The “Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel” related to H1N1 Influenza 2009 Pandemic was updated October 14 click here.
The revisions to the CDC guidance place more emphasis on influenza planning for the 2009-2010 influenza season: “The updated guidance emphasizes that “…successfully preventing transmission requires a comprehensive approach, beginning with pandemic planning that includes developing written plans that are flexible and adaptable should changes occur in the severity of illness or other aspects of 2009 H1N1 and seasonal influenza.”Revisions/updates include: criteria for identification of suspected influenza patients; recommended time away from work for healthcare personnel; changes to isolation precautions based on tasks and anticipated exposures; expansion of information on the hierarchy of controls which ranks preventive interventions in the following order of preference: elimination of exposures, engineering controls, administrative controls, and personal protective equipment; and changes to guidance on use of respiratory protection.
�� “For the purposes of this guidance, healthcare personnel are defined as all persons whose occupational activities involve contact with patients or contaminated material in a healthcare, home healthcare, or clinical laboratory setting. Healthcare personnel are engaged in a range of occupations, many of which include patient contact even though they do not involve direct provision of patient care, such as dietary and
housekeeping services. This guidance applies to healthcare personnel working in the following settings: acute care hospitals, nursing homes, skilled nursing facilities, physician's offices, urgent care centers, outpatient clinics, and home healthcare agencies. It also includes those working in clinical settings within nonhealthcare institutions, such as school nurses or personnel staffing clinics in correctional facilities. The term "healthcare personnel" includes not only employees of the organization or agency, but also contractors, clinicians, volunteers, students, trainees, clergy, and others who may come in contact with patients.”
�� The updated guidance continues to recommend use of respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for healthcare personnel who are in close contact with residents/patients with suspected or confirmed H1N1 influenza.
�� CDC has also continued to emphasize that respiratory protection is the last line of defense in a hierarchy of controls to prevent influenza transmission. The revised guidance recommends a “hierarchy of controls” approach to prevent exposure of healthcare personnel and patients and prevent influenza transmission within healthcare settings. The guidance ranks the preventive interventions in the following order:
1. Elimination of exposures;
2. Engineering controls;
3. Administrative controls; and
4. Personal protective equipment
�� Acknowledging the N95 shortage, CDC gives significant consideration to supply issues. The revised guidance recommends facemasks for healthcare personnel who are not provided a respirator due to N95 supply shortages. Facemasks should be chosen over no protection. �� The revised guidance states that healthcare personnel who develop a fever and respiratory symptoms should be excluded from work for at least 24 hours after they no longer have a fever, without the use of fever reducing medicines. (Previous guidance stated 7 days)
�� The updated guidance adow for the following:
�� Screening for symdresses the establishment of procedures for managing visitor access and movement within a facility to include limiting visitors for patients [residents] in isolation for influenza to persons whom are necessary for the patient's emotional well-being and care; as well as scheduling and controlling visits to allptoms of acute respiratory illness before entering the facility;
�� Instructions, before entering the resident’s/patient's room, on hand hygiene; limiting surfaces touched’
and use of PPE according to current facility policy while in the resident’s/patient's room
The guidance will continue to be updated as new information becomes available during and throughout the course of the flu season.