Health Update: Infection Control Guidelines for Healthcare Workers for H1N1 Flu
May 8, 2009
PLEASE NOTE: This is an evolving situation. This document provides interim guidance which might change in the days and weeks ahead as more information becomes available.This guidance applies to all healthcare personnel (e.g. employees, students, contractors, attending clinicians, and volunteers) whose activities involve contact with patients.
Epidemiologic and clinical data to date indicate that the novel influenza A (H1N1) virus appears to be behaving similarly to seasonal influenza in terms of the severity of illness and transmission of infection.
These infection control recommendations are being made in conjunction with enhanced surveillance among hospitalized patients and healthcare workers to identify early signals of increasing severity or changing epidemiology of this virus.
These recommendations represent the minimum level of infection control precautions; clinicians or infection preventionists may recommend increased levels of infection control as indicated by a specific patient or situation including health status of healthcare workers.
Level of Precautions
Droplet and Standard Precautions are recommended for all suspected or confirmed novel influenza A (H1N1) patients:
Standard Precautions (hand hygiene plus gloves, gown, face shield/eye protection as indicated by patient care activities and risk of exposure to blood/body fluids)PLUS
Droplet Precautions - surgical mask should be used for all direct patient care activities
Specimen collection
Droplet Precautions (surgical mask) should be used by the healthcare workers obtaining a clinical specimen (includes nasopharyngeal swab, nasal wash, throat swab); if splashes are anticipated, then eye protection should be considered.
Aerosol-generating procedures*:
Airborne Precautions - respiratory protection—
Fit-tested disposable N95 respirator. Prior fit-testing that must be repeated annually and fit-check / seal-check prior to each use OR
Powered air purifying respirator (PAPR). Follow facility protocols and procedures for decontamination of PAPR
PLUS Standard precautions
* (e.g., nebulized medication administration, bronchoscopy, intubation and extubation, deep open tracheal suctioning)
Aerosolizing procedures can be performed in a single patient room with the door closed.Increased levels of infection control may be implemented as indicated by a specific patient or situation, including an airborne infection isolation room (AIIR). At a minimum, AIIR rooms must: Provide negative pressure room with a minimum of 6 – 12 air exchanges per hour or exhaust directly to the outside or through HEPA (High Efficiency Particulate Air) filtration.
Transport within healthcare facilities
Procedures for transport of patients in isolation precautions should be followed.
Ill persons should wear a surgical mask to contain secretions when outside of the patient room
Encourage ill persons to perform hand hygiene frequently and follow respiratory hygiene and cough etiquette practices
Visitors
Visitors should:
Be encouraged to perform hand hygiene before and after entering a patient’s room
Be instructed to limit their movement within the facility
Wear a surgical mask when entering the room
Be restricted while aerosolizing procedures are being performed
Pregnant Healthcare Workers
CDC has guidance for pregnant healthcare workers: See: http://www.cdc.gov/h1n1flu/guidance/ under “Guidance for Pregnant and Breastfeeding Women”
Environmental cleaning and disinfection
Healthcare facilities should follow routine procedures for environmental cleaning and disinfection
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