Home Health, Assisted Living and Supportive Housing

Guidelines for Health Care Professionals Regarding Influenza A H1N1 (Human/Swine Flu) 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 clients with influenza-like illness (ILI). This includes the following best practices:

Perform hand hygiene before and after direct care – as per hand hygiene policy.

Wear a procedure mask and eye wear if client is coughing;

Wear a gown and gloves if there is a potential for exposure to body fluids;

SOURCE CONTROLS

Administrative and engineering controls are an effective way to prevent the transmission of infectious agents, including Influenza A H1N1 in settings where care is provided to multiple clients.

Administrative controls include limiting access for visitors with symptoms of ILI and ensuring staff stay home when ill. Engineering controls include the use of designated rooms, i.e., the client’s bedroom for treatment that would cause the production of aerosols or partitions to establish 2 metre separation between clients with ILI and others in clinic settings. A source control assessment should be performed in any setting where care is provided to multiple clients such as a clinic or Assisted Living.

Signage: signage should be posted at all entrances to the residence reminding persons entering the residence NOT to enter if they are having symptoms such as fever, cough, sore throat, arthralgia, or myalgia. Posted signage should provide clear instructions on how to perform respiratory hygiene and hand hygiene.

Assessment

Assess client, as applicable, for new onset respiratory illness as follows:

For clients who meet the above screening criteria, the following Infection Control protocols are to be followed:

Clients

• Taught to perform hand hygiene or assisted to do so
• Taught to perform respiratory etiquette; cough into sleeve, use tissues, wear procedure mask (if tolerated) when others are present

Accommodation

In residences where care is provided to multiple clients

• Encourage client to self isolate and refrain from group activities until 7 days after onset of symptoms or until symptoms are resolved, whichever is longer
• Conduct aerosol generating medical procedures in the clients bedroom with door closed
• Ensure there is a process to advise care providers and others regarding additional precautions required 
• Onset of flu-like symptoms is not an indication for transfer to an emergency room

In home settings

• Encourage client to self isolate and refrain from group activities until 7 days after onset of   symptoms or until symptoms are resolved, whichever is longer
• Conduct aerosol generating medical procedures in a separate room such as the clients bedroom, with door closed

Care providers

• Procedure mask and protective eye wear when within 2 meters of a client with ILI 
• N95 and protective eye wear if present in the room during aerosol generating procedures (AGMP)* 
• If N95 respirator is not available, wear a procedure mask and eye wear
• Gloves for contact with the client
• Gown if splash or spray is anticipated

Environmental Cleaning

• Follow standard protocols for environmental cleaning and cleaning products; 
• Follow standard protocols for the management of laundry, utensils, garbage and medical waste.
• As with any serious illness, if the client’s status deteriorates follow agency procedures for physician notification 

*AGMP: any procedure carried out on a patient that can induce the production of aerosols of various sizes, including droplet nuclei. Examples include: chest physiotherapy; aerosolized or nebulized medication administration; respiratory/airway suctioning; tracheostomy care; non-invasive positive pressure ventilation (BIPAP, CPAP) .Refer to the Public Health Agency of Canada information for further information.

References

1. Public Health Agency of Canada. (July 28, 2009). Guidance:Infection Prevention and Control Measures for Health Care Workers in Long-term Care Facilities. Retrieved October 5, 2009 from (http://www.phac-aspc.gc.ca/alert-alerte/h1n1/hp-ps/prevention-eng.php )
2. OHSAH, August 24, 2009 Organizational Risk Assessment, www.ohsah.bc.ca