Microsoft word - ppe guidance v6.doc

North Carolina Department of Health and Human Services
Division of Public Health • Epidemiology Section
Communicable Disease Branch
1902 Mail Service Center • Raleigh, North Carolina 27699-1902 Beverly Eaves Perdue, Governor Jeffrey Engel, MD Lanier M. Cansler, Secretary
Novel Influenza A (H1N1): Interim Infection Control Guidelines for Healthcare Workers

September 4, 2009 (3 pages) – replaces version released on May 22, 2009

New in this version: Guidance regarding respiratory hygiene/cough etiquette; guidance for
exclusion of health care workers with flu-like illness; revised definition of “aerosol-generating
procedures”.

This guidance applies to all healthcare personnel (e.g., employees, students, contractors, attending
clinicians, and volunteers) whose activities involve contact with patients.
• Epidemiologic and clinical data to date indicate that the novel influenza A (H1N1) virus appears to be behaving similarly to seasonal influenza in terms of the severity of illness and transmission of infection. • These infection control recommendations are being made in conjunction with enhanced surveillance among hospitalized patients and among patients presenting to providers in the influenza Sentinel Provider Network to identify early signals of increasing severity or changing epidemiology of this virus. • These recommendations represent the minimum level of infection control precautions; clinicians or infection preventionists may recommend increased levels of infection control as indicated by a specific patient or situation including health status of healthcare workers.
Respiratory hygiene/cough etiquette

To prevent the transmission of all respiratory infections in healthcare settings, including novel influenza A (H1N1), respiratory hygiene/cough etiquette infection control measures should be implemented at the first point of contact with a potentially infected person. They should be incorporated into infection control practices as one component of Standard Precautions. Healthcare facilities should establish mechanisms to screen patients for signs and symptoms of febrile respiratory illness at any point of entry to the facility. Provisions should be made to allow for prompt isolation and assessment of symptomatic patients.
Level of precautions
Droplet and Standard Precautions are recommended for all patients with suspected or confirmed novel
influenza A (H1N1) infection:
Location: 225 N. McDowell Street • Raleigh, N.C. 27603 Standard Precautions
Hand hygiene before and after patient care (using water and an antiseptic or a waterless alcohol
product approved by the FDA for hand antisepsis) plus gloves, gown, face shield/eye protection as
indicated by patient care activities and risk of exposure to blood/body fluids.
PLUS
Droplet Precautions
Surgical mask should be used for all direct patient care activities (don mask prior to entering room; if
patient is in an open area, don masks within 3-6 feet of patient). Use a private room if possible and
keep room door closed; if a private room is not available, make sure that the patient wears a surgical
mask.


Specimen collection
Droplet Precautions (surgical mask) and eye protection should be used by the healthcare workers obtaining a clinical specimen from the respiratory tract (includes nasopharyngeal swab, nasal wash, and throat swab).
Aerosol-generating procedures*:
Airborne Precautions - respiratory protection • Fit-tested disposable N95 respirator: Prior fit-testing must be repeated annually and fit-check/seal-check performed prior to each use • Powered air purifying respirator (PAPR). Follow facility protocols and procedures for PLUS
Standard precautions and eye protection
* Aerosol-generating procedures include bronchoscopy, open suctioning of airway secretions, resuscitation involving emergency intubation or cardiac pulmonary resuscitation, and endotracheal intubation. Aerosolizing procedures can be performed in a single patient room with the door closed. Airborne precautions should be used for the duration of the aerosol-generating procedure with droplet and standard precautions resumed thereafter. Increased levels of infection control may be implemented as indicated for a specific patient or situation, including an airborne infection isolation room (AIIR). At a minimum, AIIR rooms must: Provide negative pressure room with a minimum of 6–12 air exchanges per hour or exhaust directly to the outside or through HEPA (High Efficiency Particulate Air) filtration.
Transport within healthcare facilities

Procedures for transport of patients in isolation precautions should be followed. • Ill persons should wear a surgical mask to contain secretions when outside of the patient • Encourage ill persons to perform hand hygiene frequently and follow respiratory hygiene Visitors

Visitors should not be permitted if they have symptoms of respiratory tract infection, especially fever with cough or sore throat. Visitors to patients with suspected or confirmed novel influenza A (H1N1) infection should: • Be encouraged to perform hand hygiene before entering and after leaving a patient’s room • Be instructed to limit their movement within the facility • Wear a surgical mask when entering the room • Be restricted from entry while aerosolizing procedures are being performed
Pregnant healthcare workers

CDC has guidance for pregnant women available at http://www.cdc.gov/h1n1flu/guidance/ under “Guidance for Pregnant and Breastfeeding Women”
Environmental cleaning and disinfection

Healthcare facilities should follow routine procedures for environmental cleaning and disinfection.
Exclusion of healthcare workers with flu-like illness

Health care workers should report symptoms (fever, cough, sore throat, rhinorrhea, myalgias, or headache) early to avoid exposing others. If symptoms develop while at work, health care workers should put on a mask, reassign patient care responsibilities, and contact a supervisor immediately. All health care workers who develop flu-like illness (i.e., fever plus any respiratory symptom) should stay out of work until they have been afebrile for at least 24 hours without the use of fever-reducing medications. • If respiratory symptoms persist without fever, health care workers should be encouraged to wear surgical masks during direct patient contact until such symptoms have resolved. • Longer exclusion periods or additional precautions might be required in some settings; health care workers should check with their employers to determine what protocols are in place. • Treatment generally is not recommended for ill health care workers who are not at higher risk for complications and do not have severe influenza requiring hospitalization. Health care workers who have had a recognized, unprotected close contact to a person with confirmed or suspected influenza during that person’s infectious period should perform careful self-monitoring and should be immediately excluded from work if symptoms of influenza develop. • Post-exposure antiviral chemoprophylaxis with either oseltamivir or zanamivir can be considered if <48 hours have elapsed since the last exposure. Additional guidance regarding antiviral post-exposure prophylaxis and treatment is available at http://www.cdc.gov/h1n1flu/recommendations.htm. Location: 225 N. McDowell Street • Raleigh, N.C. 27603

Source: http://www.co.catawba.nc.us/phealth/GuidanceforHealthcareWorkers.pdf