Microsoft word - interim guidance for patient screening and infection control for swine influenza as of 04.29.2009.doc

INTERIM GUIDANCE FOR PATIENT SCREENING AND INFECTION
CONTROL FOR SWINE INFLUENZA A (H1N1) VIRUS S-OIV
OVERVIEW
In response to the current national and international Swine Influenza Outbreak ICHD, is proactively implementing
public health measures in our community. Currently, there are no cases in Ingham County, however, it is prudent
to be proactive and as consequence ICHD clinicians should consider the possibility of swine influenza virus
infections in patients presenting with febrile respiratory illness.
RECOMMENDATIONS FOR PATIENT SCREENING FOR SWINE INFLUENZA A (H1N1)
Evaluations of ill person with flu-like symptoms should be guided by the Centers for Disease Control and
Prevention (CDC) case definition (see below). Evaluation should assess for clinically compatible signs and
symptoms as well as applicable travel history to affected regions. Patients presenting with febrile respiratory
illness should be screened using the attached Flu Triage and Symptoms Form. Febrile respiratory illness is
defined as a fever > 100.0oF or 37.8oC and at least one of the following: rhinorrhea, nasal congestion, sore throat,
or cough. This assessment can be accomplished telephonically or in person.
The most current case definitions from CDC can be found online at http://www.cdc.gov/swineflu/casedef_swineflu.htm. These case definitions are very fluid and may change as additional information is obtained. If the patient meets the case definition for swine influenza, MDCH recommends that laboratory testing be
performed.
SPECIMEN COLLECTION FOR SYMPTOMATIC PATIENTS
If a patient meets the CDC’s case definition then one nasopharyngeal swab should be obtained for direct
submission to the MDCH laboratory. NP specimens should be placed in viral transport media and refrigerated
and stored at 4°C until ready to ship. Specimens should be shipped on cold packs using overnight delivery with a
completed MDCH test requisition form (available online at http://www.michigan.gov/documents/DCH-
0583TEST_REQUEST_7587_7.pdf). Suspect swine influenza specimens should NOT be set up for viral culture.
Once a specimen has been obtained ICHD Disease Control is to be notified at (517) 887-4308. Disease Control
will notify the MDCH Laboratory that a specimen is being submitted. The specimen is to be submitted to the
MDCH Laboratory following approval by Disease Control. The specimen is to be refrigerated until shipped.

If the patient does not meet the CDC’s case definition then any laboratory testing deemed appropriate by the
clinician should be processed through the Health Center’s routine laboratory provider (Sparrow, LabCorp, etc.).
SWINE INFLUENZA A TREATMENT AND PROPHYLAXIS
If swine flu is suspected, probable, or confirmed then the antiviral medications oseltamivir (for all people) or
zanamivir (people age 7 and older) are clinically indicated if administered within 48 hours of the onset of
symptoms. Current treatment recommendations and dosing can be found online at:
http://www.cdc.gov/swineflu/guidance/. Treatment with oseltamivir and zanamivir should still be considered after
48 hours of symptom onset particularly for influenza-related complications. Note that Swine Influenza A is
resistant to Amantadine and Rimantadine.
INTERIM GUIDANCE FOR PATIENT SCREENING AND INFECTION
CONTROL FOR SWINE INFLUENZA A (H1N1) VIRUS (S-OIV)
INFECTION CONTROL OF ILL PERSONS WITHIN AN ICHD HEALTHCARE SETTING
To prevent the transmission of all respiratory infections in ICHD’s healthcare settings, including influenza, the
following infection control measures should be implemented at the first point of contact with a potentially
infected person:
1. Visual alerts are to be placed at the entrance of each Health Center and next to the registration area:
a. Notice to Patients to Report Flu Symptoms b. Cover Your Cough 2. Ensure that each waiting area is equipped with the following materials to facilitate patient/client/visitor compliance with Respiratory Hygiene/Cough Etiquette: a. Provide tissues and no-touch receptacles for used tissue disposal. b. Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand washing (i.e., soap, disposable towels) are consistently available. 3. Offer masks to persons who are coughing. Either procedure masks (i.e., with ear loops) or surgical masks (i.e., with ties) may be used to contain respiratory secretions (respirators such as N-95 or above are not necessary for this purpose). When space and chair availability permit, encourage coughing persons to sit at least three feet away from others in common waiting areas. 4. All healthcare personnel are to observe Droplet Precautions (i.e., wearing a surgical or procedure mask for close contact), in addition to Standard Precautions, when examining a patient with symptoms of a respiratory infection, particularly if fever is present. These precautions should be maintained until it is determined that the cause of symptoms is not an infectious agent that requires Droplet Precaution 5. All healthcare personnel are to maintain adherence to hand hygiene by washing with soap and water or using hand sanitizer immediately after removing gloves and other equipment and after any contact with respiratory secretions. 6. Personnel providing care to or collecting clinical specimens from suspected or confirmed cases should wear disposable non-sterile gloves, gowns, and eye protection (e.g., goggles) to prevent conjunctival exposure. 7. Personnel engaged in aerosol generating activities (e.g., collection of clinical specimens, nebulizer treatment, bronchoscopy, or cardiac pulmonary resuscitation) for suspected or confirmed swine influenza A (H1N1) cases should wear a fit-tested disposable N95 respirator. 8. Pending clarification of transmission patterns for this virus, personnel providing direct patient care for
suspected or confirmed swine influenza A (H1N1) cases should wear a fit-tested disposable N95 respirator when entering the patient room. 9. Patients with suspected or confirmed case-status should be placed in a patient room with the door kept closed.
10. The ill person should wear a surgical mask when outside of the patient room, and should be encouraged to
wash hands frequently and follow respiratory hygiene practices. 11. Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management of swine influenza. CASE DEFINITIONS FOR INFECTION WITH SWINE-ORIGIN INFLUENZA A (H1N1) VIRUS (S-OIV) – 04/29/09
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:
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 INTERIM GUIDANCE FOR PATIENT SCREENING AND INFECTION
CONTROL FOR SWINE INFLUENZA A (H1N1) VIRUS (S-OIV)
• 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. INTERIM GUIDANCE FOR PATIENT SCREENING AND INFECTION
CONTROL FOR SWINE INFLUENZA A (H1N1) VIRUS (S-OIV)
Patient has the following Chronic Health Conditions: Have you or a household member recently traveled to an affected area?
Have you had direct contact with pigs?
Have you had close contact with a sick person?
Have you experienced an occupational risk of exposure (please specify below)?
ˆ Fever:
ˆ < 100.0 (37.8°C) - Measurement obtained: ˆ By report ˆ Actual reading (Specify): ˆ ≥ 100.0 (37.8°C) - Measurement obtained: ˆ By report ˆ Actual reading (Specify): ˆ Sore throat
If yes: Is the patient able to swallow solids and/or liquids?
ˆ Headache: Does the patient indicate s/he has a headache?
If Yes, patient reports severity of pain on a scale of 1 – 10 as:
Patient Assessment:
Level of Activity:
Cough: Breathing
Pattern:
Check All that Apply:
ˆ Sneezing ˆ Runny Nose ˆ Dizziness ˆ Muscle Aches ˆ Nausea

Comments:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________
ˆ Home Care Instructions Provided ˆ Office Visit Scheduled ________________________________ ˆ Referred to Local Hospital _____________________________ ˆ Nasopharyngeal Swab Specimen collected. Specimen sent to MDCH ˆ Yes ˆ No

Source: http://michiganpca.files.wordpress.com/2009/05/interim-guidance-for-patient-screening-and-infection-control-for-swine-influenza.pdf