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Infection Control Considerations
Infection control guidelines for pandemic influenza are provided in Annex 2 of the draft Federal Plan
Droplets are the major mode of influenza transmission; therefore, the draft Federal plan recommends Droplet Precautions along with Standard Precautions for prevention of transmission in healthcare settings. Airborne precautions are not recommended at this time. The draft Plan also calls for instituting programs of respiratory hygiene and cough etiquette.
Standard Precautions
According to the Federal plan, the following Standard Precautions should be taken for a patient with suspect or confirmed influenza caused by a pandemic strain:
- Wear gloves if hand contact with respiratory secretions or potentially contaminated surfaces is expected.
- Wear a gown if soiling of clothes with patient's respiratory secretions is expected.
- Change gloves and gowns after each patient encounter and before touching any noncontaminated items or touching another patient, and perform hand hygiene.
- Decontaminate hands before and after touching the patient, after touching the patient's environment, or after touching the patient's respiratory secretions, whether or not gloves are worn.
- When hands are visibly soiled or contaminated with respiratory secretions, wash hands with either a non-antimicrobial or an antimicrobial soap and water. Hand hygiene with plain soap or detergent for at least 10 to 15 seconds, under running water is an effective method of removing soil and transient microorganisms. If sinks for hand hygiene are not readily available, alcohol-based agents can be used.
- If hands are not visibly soiled and after glove removal, use an alcohol-based hand rub for routinely decontaminating hands in clinical situations. Alternatively, wash hands with an antimicrobial soap and water.
Droplet Precautions
- Place patient in a private room. When a private room is not available, place the patient in a room with a patient or patients who have active infection with the same microorganism but no other infection (cohorting). In a pandemic it is likely that most patients with suspected influenza will not have a specific laboratory confirmed diagnosis; such patients should be cohorted with other patients who have or may have influenza. If for some reason cohorting is not achievable, at least 3 feet spatial separation should be maintained between the infected patient an other patients and visitors. Special air handling and ventilation are not necessary, and the door may remain open.
- Wear a surgical mask upon entering the patient's room or when working within 3 feet of the patient. Remove the mask when leaving the patient's room and dispose of the mask in a waste container. N95 respirators, which would be recommended for infections with airborne spread such as tuberculosis, are not required for influenza. Logistically, some hospitals may want to implement policy for the wearing of a mask to enter the room.
- Limit the movement and transport of the patient fro the room to essential purposes only. If transport or movement is necessary, minimize patient dispersal of droplets by having the patient wear a surgical mask.
Respiratory Hygiene/Cough Etiquette
The draft Federal Plan indicates that respiratory hygiene/cough etiquette programs should be in place to decrease transmission of influenza. The CDC Web site outlines steps for implementing these programs (see References : CDC: Respiratory Hygiene/Cough Etiquette in Healthcare Settings).
- The following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a respiratory infection.
- Cover the nose/mouth when coughing or sneezing.
- Use tissues to contain respiratory secretions and dispose of them in the nearest waste receptacle after use.
- Perform hand hygiene (eg, hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash) after having contact with respiratory secretions and contaminated objects/materials.
- During periods of increased respiratory infection activity in the community (eg, when there is increased absenteeism in schools and work settings and increased medical office visits by persons complaining of respiratory illness), healthcare facilities should offer masks to persons who are coughing.
- Either procedure masks (ie, with ear loops) or surgical masks (ie, with ties) may be used to contain respiratory secretions.
- Respirators such as N-95 or above are not necessary.
- When space and chair availability permit, coughing persons should be encouraged to sit at least three feet away from others in common waiting areas.
- When implementing respiratory hygiene programs, healthcare facilities should:
- Ensure the availability of materials for adhering to respiratory hygiene/cough etiquette in waiting areas for patients and visitors.
- Provide tissues and no-touch receptacles for used tissue disposal.
- Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand washing (ie, soap, disposable towels) are consistently available.
Additional components of infection control can be found in Annex 2 of the draft Federal Plan.
WHO Infection Control Guidelines for H5N1 Avian Influenza
In March 2004, WHO issued infection control guidelines for preventing transmission of H5N1 influenza in healthcare facilities (see References : WHO: Influenza A (H5N1): Interim infection control guidelines for health care facilities). These guidelines indicate that the following precautions should be implemented when caring for patients with H5N1 influenza:
- Standard precautions
- Droplet precautions
- Contact precautions
- Airborne precautions (including use of high-efficiency masks and negative-pressure rooms when available)
