Infection Control Aspects of Influenza

1. Infection Control Aspects of Influenza ChariyaSangsajja, M.D. BIDI, DDC, MOPH October 2011

2. Human-to-Human Transmission of Influenza(1) • Large respiratory droplet: distance<,=6 ft. • Contact with large respiratory droplet • Airborne transmission over longer distances has not been documented

3. Human-to-Human Transmission of Influenza (2) • Smaller droplet nuclei at close-range exposure ?, may be important under special condition; e.g. aerosol- producing procedures • All respiratory secretions and bodily fluids, including diarrheal stools are considered to be potentially infectious

4. WHO :Categories of Infection Prevention and Controls • Administrative controls • Environmental/ engineering controls • Personal protective equipments

5. US CDC: Fundamental Elements to Prevent Influenza Transmission (1) • Seasonal Influenza vaccine • Respiratory hygiene and cough etiquette • Appropriate management of ill HCWs

6. US CDC: Fundamental Elements to Prevent Influenza Transmission (2) • Adherence to IC precautions for all patient-care activities and aerosol-generating procedures • Implementing environmental and engineering IC measures

7. Administrative Control Strategies (1) : Hospital Policy & Plan : Monitor influenza activities :Clinical and IC practices guidelines :Education, training and monitoring : Minimize potential exposures

8. Hospital Preparedness Training Clinical Practice Guidelines Isolation Room Exercise

9. Hand Hygiene Training Program

10. Minimize Potential Exposures • During periods of increased influenza activity, minimizing OPD and ER visits for patients with mild ILI who are not at increased risk for complications from influenza • Set up Hotline Center • Visitors screening for ILI symptoms

13. Administrative Control Strategies (2) : Implementing respiratory hygiene & cough etiquette programs :Triage system, alerting sign managing patient flow :Provide facemask, alcohol hand-rub at facility access point :Provide space and separate area for ILI patients

14. Infection Control Recommendations Standard precautions: hand hygiene, gloves : Droplet precautions Respiratory hygiene/cough etiquette Use cautions when performing aerosol-generating procedures

15. Respiratory Hygiene / Cough Etiquette • Apply to all patients with respiratory illness • Posting visual alerts • Source control measures • Early recognition, separation and isolation • Droplet precautions • Hand Hygiene • Waste management

16. Alerting Poster

17. Droplet precaution by using mask

18. 2 1 3 Steps to take off the surgical mask

20. Sink at patient waiting area

21. Posting visual alerts Early recognition and early implementation of IC practices

22. Screening site แยกจุดคัดกรอง มีระยะห่างจากผู้ป่วย>3 ฟุต

23. การเคลื่อนย้ายผู้ป่วยการเคลื่อนย้ายผู้ป่วย

24. การแยกผู้ป่วย ILI ที่ OPD

26. ห้องตรวจโรคไข้หวัดใหญ่ห้องตรวจโรคไข้หวัดใหญ่

27. ห้องตรวจโรคไข้หวัดใหญ่ห้องตรวจโรคไข้หวัดใหญ่ ห้องสังเกตอาการไข้หวัดใหญ่ Portable X-Ray

28. การแยกผู้ป่วยที่ห้องฉุกเฉินการแยกผู้ป่วยที่ห้องฉุกเฉิน

29. Administrative Controls Strategies(3) • Isolation ward/room • Limiting the numberof persons in present in patient room • Screening personnel and visitors • Patients and visitors recommendations

30. Patient Placement Single room : confirmed case, suspected case , Cohort ward : confirmed cases AIIR: patients who need mechanical ventilation 30

31. Patient Placement Single Room

32. Cohort Ward

33. AIIR

34. Bamras 34 8/25/2014

35. Airborne Infection Isolation Room

36. Cohort Ward

37. Patient recommendations Hand hygiene Personal hygiene surgical mask Post discharge recommendations

38. Family Members/Visitors Recommendations Visitor Limiting Visitor Screening : ILI, high risk group PPE Hand Hygiene

39. Monitor and Manage Ill HCWs(1) • Screening for ILI before they come on duty, register form • HCWs ILI surveillance system, self monitoring form, self-reporting and isolating • Develop sick leave policies for HCWs

40. Monitor and Manage Ill HCWs(2) • Stop patient-care activities, don a facemask, promptly notify ICN • Keeping personnel with mild ILI at home to reduce the risk of spreading influenza

41. HCWILI Monitoring Form

42. Monitor and Manage Ill HCWs(3) • Exclude from work until 24 hours after they no longer fever • Considered for temporary reassignment or exclusion from work for 7 days from symptoms onset or until the resolution of symptoms whichever is longer

43. Engineering Controls(1) • Separate triage areas, installing partitions • Using local exhaust ventilationfor aerosol generating procedures or perform in AIIR • Using hood/Bio-safety cabinet in laboratory

44. Aerosol-generating procedures produce large & small particle aerosols Bronchoscopy Sputum induction ET intubation and extubation CPR Open suctioning of airways Autopsies Non-invasive positive pressure ventilation NP swab/aspiration Aerosolized medication High-frequency ventilation

46. ห้องตรวจโรคไข้หวัดใหญ่ห้องตรวจโรคไข้หวัดใหญ่ การเก็บสิ่งส่งตรวจระบบทางเดินหายใจ

47. Bio-safety Cabinet 47

48. Engineering Controls • Using closed suctioning systems • Using high efficiency particulate filters on mechanical and bag ventilators • Ensuring effective ventilation and thorough environmentalsurface hygiene

49. Closed circuit suctioning system

50. Bacterial / virus HEPA filter