The precise impact of the flu in any given season is always a subject of speculation. That’s especially the case this year, following the first appearance of a new strain of H1N1, swine flu, in Mexico in April. By June the World Health Organization (WHO) had declared a pandemic.

Only time will reveal the depth and severity of the current outbreak. But waiting is not an acceptable strategy. Preparations and prevention efforts are under way within government and the private sector. Infection preventionists play a critical role in readying their facilities and personnel.

Cooperation between a healthcare facility and community leaders is essential for preparedness. This subject is addressed at the U.S. Department of Health and Human Services (HHS) website, pandemicflu.gov.1 The site is also a resource for information about the role of infection-control procedures to impact patient outcomes, and the importance of surveillance and reporting. Facility response should focus on WHO’s Interim Infection Control Guidelines which advise:

•  Confining all patients with confirmed or suspected cases as quickly as possible.

•  Limiting patient movement, with involved personnel using full personal protective equipment (PPE).

•  Cleaning areas of patient contact with 70% alcohol or virucidal disinfectant.

Hand hygiene and respiratory etiquette are essential elements in battling any infection, including H1N1.

Hand hygiene should comply with WHO guidelines, which state: Hands should be washed with soap, either plain or antimicrobial, and water when visibly soiled or contaminated with proteinaceous material. The use of an alcohol-based hand rub for routine hand antisepsis is recommended in the healthcare setting for all other clinical situations. Hand hygiene should be performed after touching blood, body fluids, secretions, excretions and contaminated items, also after gloves are removed, and between patient contacts.2 This also includes surfaces that may have been contaminated by virus containing droplets emanating from infected patients.

Respirator hygiene/cough etiquette helps prevent patients with respiratory infections from transmitting them. The CDC recommends that facilities:

• Post alerts that advise anyone with signs and symptoms of respiratory
infection to:

• Provide tissues and no-touch receptacles for disposal, and dispensers of alcohol hand-rub. Where sinks are available, provide soap and disposable towels.

• Offer masks to anyone who is coughing.

• Try to separate people with respiratory symptoms.

• Advise staff to observe droplet precautions, including wearing a surgical or procedure mask for close contact when examining anyone with respiratory symptoms.3

In the event of pandemic or flu outbreak, availability and proper use of PPE are vital in protecting staff, patients and visitors. Respirators, gowns and gloves are the first line of defense against the spread of infection; disposable garments are always preferred. Individuals who should use PPE include:

• All those who provide direct patient care.

• All support staff.

• All individuals involved in patient transport.

• All laboratory professionals who handle specimens from a patient being investigated for influenza A (eg. H1N1 or H5N1).

• All central service professionals who handle equipment that requires decontamination and has come from a patient with influenza A (eg. H1N1 or H5N1).

• Family members of visitors.

How much PPE is needed? CDC recommends stockpiling enough supplies (including consumables like soap, hand rub, respirators, gloves and gowns, and durable items like ventilators, beds and IV pumps) for the duration of a pandemic wave, estimated at six to eight weeks. Vigilant PPE use is especially important in order to protect healthcare workers, who will likely be in short supply during a pandemic. CDC has noted that multiple waves are expected in pandemic influenzas.

Policies and tactics selected for use at your facility should be part of a written flu and pandemic management plan. Although no plan is all-inclusive, it should be comprehensive and address the following.4

• A structure for planning and decision-making that includes an internal committee and community representatives.

•  A written plan with components including thresholds for heightened local surveillance, a system for internal review of flu activity in ER patients and a means to monitor pandemic transmission. The plan should describe responsibilities of key personnel and simulation exercises. Other sections should cover:

• Additionally, staff should be fully informed of any possibility of facility quarantine so that they may be prepared and have made their own plans to deal with a quarantine situation.

There is additional detail on planning at www.pandemicflu.gov.

References:

1. U.S. Department of Health and Human Services, www.pandemicflu.gov, Healthcare Planning section, accessed August 27, 2009.

2. Avian Influenza, Including Influenza A (H5N1), in Humans: WHO Interim Infection Control Guideline for Health Care Facilities, World Health Organization, amended May 10, 2007.

3. http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm.

4. HHS Hospital Preparedness Checklist, HHS Pandemic Influenza Plan Supplement 3 Healthcare Planning.