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TO: AHCA/NCAL State Executives et al FROM: Bruce Yarwood SUBJECT: H1N1 “Swine” Flu Pandemic & Seasonal Flu DATE: October 2, 2009 I am sending this note to call your attention to AHCA/NCAL’s efforts to date and important steps to take now to ensure that member facilities are prepared to deal both with the worldwide pandemic of the H1N1 Swine flu, and the seasonal flu this fall. Since April, AHCA/NCAL has kept membership updated and informed about the H1N1 “Swine” flu through frequent and regular communications, including weekly Capitol Connection articles and coverage in the June editions of AHCA Notes and NCAL Focus. We also maintain a complete list of tools and resources, which can be found on our H1N1 (Swine Flu) Resources Webpage on Now that flu season is upon us, here is what you and your members need to know about the H1N1 “swine” flu vaccine program, upcoming H1N1 infection control recommendations, and preparations for the seasonal flu. H1N1 “SWINE” FLU VACCINATION Facilities should understand two key points regarding H1N1 swine flu vaccination in terms of the impact on patients/residents & facility staff. Those over age 65 are NOT included in any priority group for the H1N1 vaccine. This group appears to be at lower risk for contracting the swine flu. • While long term care patients/residents typically are not prioritized for the H1N1 vaccine, long term care facilities are considered priorities for use of the antiviral drugs like Tamiflu®. Tamiflu has been used prophylactically, for example, in the New York facility that had a confirmed case of H1N1. Details on the use of antivirals can be found here: • Important note: According to the Department of Health & Human Services (HHS), under no circumstances should a customer accept expired Tamiflu, which is a doctor-prescribed anti-viral medicine for seasonal flu treatment and prevention. While the government might decide to allow use of expired Tamiflu that is in the national strategic stockpile (where the government oversees proper storage, i.e., temperature control), that would be the only expired Tamiflu allowed. AHCA/NCAL members are cautioned to stay away from expired medicines. Health care workers – including long term care employees – are considered one of the 5 priority groups identified by the Centers for Disease Control & Prevention (CDC) for the H1N1 flu vaccine. Initial doses are being distributed, but in limited supply. H1N1 vaccine will be more readily available for targeted groups by mid-October. Even so, we have learned from some members that some states may be trying to set priorities within the health care employee priority group, which could prove detrimental to the long term care workforce. While we are working with all involved to avoid such re-prioritizing (which states have the authority to do), we encourage facilities to notify their local/state public health departments regarding each facility’s need for vaccine for staff and to notify AHCA/NCAL of any incidences where access to the vaccine is limited. The CDC link to state/jurisdiction vaccine contact information can be found here: Additional details regarding CDC’s H1N1 flu vaccine recommendation are posted here: H1N1 “SWINE” FLU INFECTION CONTROL On September 3, the Institute of Medicine (IOM) released its Letter Report—Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A, which recommends that health care workers who interact with patients suspected or confirmed to be infected with novel H1N1 influenza A should wear N-95 respirators. The IOM focused solely on the efficacy of medical masks and respirators in evaluating personal protective equipment designed to guard against respiratory infection; consequently, the report does not comment on economic, logistical, or other issues, which would affect deployment of N-95s in a care setting. AHCA/NCAL opposes this recommendation. Long term care facilities already have proven success in control for seasonal flu without the use of N-95 respirators. Moreover, we have strong concerns about the burden that deployment of N-95 respirators will place on a facility since use of N-95s sets off Occupational Safety & Health Administration’s (OSHA’s) respiratory standard, requiring fit-testing and medical evaluations. In addition, there is a shortage of commercially available N-95 respirators. It is our understanding that the CDC’s revised interim H1N1 infection control guidance, which currently is in final clearance at the Office of Management & Budget (OMB), is respectful of the IOM recommendation, while also acknowledging that there is a shortage of N-95 respirators. This CDC guidance is anticipated to be released as early as today, October 2, followed by additional guidance that offers suggestions for prioritizing N-95s during a shortage. That guidance also awaits clearance. While we understand the difficulties involved in using N-95 respirators, we also know that it may be important that facilities have N-95s on hand so workers feel safe, as well as to meet guidance recommendations. Thus, AHCA/NCAL strongly urges facilities to check in with local public health departments that may have N-95 respirators as part of state strategic stockpiles. AHCA/NCAL reached out to assist in the procurement of N-95s, but has learned that distributors will honor existing customers’ orders before considering fulfilling orders for any new customers. SEASONAL FLU VACCINE & ANTIVIRAL DRUGS The CDC notes that some people are at increased risk of influenza complications and are prioritized for treatment with influenza antiviral drugs such as Tamiflu® – to include people hospitalized with suspected or confirmed influenza, adults 65 years and older, people with certain chronic medical conditions, and others. On the September 9th conference call with members of the National Influenza Vaccine Summit, AHCA learned from CDC officials that some providers are experiencing challenges in ordering seasonal flu vaccine primarily due to increased demand for the vaccine and increased media around the H1N1 flu. Please let AHCA/NCAL know if you are having difficulty obtaining seasonal influenza vaccine. POSITIVE PRESS Given all that facilities are doing to prepare for the H1N1 “Swine” flu – not to mention the seasonal flu – it should be no surprise that recent press inquiries have resulted in generally positive media stories. For a good example of the outstanding preparations that facilities are (or should be) doing, please view the following links to the August 25th story, which aired on WJLA, the ABC affiliate in Washington, DC: (story only) (video) Sincerely, Bruce


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Approfondimento tecnico del dott. Tommaso Ferretti - relatore sulla tecnica diamagnetica al XXII congressonazionale ANASMED di medicina dello sport di Vittorio Veneto del 18-21 giugno 2006- POMPA DIAMAGNETICA SISTEMA INTEGRATO DI EROGAZIONE DI ENERGIA Premesse Nei confronti di un campo magnetico la materia ha, a seconda della sua composizione, tre comportamenti. Se ha proprietà

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