Swine Flu

1. An outbreak of a virulent form of influenza has developed in Mexico. With spring breakers and other travelers cases are popping up like zits on a teenager. Swine Flu

2. Swine Flu is a respiratory infection caused by the Influenza A virus. The influenza virus is a primitive virus that affects both mammals and birds. What causes Swine Flu?

3. A virus is a microscopic object that is significantly smaller than a bacterium. Viruses do not contain the cellular stuff to reproduce. Instead, when they enter the cell of a host, they hijack the cell’s biochemical process in order to replicate and produce millions of new viruses. What is a virus?

4. There are three major types of influenza virus: Influenza A The most virulent which normally reside in aquatic birds, but have been known to “jump species”, as seen in the current outbreak. Influenza B And Influenza C How many types of influenza are there?

5. The current swine flu strain in question is H1N1. H1N1 is thought to have caused the Spanish flu in 1918 which killed approximately 50-100 million people worldwide. What is the current strain?

6. Fever Cough Sore throat Body aches Headache Chills Fatigue Diarrhea vomiting What are the symptoms of swine flu?

7. Influenza A is primarily a respiratory virus. The strain of swine flu in Mexico appears to be more virulent than strains seen in the United States. It tends to affect people between 25 and 45 years of age as opposed to the normal strains that affect older adults. What's different with this batch

8. Mainly person-to-person through coughing or sneezing from infected individuals. Some infections can occur by touching something with flu viruses on it and then touching the mouth or nose. How is Swine flu spread?

9. Use Standard Precautions Frequent hand washing Use mask when treating patients that are coughing or sneezing. Get plenty of sleep. Maintain adequate nutrition. Slowing the spread

10. There is not enough time to develop a vaccine, administer it, and wait for the person’s body to manufacture antibodies for the swine flu. How about a vaccine?

11. Tamiflu or Relenza seem to help with swine flu. The drugs will not prevent infection. Influenza A tends to develop resistance to antiviral agents quickly. What's the treatment?

12. As of April 29, 2009 the current World Health Organization pandemic alert is at 4. Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks”. The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion, What’s the current who phase

13. Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized, so that its spread may be possibly be delayed or contained. Rational behind phase 4

14. Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. Update

15. Virus is more adapted to humans, and therefore more easily transmissible among humans. It spreads in lager clusters, but spread is localized. This is likely to be the last chance for massive coordinated global intervention, targeted to one or more foci, to delay or contain spread. Rational

16. On April 28 St. Louis County Department of Health issued an alert St. Louis County Health Guidance

17. Fever of >=37.8 degrees C (100 degrees F) plus cough or sore throat AND Travel to an area where swine flu is confirmed or contact to a known case Working Case Definition

18. CDC strongly recommends home isolation of cases Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved. Home Isolation

19. Persons with ILI and wish to seek medical care should contact their medical care provider by phone. Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention. Medical Care

20. The CDC recommends that standard, droplet, and contact precautions be used for all patient care activities for ILI patients. Maintain hand washing hygiene Infection Control

21. Interim Guidance for Emergency Medical Services (EMS) Systems and9-1-1 Public Safety Answering Points (PSAPs) for Management ofPatients with Confirmed or Suspected Swine-Origin Influenza A(H1N1) Infection

22. Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness onset. Persons who continue to be ill longer than 7 days after illness onset should be considered potentially contagious until symptoms have resolved. Children, especially younger children, might potentially be contagious for longer periods. Infectious Period

23. A confirmed case of S-OIV infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed S-OIV infection at CDC by one or more of the following tests: 1. real-time RT-PCR 2. viral culture A probable case of S-OIV infection is defined as a person with an acute febrile respiratory illness who is positive for influenza A, but negative for H1 and H3 by influenza RT-PCR A suspected case of S-OIV infection is defined as a person with acute febrile respiratory illness with onset 􀁺 within 7 days of close contact with a person who is a confirmed case of S-OIV infection, or 􀁺 within 7 days of travel to community either within the United States or internationally where there are one or more confirmed cases of S-OIV infection, or 􀁺 resides in a community where there are one or more confirmed cases of S-OIV infection. Case Definitions for Infection with Swine-origin Influenza A(H1N1) Virus (S-OIV)

24. It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin influenza A (H1N1) virus, to communicate the possible risk to EMS personnel prior to arrival, and to assign the appropriate EMS resources. PSAPs should review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local department of public health. Interim recommendations: 􀁺 PSAP call takers should screen all callers for any symptoms of acute febrile respiratory illness. Callers should be asked if they, or someone at the incident location, has had nasal congestion, cough, fever or other flu-like symptoms. 􀁻 If the PSAP call taker suspects a caller is noting symptoms of acute febrile respiratory febrile illness, they should make sure any first responders and EMS personnel are aware of the potential for “acute febrile respiratory illness” before the responders arrive on scene. Recommendations for 9-1-1 Public Safety Answering Points(PSAP)

25. 􀁺 Step 1: EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza. 􀁺 Step 2: Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following: nasal congestion/ rhinorrhea, sore throat, or cough). 􀁻 If no acute febrile respiratory illness, proceed with normal EMS care. 􀁻 If symptoms of acute febrile respiratory illness, then assess all patients for travel to a geographic area with confirmed cases of swine-origin influenza within the last 7 days or close contact with someone with travel to these areas. 􀂄 If travel exposure, don appropriate PPE for suspected case of swine-origin influenza. 􀂄 If no travel exposure, place a standard surgical mask on the patient (if tolerated) and use appropriate PPE for cases of acute febrile respiratory illness without suspicion of swine-origin influenza (as described in PPE section). If there HAS NOT been swine-origin influenza reported in the geographic area (http://www.cdc.gov/swineflu/), EMS providers should assess all patients asfollows:

26. 􀁺 Step 1: Address scene safety: 􀁻 If PSAP advises potential for acute febrile respiratory illness symptoms on scene, EMS personnel should don PPE for suspected cases of swine-origin influenza prior to entering scene. 􀁻 If PSAP has not identified individuals with symptoms of acute febrile respiratory illness on scene, EMS personnel should stay more than 6 feet away from patient and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza. 􀁺 Step 2: Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following: nasal congestion/ rhinorrhea, sore throat, or cough). 􀁻 If no symptoms of acute febrile respiratory illness, provide routine EMS care. 􀁻 If symptoms of acute febrile respiratory illness, don appropriate PPE for suspected case of swine-origin influenza if not already on. If the CDC confirmed swine-origin influenza in the geographic area (http://www.cdc.gov/swineflu/ )

27. 􀁺 When treating a patient with a suspected case of swine-origin influenza as defined above, the following PPE should be worn: 􀁻 Fit-tested disposable N95 respirator and eye protection (e.g., goggles; eye shield), disposable non-sterile gloves, and gown, when coming into close contact with the patient. 􀁺 When treating a patient that is not a suspected case of swine-origin influenza but who has symptoms of acute febrile respiratory illness, the following precautions should be taken: 􀁻 Place a standard surgical mask on the patient, if tolerated. If not tolerated, EMS personnel may wear a standard surgical mask. 􀁻 Use good respiratory hygiene – use non-sterile gloves for contact with patient, patient secretions, or surfaces that may have been contaminated. Follow hand hygiene including hand washing or cleansing with alcohol based hand disinfectant after contact. 􀁺 Encourage good patient compartment vehicle airflow/ ventilation to reduce the concentration of aerosol accumulation when possible. Personal protective equipment (PPE):

28. 􀁺 All patients with acute febrile respiratory illness should wear a surgical mask, if tolerated by the patient.

29. 30 April 2009 -- The situation continues to evolve rapidly. As of 17:00 GMT, 30 April 2009, 11 countries have officially reported 257 cases of influenza A (H1N1) infection.

30. The United States Government has reported 109 laboratory confirmed human cases, including one death. Mexico has reported 97 confirmed human cases of infection, including seven deaths. The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (19), Germany (3), Israel (2), Netherlands (1), New Zealand (3), Spain (13), Switzerland (1) and the United Kingdom (8).

31. Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings

32. Improve personnel safety in the healthcare environment through appropriate use of PPE. PPE Use in Healthcare Settings:Program Goal PPE Use in Healthcare Settings

33. PPE Use in Healthcare Settings: Program Objectives • Provide information on the selection and use of PPE in healthcare settings • Practice how to safely don and remove PPE PPE Use in Healthcare Settings

34. Personal Protective Equipment Definition “specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA) PPE Use in Healthcare Settings

35. OSHA issues workplace health and safety regulations. Regarding PPE, employers must: Provide appropriate PPE for employees Ensure that PPE is disposed or reusable PPE is cleaned, laundered, repaired and stored after use OSHA also specifies circumstances for which PPE is indicated CDC recommends when, what and how to use PPE Regulations and Recommendations for PPE PPE Use in Healthcare Settings

36. Hierarchy of Safety and Health Controls • Training and administrative controls • Engineering controls • Work practice controls • Personal protective equipment PPE Use in Healthcare Settings

37. Types of PPE Used in Healthcare Settings • Gloves – protect hands • Gowns/aprons – protect skin and/or clothing • Masks and respirators– protect mouth/nose • Respirators – protect respiratory tract from airborne infectious agents • Goggles – protect eyes • Face shields – protect face, mouth, nose, and eyes PPE Use in Healthcare Settings

38. Factors Influencing PPE Selection • Type of exposure anticipated • Splash/spray versus touch • Category of isolation precautions • Durability and appropriateness for the task • Fit PPE Use in Healthcare Settings

39. Gloves • Purpose – patient care, environmental services, other • Glove material – vinyl, latex, nitrile, other • Sterile or nonsterile • One or two pair • Single use or reusable PPE Use in Healthcare Settings

40. Gloves • Purpose – patient care, environmental services, other • Glove material – vinyl, latex, nitrile, other • Sterile or non-sterile • One or two pair • Single use or reusable PPE Use in Healthcare Settings

41. Do’s and Don’ts of Glove Use • Work from “clean to dirty” • Limit opportunities for “touch contamination” - protect yourself, others, and the environment • Don’t touch your face or adjust PPE with contaminated gloves • Don’t touch environmental surfaces except as necessary during patient care PPE Use in Healthcare Settings

42. Change gloves During use if torn and when heavily soiled (even during use on the same patient) After use on each patient Discard in appropriate receptacle Never wash or reuse disposable gloves Do’s and Don’ts of Glove Use (cont’d) PPE Use in Healthcare Settings

43. Gowns or Aprons • Purpose of use • Material – • Natural or man-made • Reusable or disposable • Resistance to fluid penetration • Clean or sterile PPE Use in Healthcare Settings

44. Face Protection • Masks – protect nose and mouth • Should fully cover nose and mouth and prevent fluid penetration • Goggles – protect eyes • Should fit snuggly over and around eyes • Personal glasses not a substitute for goggles • Antifog feature improves clarity PPE Use in Healthcare Settings

45. Face shields – protect face, nose, mouth, and eyes Should cover forehead, extend below chin and wrap around side of face Face Protection PPE Use in Healthcare Settings

46. Respiratory Protection • Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis) • PPE types for respiratory protection • Particulate respirators • Half- or full-face elastomeric respirators • Powered air purifying respirators (PAPR) PPE Use in Healthcare Settings

47. Elements of a Respiratory Protection Program • Medical evaluation • Fit testing • Training • Fit checking before use PPE Use in Healthcare Settings

48. For additional information on respirators…. • http://www.cdc.gov/niosh/npptl/respirators/ respsars.html • http://www.cdc.gov/niosh/99-143.html • http://www.cdc.gov/niosh/topics/respirators PPE Use in Healthcare Settings

49. PPE Use in Healthcare Settings:How to Safely Don, Use, and Remove PPE

50. Key Points About PPE • Don before contact with the patient, generally before entering the room • Use carefully – don’t spread contamination • Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room • Immediately perform hand hygiene PPE Use in Healthcare Settings