INFLUENZA

Caring for our CaregiversAND

Our Patients ~ Our Community

09/29/09 Janice Parker, APRN, Employee Health Services

Seasonal Influenza

Key Facts

The flu is a contagious respiratory illness

Every year in the United States, on average: 5% to 20% of the population gets the flu; more than 200,000 people are hospitalized from

flu-related complications (a high of 430,960); about 36,000 people die from flu-related causes

(a high of 52,000).

Seasonal Influenza

Symptoms of flu include: abrupt onset of fever (usually high)* headache extreme tiredness* dry cough sore throat runny or stuffy nose muscle aches Stomach symptoms, such as nausea, vomiting, and

diarrhea, also can occur but are more common in children than adults

* unlike a cold

Healthcare personnel should not

be at work if they have a fever*

*100º F or greater

Seasonal Influenza ~ transmission

How Flu Spreads

person to person through coughing or sneezing

sometimes by contact with something with flu viruses on it and then touching mouth or nose

The virus can survive and can infect a person for up to 2-8 hours after being deposited on a surface

Seasonal Influenza ~ transmission

Healthy adults may infect others 1 day before symptoms develop

and up to 5 days after becoming sick.

Some healthy adults are infected and have very mild symptoms or none at all

Healthcare workers may pass on the flu before they know they are sick.

HCP are considered “a source of influenza virus transmission” (ACIP)

Decreasing transmission from caregivers reduces flu and complications among persons at high risk

Seasonal Influenza ~ Health-Care Personnel

Seasonal Influenza ~ PREVENTION

Vaccination

Meticulous hand hygiene

Respiratory & cough etiquette

Environmental hygiene

Work restrictions

Seasonal Influenza ~ PREVENTION

Meticulous hand hygiene Have both gloves and hand cleaner CONVENIENTLY available

at all times For staff, patients and visitors Expect people to USE them!

Respiratory & cough etiquette Have masks, tissues and waste containers CONVENIENTLY

available at all times For staff, patients and visitors Expect people to USE them!

Environmental hygiene Cleaning everything touched by staff & patients is more

important than ever.

Work restrictions – STAY HOME when ill!

The single best way to prevent the flu is to get a flu vaccination each year.

Influenza outbreaks in hospitals attributed to low vaccination rates among healthcare workers

Vaccination both of HCW & patients provided significant reductions in deaths

Seasonal Influenza ~ vaccination

ACIP recommends that health-care administrators consider the level of vaccination coverage among health-care personnel (HCP) to be one measure of a patient safety quality program and implement policies to encourage HCP vaccination (e.g., obtaining signed statements from HCP who decline influenza vaccination).

The Infectious Diseases Society of America has recommended mandatory vaccination for HCP, with a provision for declination of vaccination based on religious or medical reasons.

The Joint Commission on Accreditation of Health-Care Organizations has an accreditation requirement (beginning January 1, 2007) that requires accredited organizations to offer influenza vaccinations to staff.

Seasonal Influenza ~ Health-Care Personnel

Seasonal Influenza ~ Health-Care Personnel

CDC/ ACIP ~

“Health-care facilities should offer influenza vaccinations to all HCP, including night, weekend, and temporary staff.

Particular emphasis should be placed on providing vaccinations to workers who provide direct care for persons at high risk for influenza complications.

Efforts should be made to educate HCP regarding the benefits of vaccination and the potential health consequences of influenza illness for their patients, themselves, and their family members.

All HCP should be provided convenient access to influenza vaccine at the work site, free of charge, as part of employee health programs.”

Seasonal Influenza ~ vaccination

Vaccine effectiveness

when the vaccine and circulating viruses are well-matched prevents illness among approximately 70%-90% of

healthy adults aged <65 years

when the vaccine strains are not well-matched to the majority of circulating strains

Effectiveness against influenza illness 50%-77% However, effectiveness among healthy adults against

influenza-related hospitalization was 90%

antibodies develop within two weeks after vaccination protection lasts up to one year

flu vaccines will not protect against flu-like illnesses caused by non-influenza viruses.

Seasonal Influenza ~ vaccination

Who Should Not Be Vaccinated without first consulting a physician

People who have a severe allergy to chicken eggs. People who have had a severe reaction to an

influenza vaccination in the past. People who developed Guillian-Barre syndrome

within 6 weeks of getting an influenza vaccine previously.

People who have a moderate or severe illness with a fever should wait

(they should not be at work!)

Seasonal Influenza ~ vaccination

Side Effects the most frequent side effect of vaccination:

soreness at the vaccination site typically mild

the flu vaccine is not associated with higher rates for systemic symptoms (e.g., fever, malaise, myalgia, and headache) when compared with placebo injections

THE FLU VACCINE CANNOT CAUSE THE FLU

nH1N1 Influenza

Signs and symptoms fever, respiratory tract illness (cough, sore throat, runny

nose), headache, muscle aches some cases have had vomiting and diarrhea

nH1N1 Influenza

“Currently the 2009 H1N1 influenza virus (sometimes called “swine flu”) virus seems to be causing serious health outcomes for: healthy young people from birth through age 24; pregnant women; and adults 25 to 64 who have underlying

medical conditions.” CDC, 09/17/09

nH1N1 ~ PREVENTION

Vaccination

Meticulous hand hygiene

Respiratory & cough etiquette

Environmental hygiene

Work Restriction

Vaccination Planning ~ novel H1N1 Vaccine trials have shown excellent immunity after a

single dose of inactivated vaccine for ages 10 and up People who have a severe (life-threatening) allergy to

chicken eggs or to any other substance in the vaccine should not be vaccinated.

The vaccine will be released from federal to state public health, then to us gradually, beginning in October

NH DHHS ‘alert’ on 09/25/09 Live, nasal mist vaccine will arrive first of October Inactivated vaccine will be available mid-to-late October

INFLUENZA & Healthcare Workers

MINIMUM Infection Control measures NH DHHS guidelines for healthcare settings

Standard Precautions Droplet Precautions

Surgical Mask when entering the room; or when within 6 feet of influenza-like illness (ILI)

Meticulous Hand Hygiene Respiratory Hygiene & Cough Etiquette Early Recognition & Separation of those Infected Restriction of Visitors & HCWs with ILI

~ FRISBIE STAFF ~ Flu Exposure & Illness Algorithms

Based on the guidelines from the NH DHHS Subject to change when updated in

mid-October May (or may not!) be different if the staff

member has been immunized against seasonal and H1N1 influenza viruses

Algorithm #1 ~ What to do if Frisbie direct patient care givers are exposed to the flu

HCW* has unprotected exposure * to person with ILI* (at work or at home)

~

HCW must report exposure to Employee Healthor Nursing Supervisor for evaluation & treatment

YESHCW develops fever

(100º F or higher) with cough

and/ or sore throat~

SEE ALGORITHM #2

Does HCW develop symptoms of ILI*?

NOBegin PEP* & return to work

OR wear a surgical mask while at work for 7 days.

If symptoms develop – see “YES”

NO – Algorithm #3Begin PEP* & return to work

OR wear a surgical mask while at work for 7 days.

- - - - -

If symptoms develop ~ see ALGORITHM #2

Algorithm #2 ~ Frisbie Direct Patient Care HCW* who develop ILI*

HCW* develops fever (100º F or higher) with cough and/ or sore throat

YES1. Put on a surgical mask

2. Report to Dept./ Nursing Supervisor3. Send to Employee Health

(or ED, when Employee Health closed))

Symptoms begin at work

NO1. STAY HOME

2. Call Supervisor

Did HCW have patient contact 24 hours before or after symptoms began?

NO

YESOBTAIN TESTING*

~ if at work, done by Employee Health or ED~ if at home to go to PCP or Urgent Care

OR if severely ill*, to go to ED

Is HCW in high risk category* or severely ill?

NO 1. Stay home until no fever (100ºF or higher)

for 24 hours without anti-fever medication2. Wear a mask after return to work

until no symptoms such as cough

YESRECOMMEND TREATMENT*

~ if at work, Rx by Employee Health or ED~ if at home to go to PCP or Urgent Care

OR if severely ill*, to go to ED

Algorithm #3 ~ Frisbie Staff Testing & Treatment

HCW sent to Employee Health or ED for PEP, TESTING, TREATMENT

YESTEST*

Is HCW in high risk category*?

YESDid HCW have patient contact*

24 hours before or after symptoms began?

Does HCW have symptoms of ILI*?

NO

NOPEP only

1. Prescribe PEP*(call Rx to employee's drug store)

& instruct employee to: a. wear a surgical mask at work

until PEP is started;b. have Rx filled, c. & begin PEP ASAP

OR 2. instruct to wear a surgical mask

while at work for 7 days.

YESTREAT* 1. Prescribe anti-viral

2. Send home & instruct:a. Stay home until no fever (100ºF or higher)

for 24 hours without anti-fever medicationb. Wear a mask after return to work

until no symptoms such as cough

NOSend home & instruct:

1. Stay home until no fever (100ºF or higher) for 24 hours without anti-fever medication

2. Wear a mask after return to work until no symptoms such as cough

FRISBIE STAFF ~ FLU TESTING & TREATMENT(* see definitions)

• TESTING– the following groups ONLY

• HCW* with ILI* with direct patient contact during infectious period (24 hours before symptoms to 7 days after symptoms started)

• IF recent onset fever (100ºF or higher) with cough and/ or sore throat AND– Hospitalized patients– Requested by Public Health

– nasopharyngeal swab, aspirate or wash for influenza PCR testing

• Post Exposure Prophylaxis– Begin within 24 hours of exposure & continue until 10 days after last

unprotected exposure*– PEP* for adults

• Oseltamivir 75 mg orally once daily• Zanamivir 10 mg inhaled once daily

• TREATMENT– Begin within 48 hours of start of symptoms – IF at high risk of complications* or severely ill (hospitalized)– Treatment for ill adults

• Oseltamivir 75 mg orally twice daily for 5 days• Zanamivir 10 mg inhaled twice daily for 5 days

~ How You Can Help ~

Get your flu shot(s) ~ set an example Educate & encourage your staff; Confront

misconceptions & misinformation with the facts Help me schedule flu shot clinics that reach your

staff most efficiently & effectively ENFORCE PREVENTIVE MEASURES ~

Meticulous hygiene with patients, visitors & staff Hand hygiene, cough etiquette & environmental

Work restrictions with your staff NO ONE is to come to work with a fever

Thanks!