H1N1 Prevention and Protection Procedures

[Pathfinder]

H1N1 Prevention and Protection Procedures
Posted on: Wednesday, 12 August 2009, 08:20 CDT

As flu season draws nearer along with the potential for resurgence in H1N1, leading infectious diseases doctors, hospital epidemiologists, and infection preventionists urge officials to base recommendations for the public and healthcare workers on scientific knowledge and frontline experience gained from the outbreak this summer.

In a joint statement, the three leading scientific organizations focusing on infectious disease prevention, The Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Association for Professionals in Infection Control and Epidemiology (APIC), as well as the American College of Occupational and Environmental Medicine (ACOEM) cautioned that failing to act on what science indicates will not lead to enhanced protection, but instead could inhibit an effective response to a future outbreak.

"In response to the H1N1 influenza pandemic, the infectious diseases community immediately launched studies into how the virus spreads, how it causes disease, and what is the best means to treat and present illness. We now know that the H1N1 virus appears to spread like seasonal influenza ? primarily through droplets. It is not an airborne transmissible disease, like tuberculosis ? an important distinction that must be the basis for protocols in hospitals and healthcare settings," said Mark Rupp, MD, of the University of Nebraska Medical Center and President of SHEA.

Prudent measures, according to Rupp, require rigorous and consistent application of basic infection control and personal hygiene practices including: adherence to hand hygiene and cough etiquette, rapid identification and separation of patients with the virus, and utilization of appropriate personal protective equipment ? surgical masks, in the case of droplet transmissible diseases like H1N1.

The scientific groups also offered recommendations for circumstances that would warrant the use of fit-tested respirator masks . In the case of certain procedures that could potentially "aerosolize" the virus, thereby allowing for airborne transmission, healthcare workers should wear respirators. The procedures warranting this extra precaution include: bronchoscopy, open suctioning of airway secretions, resuscitation involving emergency intubation or cardiac pulmonary resuscitation, and endotracheal intubation.

"Surgical masks provide the level of protection needed for healthcare workers who may be exposed to the H1N1 virus. Using respirators in situations other than when there is the potential for the virus to become aerosolized is not wise," said Anne Gershon, MD, FIDSA, President of IDSA. "Respirators do not provide increased protection against the H1N1 virus. Inappropriate use could result in a shortage of the respirators, which are essential to the prevention and control of truly airborne pathogens such as tuberculosis. This would put healthcare workers and patients at even greater risk," Gershon added.

Another critical component to an appropriate response to the H1N1 virus, according to the groups, is avoiding implementation of automatic reassignment of high-risk healthcare workers who could be exposed to the virus. The current protocol provides sufficient protection, and reassignment wrongfully implies this is not the case.

"The members of our organizations are professionals who come face to face with patients on a daily basis. Our utmost concern is the protection of healthcare workers and the community against the spread of this virus," said Christine Nutty RN, CIC, President of APIC. "Adherence to basic infection prevention precautions is crucial. Community exposures, failing to adhere to precautions like rigorous hand hygiene, and failing to identify and isolate affected patients are causes of the majority of H1N1 illnesses among healthcare workers."

"Scientists around the world are researching the H1N1 virus to keep patients and healthcare workers safe as we enter the flu season this fall. Our goal is to protect our colleagues and ourselves, to provide excellent care to our patients, and to make sure our hospitals are safe for visitors and families," said Rupp of SHEA. "Ignoring what we know about the biology of this virus and how it spreads, and allowing fear to drive our decisions will make us no safer, and will undoubtedly put us at greater risk by limiting our capacity to manage future outbreaks of this virus and other infectious diseases."


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[Laidback Al]

Re: H1N1 Prevention and Protection Procedures

"Surgical masks provide the level of protection needed for healthcare workers who may be exposed to the H1N1 virus. Using respirators in situations other than when there is the potential for the virus to become aerosolized is not wise," said Anne Gershon, MD, FIDSA, President of IDSA. "Respirators do not provide increased protection against the H1N1 virus. Inappropriate use could result in a shortage of the respirators, which are essential to the prevention and control of truly airborne pathogens such as tuberculosis. This would put healthcare workers and patients at even greater risk," Gershon added.

Listen now to a live webcast about avoiding H1N1 infection by HCW.

Live Webcast Starts Today for Workshop on Protecting Health Care Workers From Flu
Listen to a live audio webcast of a workshop on protecting health care workers from influenza infection in the event of a pandemic. The webcast will run from 8 a.m. to 5 p.m. on Aug. 12 and from 8 a.m. to noon on Aug. 13.

• Live! Listen to the Briefing (requires free RealPlayer)
• Study Web site
• Powerpoint presentation

Please refresh this page after 7:50 a.m. for a link to the webcast audio. <!-- End Table --> <!-- Start Top News -->

http://www.nas.edu/

 

[Rainbow Lake]

Re: H1N1 Prevention and Protection Procedures

Studies: Swine flu spreads long after fever stops (or, "You are Safe to Others when the Coughing Stops")

By MARILYNN MARCHIONE (AP) ?

SAN FRANCISCO ? When the coughing stops is probably a better sign of when a swine flu patient is no longer contagious, experts said after seeing new research that suggests the virus can still spread many days after a fever goes away.

The federal Centers for Disease Control and Prevention has been telling people to stay home from work and school and avoid contact with others until a day after their fever breaks. The new research suggests they may need to be careful for longer ? especially at home where the risk of spreading the germ is highest.

Swine flu also appears to be contagious longer than ordinary seasonal flu, several experts said.

"This study shows you're not contagious for a day or two. You're probably contagious for about a week," said Gaston De Serres, a scientist at the Institute of Public Health in Quebec.

He presented one of the studies Monday at an American Society for Microbiology conference. It is the first big meeting of infectious disease experts since last spring's emergence of swine flu, which now accounts for nearly all of the flu cases in the United States. More than 1 million Americans have been infected and nearly 600 have died from it, the CDC estimates.

It is unclear whether the new research will lead the CDC to rethink its advice on how long people with swine flu should hole up. Long breaks from school and work do not seem worth it for a virus that now seems to cause mostly mild illness, said the CDC's flu chief, Nancy Cox. Swine flu is spreading so widely now that confining the sick does less good, she said.

"We tried to have our guidance balance out all of these factors," she said. "It's just virtually impossible not to have virus introduced into settings such as schools and universities."

Doctors know that people can spread ordinary seasonal flu for a couple of days before and after symptoms start by studying virus that patients shed in mucus. The first such studies of swine flu are just coming out now, and they imply a longer contagious period for the novel bug.

"It's probably realistic that this virus sheds much longer than seasonal flu," said Dr. Jonathan McCullers, an infectious diseases specialist at St. Jude Children's Research Hospital in Memphis, Tenn.

Three reports suggest this is so. De Serres and other researchers in Canada took nose and throat swabs from 43 patients with lab-confirmed flu and dozens of other sick family members.

On the eighth day after symptoms first appeared, 19 to 75 percent showed signs of virus remaining in their noses, depending on the type of test used.

"This proportion appears to be very big, and it is," but it's not clear how much virus is needed to actually spread flu, so the lower number is more reliable, he said.

Dr. David C. Lye reported on 70 patients treated at Tan Tock Seng Hospital in Singapore. Using a very sensitive test to detect virus in the nose or throat, he found that 80 percent had it five days after symptoms began, and 40 percent seven days after. Some still harbored virus as long as 16 days later. How soon they started on antiviral medicines such as Tamiflu made a difference in how much virus was found, but not whether virus was present at all.

A third report came from Dr. Guillermo Ruiz-Palacios of the National Institutes of Medical Science and Nutrition in Mexico, where the first cases of swine flu were detected.

Infected people "shed the virus for a very, very long time," often for more than a week after the start of symptoms, he told the conference. This was especially true of obese people, and patients who started on medicines longer than two days after symptoms first appeared.

The new reports suggest a longer contagious period for swine flu, but how long is not clear, Cox said. Even with it in your nose, "you might not be shedding enough virus to infect other people," she said.

That is why signs like coughing may matter more, De Serres said.

"Contagiousness varies, not only with the presence of the virus, but the other symptoms that would make you transmit," he said.

Swine flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue, and sometimes diarrhea and vomiting. Young children may be cranky, less playful or not eat as much as normal, the CDC advises.

The agency's advice to stay home for a day after fever breaks does not apply to health care settings. There, confinement for seven days from the start of symptoms ? or until they go away, whichever is longer ? is still advised.

People who have had swine flu should cover their mouths when they cough or sneeze and wash their hands a lot once they do return to work and school, the CDC says.



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