IF at high risk of complications* or severely ill (hospitalized) • Treatment for ill adults • Oseltamivir 75 mg orally twice daily for 5 days • Zanamivir 10 mg inhaled twice daily for 5 days

8. Algorithm #5 ~ Chemoprophylaxis of CONTACTS of ill HCW

9. Table #2 ~ Chemoprophylaxis of CONTACTS of ill HCW