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 care – as per hand hygiene policy.
- Wear a procedure mask and eye wear if resident is coughing;
- Wear a gown and gloves if there is a potential for exposure to body fluids;
Source Controls
Administrative and engineering controls are the most effective way to prevent the transmission of infectious agents, including Influenza A H1N1, in the residential care setting.
Administrative controls include limiting access for visitors with symptoms of ILI. Engineering controls include the use of partitions to establish 2 metre distance between residents with ILI and others. The importance of applying administrative and engineering controls as the first strategy in protecting residents and HCW from exposure to infectious agents in the residential care facility cannot be overemphasized. Residential Care organizations should complete assessments of each area of all of their residential care facilities including the physical plant (e.g. availability of single rooms, use of partitions, ability to establish 2 metre distance between residents with ILI and others) and the types of resident care activities undertaken in residential areas. Based on these assessments, organizations needs to determine what administrative and engineering controls are needed.
This is especially important for residential care areas/settings where residents are returning from visits/appointments in the community where Influenza A H1N1 is circulating.
Assessment
- Assess Resident, as applicable, for new onset respiratory illness as follows:
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.
For clients who meet the above screening criteria, the following Infection Control protocols are to be followed:
Residents
- 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 HCWs or other staff or visitors are present
- Wear procedure mask (if tolerated) when outside room
Accommodation
- Move resident to a private room if possible or isolate to their bed space
- Where possible, be separated 2 meters from other residents
- Onset of flu-like symptoms is not an indication for transfer to an emergency room
Health Care Workers (HCW)
- Procedure mask and protective eye wear when within 2 meters of a resident 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 resident - Gowns 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 in Residential Care, if the resident’s status deteriorates review resident’s advance directives or code status and proceed accordingly;
- In the event of an outbreak of ILI; refer to the Fraser Health Respiratory* Outbreak Protocol for Residential Care Facilities
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.
