Sunday, September 20, 2009

Position Statement of Australian Society for Infectious Diseases: infection control guidelines for patients with influenza-like illnesses

Position Statement of ASID (HICSIG): infection control guidelines for patients with influenza-like illnesses, including pandemic (H1N1) influenza 2009
  1. Standard and Droplet Precautions are considered adequate to control the transmission of influenza in most health care situations. 
  2. Vaccination of health care staff, carers and vulnerable patients against seasonal and, eventually, pandemic influenza strains is an essential protective strategy.

Management principles include:
  • performance of hand hygiene before and after every patient contact or contact with the patient environment, in accord with the national 5 Moments for Hand Hygiene Standard;
  • disinfection of the patient environment
  • early identification and isolation of patients with suspected or proven influenza;
  • adoption of a greater minimum distance of patient separation (2 metres) than previously recommended;
  • use of a surgical mask and eye protection for personal protection on entry to infectious areas or within 2 metres of an infectious patient;
  • contact tracing for patient and health care staff and restriction of prophylactic antivirals mainly to those at high risk of severe disease;
  • in high aerosol-risk settings, use of particulate mask, eye protection, impervious long-sleeved gown, and gloves donned in that sequence and removed in reverse sequence, avoiding self-contamination;
  • exclusion of symptomatic staff from the workplace until criteria for non-infectious status are met;
  • reserving negative pressure ventilation rooms (if available) for intensive care patients, especially those receiving non-invasive ventilation;
  • ensuring that infectious postpartum women wear surgical masks when caring for their newborn infants and practise strict hand hygiene; and implementation of special arrangements for potentially infected newborns who require nursery or intensive care.

    [Healthcare Infection Control Special Interest Group (HICSIG) of the Australasian Society for Infectious Diseases (ASID)]

    Health care staff
    • As infection control measures effectively reduce the risk of acquisition, and as most disease caused by seasonal or pandemic (H1N1) 2009 is mild, antiviral prophylaxis is usually reserved for vulnerable staff who have a significant unprotected exposure.
    • Unprotected exposure to an infectious patient with confirmed H1N1 during an aerosol-generating procedure denotes high-risk contact.25
    • Patient care (within the patient’s room or within 2 metres of the patient) for longer than 15 minutes without use of a surgical mask and protective eyewear denotes moderate-risk contact.
    • Antiviral prophylaxis should be given within 48 hours of contact as efficacy has been demonstrated only before this time. If more time has elapsed, expert advice should be sought. If exposed staff are not provided with prophylaxis, they should have access to early treatment if required.
    • Those who do not require prophylaxis should be counselled to watch for symptoms of ILI and not to come to work if these develop.

  • For patients, significant contact is arbitrarily defined as:
  • More than 15 minutes of face-to-face contact with another patient with confirmed influenza, including pandemic (H1N1) 2009.
  • More than 24 hours spent in the same room as the index patient, when the index patient is mobile and sharing facilities.
  • More than 24 hours spent in the same room as the index patient, when the index patient is not mobile, but beds are placed less than 2 metres apart and a curtain has not been drawn between them.
  • Care by an HCW with confirmed influenza A, including pandemic (H1N1) 2009, for > 15 minutes while the HCW is infectious (1 day before symptom onset until 7 days after if the HCW has not received antiviraltreatment, or 3 days after if the HCW has received antiviral treatment)



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