Acute and Primary Care Patients Presenting For Assessment or Appointments (taken from PHAC – please see references)
General
All staff should adhere to routine practices when there is a likelihood of contact with body fluids, including respiratory secretions from patients with influenza-like illness. This includes the following best practices:
- Perform hand hygiene before and after direct patient care – as per hand hygiene policy
- Don procedure mask and eyewear and provide a procedure mask to your patient if coughing
- Don a gown and gloves if there is a potential for exposure to body fluids
Primary Care
Primary care includes any area where patients are seen for assessment of new symptoms or illness, in ambulatory care clinics where people present for appointments and in home care settings. These include; Acute care, Emergency departments, Physician offices, Walk-in clinics, Outpatient clinics, Hemodialysis, Public Health Units, Mental Health & Addictions and Home Health.
Source Controls
Administrative and engineering controls are the first strategy in protecting the HCW from exposure to infectious agents in the health care setting.
This is especially important for patient care areas/settings where patients appear for initial assessment/investigation before a diagnosis of Influenza A H1N1 has been made.
Refer to Appendix B "Source Controls" and Appendix A "Point of Care Risk Assessment"
Assessment
Assess client, as applicable, for history of recent acute respiratory illness;
Influenza Like Illness (ILI) Screening Criteria
- Acute onset of respiratory illness with cough, with or without fever*
*Note: in children under 5, gastrointestinal symptoms may also be present. In patients under 5 or 65 and older, fever may not be prominent.
AND one or more of the following:
- Sore throat, arthralgia, myalgia, or prostration which could be due to influenza.
The following recommendations for suspect or confirmed cases of Influenza A H1N1 are to be followed in addition to routine practices:
- Patients should be directed to designated, segregated waiting area 2 metres from others who do not have respiratory symptoms
Accommodation
- Isolated on Enhanced Droplet/Contact in a private room or cohort with other patients with same microorganism.
- Negative pressure room for non-urgent aerosol generating procedures (AGMP)* if possible
Patients
- Taught to perform hand hygiene
- Taught to perform respiratory etiquette; cough into sleeve, use tissues, wear procedure mask (if tolerated) when HCWs or other staff or visitors are present
- Wear procedure masks when being transported
Health Care Workers (HCW)
- Procedure mask and protective eye wear for all routine care
- N95 and protective eye wear if performing aerosol generating procedures (AGMP)*
- Gloves for contact with the patient and the patient’s environment
- Gowns if splash or spray is anticipated;
Environmental Cleaning
- Follow standard protocols for isolation room cleaning and cleaning products; Follow standard protocols for the management of laundry, utensils, garbage and medical waste.
AGMP * any procedure carried out on a patient that can induce the production of aerosols of various sizes, including droplet nuclei. Examples include: non-invasive positive pressure ventilation (BIPAP, CPAP); endotrachial intubation; respiratory/airway suctioning; high-frequency oscillatory ventilation; tracheostomy care; chest physiotherapy; aerosolized or nebulized medication administration; diagnostic sputum induction; bronchoscopy procedure; autopsy of lung tissue.
References
1. Public Health Agency of Canada. (July 28, 2009). Interim Guidance: Infection prevention and control measures for Health Care Workers in Acute Care Facilities. Retrieved August 17, 2009 from (http://www.phac-aspc.gc.ca/alert-alerte/h1n1/hp-ps/ig_acf-ld_esa-eng.php?option=print).
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