Management of Influenza in the Perinatal Population

1. Management of Influenza in the Perinatal Population New Policy Pam Sanders, MSN, RNC-NIC, CENP Vice President, Women & Children’s Services

2. Purpose: • To provide guidelines for staff when a pregnant woman with respiratory symptoms presents to our facility for labor and delivery. • This policy is designed to minimize the potential for infant exposure to influenza viruses when a pregnant woman with respiratory symptoms that may be due to the flu, delivers a baby at TGH. • Infants that become infected with the influenza virus are at higher risk for severe complications.

3. Respiratory Symptoms include: • Fever • Cough • Runny nose • Sore throat • body/muscle aches • fatigue

4. Actions: • Pregnant women who present with flu-like symptoms are: • Given a surgical mask • Put on Droplet precautions • Instructed on respiratory hygiene & cough etiquette • Given an Influenza PCR screen on admission (consider starting antivirals while results pending) • Visitors will be screened for flu-like symptoms by Security by completing a questionnaire. • Visitors will not be allowed to visit in the event of illness.

5. After Delivery of the infant: • Separate the baby in the Delivery Room by a distance of 6 feet or greater. • Stable infants may remain in the Delivery Room. • Unstable infants will transfer to the appropriate Level of Care.

6. Postpartum: • To reduce the risk of exposure to the infant, the CDC recommends separating the infant from the mother in a separate room or by a distance of 6 feet or greater until: • The ill mother has received anti-viral medications for greater than 48 hours • The ill mother is afebrile without the aid of antipyretics for greater than 24 hours • The ill mother has control over her cough & respiratory secretions

7. Maternal Refusal of Separation: • If the mother refuses separation or other circumstances are present that inhibit separation, the following measures should be implemented to reduce influenza exposure to the infant by minimizing contact. • Utilize physical barriers such as privacy screens and curtains • Keep the newborn at least 6 feet away from the mother • Ensure a healthy adult support person is present & available to care for the infant • Teach the mother and significant other the importance of respiratory etiquette • Document all interventions & education.

8. Breastfeeding: • Breastfeeding is important. • Breast milk has antibodies that babies need to fight infection. • Encourage & assist the ill mother with expressing her breast milk. • Infant feeding of expressed breast milk should be done by a healthy care giver. • In the event no other caregiver is present and/or the mother chooses to put the infant to breast, the mother should be instructed to: • Wash her hands • Put on a clean gown • Wear a surgical mask • Follow strict respiratory etiquette

9. Infant Care: • Unless clinically indicated by the need for a higher level of care or the mother’s refusal of separation, newborns of influenza-infected mother’s will be cared for in the term newborn nursery. • Symptomatic mothers & exposed family members are not allowed to enter the nursery. • All infants of ill mothers, regardless of separation status, will be observed for signs & symptoms of influenza. • Any newborn that develops symptoms will be cared for in a private room in the NICU on Droplet Precautions.

10. Respiratory Etiquette: • Frequent hand washing • No touching or rubbing the face • Cover mouth & nose when sneezing • Discard used tissues in the trash

11. Visitors: • Visitors should be limited to individuals necessary for the patient’s emotional well-being & care. • All unvaccinated family members & care givers who will be in contact with the infant should be encouraged to get an influenza vaccination. • Visitors who have been in contact with the patient during the symptomatic period ( 1 day before the onset of symptoms until 7 days after the development of symptoms) may be contagious & should be encouraged not to visit. • Visitors should be instructed to: • Limit movement throughout the hospital. • Avoid common areas: Starbucks, McDonald’s the cafeteria • Use good infection prevention practices: hand hygiene, PPE, respiratory etiquette • Limit surfaces touched in the room

12. Patient Education: • It is important to teach the mother & significant others the importance of minimizing risk to the infant through: • Hand hygiene • Respiratory etiquette • Frequently cleaning touched surfaces • Do not allow contact with ill persons, until they have been without fever for 24 (hours without medication) or until 7 days after the onset of symptoms, whichever is longer. • Encourage vaccination among other caregivers & family members that will have contact with the baby • Contact your pediatrician immediately if the infant develops symptoms that suggest the flu: sneezing, coughing, runny nose, fever Recommendations adapted from the CDC Guideline for the Prevention and Control of Influenza in the Intrapartum and Postpartum Hospital Settings, March 7, 2011.