Infection prevention and control in health care
in providing care for confirmed or suspected A(H1N1)
swine influenza patients
Interim guidance – Source WHO
Background
The current situation regarding the outbreaks of A(H1N1) swine influenza is evolving rapidly, and countries from different regions of the globe have been affected. Based on epidemiological data, human-to-human transmission has been demonstrated along with the ability of the virus to cause community-level outbreaks which together suggest the possibility of sustained human-to-human transmission. Health-care facilities now face the challenge of providing care for patients infected with A(H1N1) swine influenza. It is critical that health-care workers use appropriate infection control precautions when caring for patients with influenza-like symptoms, particularly in areas affected by outbreaks of A(H1N1) swine influenza, in order to minimize the possibility of transmission among themselves, to other health-care workers, patients and visitors.
As at 29 April, human-to-human transmission of A(H1N1) swine influenza virus appears to be mainly through droplets. Therefore, the infection control precautions for patients with suspected or confirmed A(H1N1) swine influenza and those with influenza-like symptoms should prioritize the control of the spread of respiratory droplets. The precautions for influenza virus with sustained human-to-human transmission (e.g. pandemic-prone influenza) are described in detail in the document “Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care WHO Interim Guidelines” 1.
This guidance may change as new information becomes available.
Fundamentals of infection prevention strategies :
1. Administrative controls are key components, including: implementation of Standard and Droplet Precautions; avoid crowding, promote distance between patients (≥ 1 m); patient triage for early detection, patient placement and reporting; organization of services; policies on rational use of available supplies; policies on patient procedures; strengthening of infection control infrastructure.
2. Environmental/engineering controls, such as basic health-care facility infrastructure adequate ventilation, proper patient placement, and adequate environmental cleaning can help reduce the spread of some respiratory pathogens during health care.
3. Rational use of available personal protective equipment (PPE) and appropriate hand hygiene.
CRITICAL MEASURES:
• Avoid crowding patients together, promote distance between patients
• Protect mucosa of mouth and nose
• Perform hand hygiene
KEY ELEMENTS FOR HEALTH CARE:
1. Basic infection control recommendations for all health-care facilities
Standard and Droplet Precautions when caring for a patient with an acute, febrile, respiratory illness.
2. Respiratory hygiene/cough etiquette
Health-care workers, patients and family members should cover mouth and nose with a tissue when coughing and perform hand hygiene afterwards.
3. Infection control precautions for suspected and confirmed A(H1N1) swine influenza infection
Place patient in adequately-ventilated room. If single rooms are not available, cohort patients in wards keeping at least 1 metre distance between beds. Standard, and Droplet Precautions for all persons entering the isolation room.
4. Triage, early recognition and reporting of A(H1N1) swine influenza infection.
Consider A(H1N1) swine influenza infection in patients with acute, febrile, respiratory illness who have been in an affected region within the one week prior to symptom onset and who have had exposure to an A(H1N1) swine influenza infected patient or animal.
5. Additional measures to reduce nosocomial A(H1N1) swine influenza virus transmission
Limit numbers of health-care workers/family members/visitors exposed to the A(H1N1) swine influenza patient.
6. Specimen collection/transport/handling within health-care facilities
Use Standard, and Droplet Precautions for specimen collection. Use Standard Precautions for specimen transport to the laboratory. Health-care facility laboratories should follow good bio-safety practices.
7. Family member/visitor recommendations
Family members/visitors should be limited to those essential for patient support and should use the same infection control precautions as health-care workers.
8. Patient transport within health-care facilities
Suspect or confirmed A(H1N1) swine influenza patients should wear a medical/surgical mask.
9. Pre-hospital care
Infection control precautions are similar to those practiced during hospital care for all involved in the care of suspected A(H1N1) swine influenza patients. (e.g. transportation to hospital).
10. Occupational health
Monitor health of health-care workers exposed to A(H1N1) swine influenza patients. Antiviral prophylaxis should follow local policy. Health-care workers with symptoms should stay at home.
11. Waste disposal
Treat any waste that could be contaminated with A(H1N1) swine influenza virus as infectious clinical waste, e.g. used masks.
12. Dishes/eating utensils
Wash using routine procedures with water and detergent. Use non-sterile rubber gloves.
13. Linen and laundry
Wash with routine procedures, water and detergent; avoid shaking linen/laundry during handling before washing. Use non-sterile rubber gloves.
14. Environmental cleaning and disinfection
Clean soiled and/or frequently touched surfaces regularly with a disinfectant. e.g. door handles.
15. Patient care equipment
Dedicate separate equipment to A(H1N1) swine influenza patients. If not possible, clean and disinfect before reuse in another patient.
16. Duration of A(H1N1) swine influenza infection control precautions
For the duration of symptoms.
17. Patient discharge
If the A(H1N1) swine influenza patient is discharged while still infectious (i.e. discharged within the period of infection control precautions: see 16 above), instruct family members on appropriate infection control precautions in the home.
18. Prioritization of PPE (Personal Protective Equipment) when supplies are limited
Medical/surgical mask for the care of all A(H1N1) swine influenza patients and hand hygiene are priorities.
19. Health-care facility engineering controls
If available, A(H1N1) swine influenza patients must be placed in adequately-ventilated single rooms. Aerosol-generating procedures should be performed in well ventilated spaces.
20. Health care in the community
Limit contact with the ill person as much as possible. If close contact is unavoidable, use the best available protection against respiratory droplets and perform hand hygiene
