Infection Control Aspects of Influenza

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Infection Control Aspects of Influenza

• Chariya Sangsajja, M.D.
• BIDI, DDC, MOPH
• October 2011

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Human-to-Human Transmission of Influenza(1)

• Large respiratory droplet distancelt,6 ft.
• Contact with large respiratory droplet
• Airborne transmission over longer distances has
  not been documented

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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

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WHO Categories of Infection Prevention and
Controls

• Administrative controls
• Environmental/ engineering controls
• Personal protective equipments

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US CDC Fundamental Elements to Prevent Influenza
Transmission (1)

• Seasonal Influenza vaccine
• Respiratory hygiene and cough etiquette
• Appropriate management of ill HCWs

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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

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Administrative Control Strategies (1)

• Hospital Policy Plan
• Monitor influenza activities
• Clinical and IC practices guidelines
• Education, training and monitoring
• Minimize potential exposures

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Hospital Preparedness
Training
Clinical Practice Guidelines
Isolation Room
Exercise
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Hand Hygiene Training Program
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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

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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

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Infection Control Recommendations

• Standard precautions hand hygiene, gloves
• Droplet precautions
• Respiratory hygiene/cough etiquette
• Use cautions when performing aerosol-generating
  procedures

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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

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Alerting Poster
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Droplet precaution by using mask
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Steps to take off the surgical mask
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Sink at patient waiting area
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Posting visual alerts Early recognition and early
implementation of IC practices
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Screening site
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Portable X-Ray
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Administrative Controls Strategies(3)

• Isolation ward/room
• Limiting the number of persons in present in
  patient room
• Screening personnel and visitors
• Patients and visitors recommendations

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Patient Placement

• Single room confirmed case, suspected case ,
• Cohort ward confirmed cases
• AIIR patients who need mechanical ventilation

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Patient Placement
Single Room
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Cohort Ward
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AIIR
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Bamras
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10/11/2013
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Airborne Infection Isolation Room
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Cohort Ward
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Patient recommendations

• Hand hygiene
• Personal hygiene
• surgical mask
• Post discharge recommendations

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Family Members/Visitors Recommendations

• Visitor Limiting
• Visitor Screening ILI, high risk group
• PPE
• Hand Hygiene

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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

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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

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HCW ILI Monitoring Form
Day1 Day2 Day3 Day4 Day5
Date. Date. Date. Date. Date.
AM temp AM temp AM temp AM temp AM temp
PM temp PM temp PM temp PM temp PM temp
ILI symptoms No....Yes ILI symptoms No....Yes ILI symptoms No....Yes ILI symptoms No....Yes ILI symptoms No....Yes
Day6 Day7 Day8 Day9 Day10
Date. Date. Date. Date. Date.
AM temp AM temp AM temp AM temp AM temp
PM temp PM temp PM temp PM temp PM temp
ILI symptoms No....Yes ILI symptoms No....Yes ILI symptoms No....Yes ILI symptoms No....Yes ILI symptoms No....Yes
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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

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Engineering Controls(1)

• Separate triage areas, installing partitions
• Using local exhaust ventilation for aerosol
  generating procedures or perform in AIIR
• Using hood/Bio-safety cabinet in laboratory

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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

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Bio-safety Cabinet
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Engineering Controls

• Using closed suctioning systems
• Using high efficiency particulate filters on
  mechanical and bag ventilators
• Ensuring effective ventilation and thorough
  environmental surface hygiene

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Closed circuit suctioning system
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Bacterial / virus HEPA filter
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Personal Protective Equipments (PPE)

• Supplies
• Training
• Proper PPE
• Monitoring

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PPE Seasonal and Pandemic Flu 2009

• Surgical mask
• N-95 mask, Goggles Aerosol-generating
  procedures
• GOWN
• GLOVES

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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

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Research on Influenza IC

• PPE N-95 mask vs surgical mask
• Unpublished multiple hospital study in China
• N-95 provided 75 protection against
  lab-confirmed flu
• N-95 were 42 more effective than surgical mask
  over all

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Research on Influenza IC

• Household influenza transmission Cowling B.,et
  al
• HHalcohol hand rub vs.
• HHfacemask vs. control gr.
• Substantial and significant benefits of
  facemask and HH if implement within 36 hours of
  index case ILI onset

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