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Tulare Regional Medical CenterEducation Services

Influenza Prevention Program

INFLUENZA VACCINATION PROGRAM

Introduction:

Welcome to our Influenza Vaccination Program Module. This module is for Tulare Regional Medical Center personnel who have patient, client, or customer contact while performing their regular work for the organization.

Description:

The purpose for this module is to provide a better understanding about seasonal influenza, what you can do to prevent the spread of influenza virus, and what options regarding influenza vaccine are available to you as an employee of Tulare Regional Medical Center.

This module consists of information from the Policy #20-8029 Health Care Staff Influenza Vaccination Program, the Policy #20-8034 Seasonal Influenza Plan, and the Policy #20-8035 Pandemic Influenza Plan

Objectives:

By the completion of this module, the employee will:

1. Describe the benefits of the influenza vaccine.2. Recognize potential health consequences of influenza illnesses for

themselves and their patients.3. Practice respiratory hygiene and cough etiquette.4. Ensure visitor restrictions are practiced during influenza season.5. Restate what activities may be implemented during an influenza

pandemic.

Target Group:

All TRMC Personnel, Volunteers, and Contracted Employees

RN’s; LVN’s: 1 C.E.

Prepared by:Shawn Elkin, MPA, BSN, RN, PHN, Infection Preventionist

Course Sequence:

A. Read Top Ten Points to RememberB. Read Tips to Prevent and Fight the Flu (Association of Professionals in

Infection Control and Epidemiology - APIC)C. Read Policy #20-8029 Health Care Staff Influenza Vaccination ProgramD. Read Policy #20-8034 Seasonal Influenza PlanE. Read Policy #20-8035 Pandemic Influenza Plan

TOP TEN POINTS TO REMEMBER1. Flu Vaccine does not cause the flu

*(exception Live Attenuated Influenza Vaccine (LAIV) – Intranasal spray – not offered at Tulare Regional Medical Center)

2. Flu Vaccine is available to all Tulare Regional Medical Center: employees, physicians, contracted employees, volunteers, and students.

3. There are visitor restrictions in effect during flu season.

4. You should practice respiratory hygiene and cough etiquette at all times.

5. You should practice hand hygiene at all times. (“Are You Gellin” Hand Hygiene Campaign)

6. Droplet precautions are appropriate for patients with seasonal influenza and H1N1 influenza.

7. During performance of a High-Hazard (Aerosol-generating) procedure (i.e. Bronchoscopy), Enhanced Airborne Precautions are required – wear an N95 respirator or PAPR.

8. There are 6 stages to a disease pandemic. The pandemic starts with no cases of disease present; increases to larger and larger clusters of people becoming ill, and ends with most of world’s population becoming ill.

9. During flu pandemic Tulare Regional Medical Center as an organization may start a hospital incident command system (H.I.C.S.) to address the additional needs of the community with the resources available at the hospital.

10.During flu pandemic Enhanced Airborne and Airborne precautions are appropriate.

TULARE LOCAL HEALTH CARE DISTRICTdba TULARE REGIONAL MEDICAL CENTER

POLICY / GUIDELINE

TO: All Departments

FROM: Administration

SUBJECT: Health Care Staff Influenza Vaccination Program

I. Purpose:

To provide healthcare workers protection against the strains of influenza expected for the annual influenza season. Tulare Regional Medical Center’s goal is to protect staff, patients, and family members from the flu, its complications, and to decrease healthcare worker absenteeism.

II. Policy:

Tulare Regional Medical Center will offer all employees as well as volunteers, physicians, and licensed independent practitioners (LIP) the influenza (flu) vaccine annually, when the vaccine is available. Healthcare workers providing direct patient care, especially to patients in high risk areas, and those essential to running of the health care institution will be given priority when there is a flu vaccine shortage. All hospital workers will either obtain the influenza vaccination or complete and sign an Influenza Vaccination Declination Form. This policy ensures compliance with applicable law specifically, California Health & Safety Code Section 1288.7.

III. Procedure:

A. All employees, volunteers, physicians, and licensed independent practitioners will be offered annually, while available, onsite influenza vaccinations.

B. Infection Prevention and Control Program will obtain a physician signature on the Standing Order for Administering Healthcare Workers Seasonal Influenza Vaccine once annually.1. If flu vaccination supply is available, clinical students will be offered the

flu vaccine free of cost as they have contact with Tulare Regional Medical Center patients.

C. Influenza vaccinations will be offered at no cost.

___________________________________________________________________Effective Date: 05/26/16 (20) Clinical Guidelines

Infection Prevention:Approved: Health Care Staff Influenza

Vaccination ProgramMedical Executive Comm.: 05/11/16 20-8029

Board of Directors: 05/25/16


POLICY/GUIDELINE MANUAL

D. Education regarding influenza and the influenza vaccine will be provided to employees, including but not limited to:1. Benefits of the influenza vaccine.2. Potential health consequences of influenza illnesses for themselves

and their patients.3. Modes of transmission, diagnosis, treatment and non-vaccine infection

control strategies.4. Respiratory hygiene and cough etiquette.

E. Written consent will be obtained from the employee in order to receive the vaccination. 1. Any employee who declines the influenza vaccination for medical

reasons will need to note this on the declination form. 2. If employee receives flu vaccination elsewhere, i.e. PCP, another

employer, the employee will be asked to state facility he/she received the vaccine from on the declination form. Proof of vaccination will be required.

F. Any employee who declines influenza vaccination will be required to sign the Influenza Vaccination Declination Form.1. Reasons for declination on form are to be completed for influenza

vaccination program evaluation purposes. These will be reviewed annually and incorporated into the overall Infection Control Performance Improvement program. An action plan will be developed targeted toward increasing the vaccination rate.

2. The following reasons on the declination form will not be tallied as declinations for Performance Improvement purposes:1. Allergy to vaccine components2. History of Guillain-Barre or other medical condition3. Received the vaccine from another provider

G. Strategies that have been demonstrated to increase influenza vaccine acceptance shall be implemented. Strategies include, but are not limited to:

A. Vaccination ClinicsB. Bucket BrigadesC. Vaccination access during all work shifts via Nursing SupervisorsD. Modeling and support by institutional leaders

IV. Declinations:

A. Healthcare staff receiving/declining or having received seasonal influenza vaccination elsewhere will have their individual vaccination data added to an electronic database maintained by Human Resources and Infection Prevention.

Effective Date: 05/26/16 of 14 #20-8029



B. Each clinical Director will receive a list of employees he/she supervises who have declined the seasonal influenza vaccine.

C. Healthcare staff that decline the seasonal influenza vaccine for any reason will be required to wear a simple surgical mask at all times during their scheduled shift with the exception of during scheduled breaks for the duration of the influenza season.

D. Clinical Directors are required to enforce that a simple surgical mask be worn by their designated health care staff what have declined influenza vaccination.

E. Surgical masks shall not be worn or left secured around the neck when not in use outside patient care areas.

F. Surgical masks shall be changed when soiled or saturated with moisture.

V. Reporting:

A. Healthcare staff vaccination rates will be reported to the State of California Department of Public Health – Healthcare Associated Infection (CDPH-HAI) Program and The Centers for Medicare & Medicaid Services (CMS) via the National Healthcare and Safety Network (NHSN) on an annual basis at the end of the seasonal influenza period (usually the end of March).

VI. References:

A. Centers for Disease Control, MMWR, Influenza Vaccination of Health-Care Personnel, Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP), February 9, 2006/55 (Early Release);1-16, http://www.cdc.gov/mmwr/preview/mmwrhtml/rr55e209a1.htm

B. Prevention and Control of Influenza, Recommendations of the Advisory Committee on Immunization Practice (ACIP); MMWR 29 July, 2007/56 (Early Release); 1-54, http://www.cdc.gov/mmwr/preview/mmwrhtml/rr56e629a1.htm

C. California Health & Safety Code Section 1288.7

Questions concerning any aspect of this policy/guideline should be referred to Human Resources or Administration.

This policy/guideline replaces and supersedes all previous policies/guidelines concerning this matter and is effective immediately.


http://www.cdc.gov/mmwr/preview/mmwrhtml/rr56e629a1.htm

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr55e209a1.htm



Tulare Regional Medical CenterConsent to Receive the Influenza (Inactivated) Vaccine

ALL AREAS MUST BE COMPLETELY FILLED OUT- NO BLANKS PLEASELast Name: First Name: Birth Date: / /Dept Name: Job Title:Employee #: Work Phone Extension:

Does your job require? Direct Patient Contact No Patient Contact

Please mark one box below:

Employee Volunteer Student Physician Other: ____________

Your signature below indicates that:

I have read and received the Vaccine Information Statement (VIS) about Influenza and Influenza vaccine. I have had an opportunity to ask questions and have them answered to my satisfaction. I understand the benefits and risks of influenza vaccine. I have been informed that I will wait 15 minutes in the area after the immunization if I have never received a flu shot before.

Allergy to eggs or egg products- If you have a serious allergy to these you should not receive the flu vaccination.

Guillain-Barre Syndrome- If you have ever had Guillain-Barre Syndrome within 6 weeks of taking the flu vaccine in the past you should not receive the flu vaccination.

Flu vaccines do not cause influenza. This vaccine is made with a killed virus and does not transmit influenza.

If you are pregnant please inform the nurse providing the injections so that she may provide you with a preservative free influenza vaccine.

Signature: ____________________________________________ Date: __________

To be filled out by Vaccination Staff:

CDC-VIS Title and Date______________________________Administered 0.5 ml Influenza Vaccine IMDate Vaccine Administered: ____________ Time __________Manufacturer Name: _________________________________Vaccine Lot #: _________________________Exp. __________Site/Route of Injection: RUA LUAPerson Administering Vaccine: __________________________ Effective Date: 05/26/16 of 14 #20-8029



TULARE REGIONAL MEDICAL CENTERDECLINATION OF ANNUAL SEASONAL INFLUENZA VACCINATION

ALL AREAS ON THE FRONT AND BACK MUST BE COMPLETELY FILLED OUT- NO BLANKS PLEASE Write legibly

Last Name: First Name: Birth Date: / /Dept Name: Job Title:Employee #: Work Phone Extension:

Does your job require? Direct Patient Contact No Patient Contact

Please mark one box below:

Employee Volunteer Student Physician Other: ____________

DECLINATION STATEMENT:

I acknowledge that I am aware of the following facts:

Influenza is a serious respiratory disease; on average, 36,000 Americans die every year from influenza-related causes.

Influenza virus may be shed for up to 24 hours before symptoms begin, increasing the risk of transmission to others.

Some people with influenza have no symptoms, increasing the risk of transmission to others.

Influenza virus changes often, making annual vaccination necessary. Immunity following vaccination is strongest for 2 to 6 months. In California, influenza usually begins circulating in early January and continues through February or March.

I understand that the influenza vaccine cannot transmit influenza and it does not prevent all disease.

I have declined to receive the influenza vaccine for the 2010-2011 season. I acknowledge that influenza vaccination is recommended by the Centers for Disease Control and Prevention for all healthcare workers in order to prevent infection from and transmission of influenza and its complications, including death, to patients, my coworkers, my family, and my community.

I have received education about the effectiveness of the seasonal influenza vaccination as well as the adverse events. I have also been given the opportunity to be vaccinated with influenza vaccine, at no charge to myself. I understand that by declining this vaccine, I continue to be at risk of acquiring influenza, potentially resulting in transmission to my patients. If in the future I want to be vaccinated with seasonal influenza vaccine, I can receive the vaccine at no charge to me, as long as Tulare Regional Medical Center still has Effective Date: 05/26/16 of 14 #20-8029



a supply of the vaccine.

I have declined the seasonal influenza vaccination for the 2010-2011 influenza season. I acknowledge that influenza vaccination is recommended by the Centers for Disease Control and Prevention (CDC) for all healthcare personnel to prevent infection from and transmission of influenza and its complications, including death, to my patients, my coworkers, my family, and my community.

I understand that I am required by California Health & Safety Code Section 1288.7 to sign this form.

_________________________________ ____________________________Signature Date For evaluation purposes only, please share your reason(s) for declination:

I am allergic to components of the vaccine. I have had Guillen-Barre or other medical problem that precludes me from receiving

the vaccine. I am concerned about the flu vaccine side effects. I do not believe the flu vaccine works. I am afraid of injections. I think the flu vaccine will give me the flu. I have had a prior adverse reaction to the flu vaccine. Other reason, Please list:________________________________________

(If already received the flu vaccination, please complete the section below.)

2010-2011 Influenza Vaccination Received Elsewhere Form

ALL AREAS MUST BE COMPLETELY FILLED OUT- NO BLANKS PLEASEWrite legibly

I HAD THE FLU SHOT ELSEWHERE.

Print Name ___________________________ Department ______________________

Signature ____________________________ Date signed ______________________

(We will count you as vaccinated.)

Tulare Regional Medical CenterMEDICAL STAFF – SCREENING FOR INFLUENZA VACCINATION




Physician Attestation

Write ClearlyLast Name: First Name:ID # DOB: Today’s Date:Address:Phone: Fax:

Attestation for Receipt of Seasonal Influenza Vaccination:

I have received the influenza vaccine for the 2010-2011 Influenza season.(If already received the flu vaccination, please complete the reverse side of this

document.)

Attestation: Signature ______________________________Date__________________

Declination:

I have declined the influenza vaccination for the 2010-2011 influenza season. I acknowledge that influenza vaccination is recommended by the Centers for Disease Control and Prevention (CDC) for all healthcare personnel to prevent infection from and transmission of influenza and its complications, including death, to my patients, my coworkers, my family, and my community.

For evaluation purposes only, please share your reason(s) for declination: I am allergic to components of the vaccine. I have had Guillen-Barre or other medical problem that precludes me from receiving

the vaccine. I am concerned about the flu vaccine side effects. I do not believe the flu vaccine works. I am afraid of injections. I think the flu vaccine will give me the flu. I have had a prior adverse reaction to the flu vaccine. Other reason, Please list:________________________________________

Attestation: Signature ____________________________ Date_________________

By signing above, I authorize release of the information above to the Infection Prevention and Control Office and Medical Staff Office. I understand that I have the right to receive a copy of this signed form if requested.

(If you have already received the vaccine, please complete the reverse side of this form

2010-2011 Influenza Vaccination Received Elsewhere Form

ALL AREAS MUST BE COMPLETELY FILLED OUT- NO BLANKS PLEASEEffective Date: 05/26/16 of 14 #20-8029



Write legibly

I HAD THE FLU SHOT ELSEWHERE.

Print Name __________________________ Department ______________________

Signature ____________________________ Date signed ______________________

(We will count you as vaccinated.)

Clinic where vaccinated ____________________________________________

Date vaccinated ____________________




TO: All Departments


SUBJECT: Seasonal Influenza Plan

I. POLICY:

The medical and professional staff at Tulare Regional Medical Center (TRMC), including its entities, will follow infection control measures to prevent and control influenza transmission within the organization. TRMC will also provide its employees protection against annual flu strains and any new strains as vaccines become available. TRMC’s goal is to protect staff, patients, and family members from the flu, its complications and to decrease healthcare worker absenteeism.

II. PROCEDURE: For the management of the seasonal flu

The Infection Prevention & Control (IP & C) department will assess at the beginning of each flu season, the previous flu season and any current Centers for Disease Control & Prevention (CDC) recommendations. Flu committees will meet as needed.

In addition to influenza immunizations, the following infection control measures, recommended by the CDC, will be followed to prevent person-to-person transmission of influenza and to control influenza outbreaks:

1. A Respiratory Hygiene/Cough Etiquette program will be implemented at the first point of contact with a potentially infected patient or visitor, to prevent the transmission of all respiratory tract infections, including influenza. See Isolation Precautions for Infection Control, policy # 20-8003. The program includes:

Posting visual alerts, signs, and posters, instructing patients and visitors to inform healthcare personnel if they have symptoms of a respiratory infection.

Implement a restricted visitor policy. Limit the number of visitors to two at a time per patient, children under 13 may not visit patient and no one who is sick with a cold or flu symptoms may visit patients.

Flu bags and/or Respiratory Kiosks are accessible to patients and visitors. The flu bags include a mask, tissues and information in English and Spanish on how to help prevent respiratory infection. The Respiratory Kiosks contain alcohol based hand gel, facial tissues, and masks to be stocked by Environmental Services.

Effective Date: 02/25/16 #20-8034



Dispensers of alcohol-based hands rubs will be made available to everyone in the facility. Staff and visitors will be encouraged to use the hand gel.

Supplies for handwashing will be readily available at all patient locations.

Masks will be offered to those persons who are coughing.

Healthcare personnel will encourage persons who are coughing to sit at least three (3) feet away from others.

Healthcare personnel will observe Droplet (depending on current CDC guidelines for identified virus) Precautions as well as Standard Precautions.

2. Influenza Identification:

Influenza virus testing of patients with recent onset of symptoms that are suggestive of influenza will be performed to identify influenza as the causative agent per physicians order.

3. Standard Precautions:

Healthcare personnel will:

Wear gloves if hand contact with respiratory secretions or potentially contaminated surfaces is expected.

Wear a gown, masks and goggles if contact with a patient’s respiratory secretions is expected.

Change gloves and gowns after each patient encounter.

Perform hand hygiene before and after touching the patient, after touching the patient’s environment or after touching the patient’s respiratory secretions, whether or not gloves are worn. CDC Hand Hygiene Guidelines, policy # 20-8025.

Perform hand hygiene with either a non-antimicrobial or an antimicrobial soap and water when hands are visible soiled or contaminated with respiratory secretions.

Perform hand hygiene with an alcohol-based hand rub if hands are not visibly soiled.

Effective Date: 02/25/16 #20-8034



4. Droplet and / or [Enhanced] Airborne Precautions: (depending on identifying circulating virus according to current CDC recommendations)

In addition to Standard Precautions, the healthcare personnel will observe Droplet and / or [Enhanced] Airborne Precautions per local health department and CDC recommendations during the care of a patient with suspected or confirmed influenza. See Isolation Precautions for Infection Control, policy # 20-8003.

Place patient in a private room. If a private room is not available, place (cohort) suspected influenza patients with other patients suspected of having influenza; cohort confirmed influenza patients with other patients confirmed to have influenza.

Healthcare personnel will wear a surgical mask upon entering the patient’s room or when working within six (6) feet of the patient. Remove the mask when leaving the patient’s room and dispose of the mask in a waste container. If the patient is in Enhanced Airborne Precautions, the healthcare personnel will wear a N95 fit tested mask. Removal and disposal of the mask will be inside the patient’s room. Re-donning will occur only when the facility has documented inability to obtain a sufficient supply of N95 masks. Re-donning shall follow CDC and Cal/OSHA’s recommendations.

If patient movement or transport is necessary have the patient wear a surgical mask, if possible.

Aerosol-generating procedures: during procedures that may generate small particles of respiratory secretions, healthcare workers should wear gloves, gown, face/eye protection, and a fit-tested N 95 respirator (Enhanced Airborne Precautions).

5. Healthcare personnel with symptoms of respiratory infection will be excluded from work for the duration of the illness, per local health department and CDC guidelines.

6. Control of Influenza Outbreak:

As noted above, implement Droplet and / or [Enhanced] Airborne precautions for all patients with suspected or confirmed influenza in an outbreak situation.

Effective Date: 02/25/16 #20-8034



Separate suspected or confirmed influenza patients from those patients that are asymptomatic.

Restrict staff travel between units and buildings.

Administer influenza antiviral therapy to patients acutely ill with influenza, within 48 hours of onset of illness per CDC guidelines and physician’s orders.

Administer current inactivated influenza vaccine to unvaccinated patients per physician’s orders.

All employees, volunteers, physicians, and licensed independent practitioners will be offered annually, free of cost, while available, onsite influenza vaccinations. If the employee declines the flu vaccination, they must sign an Influenza Vaccination Declination Form. This ensures compliance with California Health & Safety Code Section 1288.7. Also see Health Care Staff Influenza Vaccination Program policy #20-8029.

If flu vaccination supply is available, clinical students will be offered the flu vaccine free of cost, as they have contact with Tulare Regional Medical Center patients.

In cases of influenza outbreaks, particularly those with high attack rates and severe illness, cancel elective medical and surgical admissions, if possible, and restrict cardiovascular and pulmonary surgical procedures to emergency cases only.

Staff Education. Staff shall be educated regarding influenza and the influenza vaccine including but not limited to: potential health consequences of influenza illnesses for themselves and their patients, modes of transmission, diagnosis, treatment, non-vaccine infection control strategies and respiratory hygiene and cough etiquette. The benefits of the influenza vaccine will be stressed. All TRMC facilities need to apply infection prevention and control measures. Staff will be educated during General Orientation and Annual Update.

Patient Education. Patients shall be educated about what they can do to decrease transmission of influenza to other patients, healthcare workers, visitors and family. Information on Respiratory Hygiene/Cough Etiquette shall be posted and communicated to

Effective Date: 02/25/16 #20-8034



patients and family especially if the patient is being hospitalized with a respiratory disease.

Patient care equipment and patient occupied rooms will be cleaned according to Tulare Regional Medical Centers Environment of Care: Medical Waste Management Plan policy #22-1019 and Cleaning & Performing Low Level Disinfection policy #20-8030.

Should we receive a large influx of patients with influenza, we would refer to TRMC’s Pandemic Plan, policy #20-8035, Plan to Manage the Influx of Potentially Infectious Patients, policy #21-2014, and Emergency Operations Plan, policy #22-1000.

Questions concerning any aspect of this policy/guideline should be referred to Administration.


Effective Date: 02/25/16 #20-8034



TO: All Departments


SUBJECT: Pandemic Influenza Plan

PURPOSE

The medical and professional staff at Tulare Regional Medical Center (TRMC), including its entities, will follow Infection Prevention & Control measures to prevent and control pandemic influenza transmission within the organization. TRMC’s goal is to protect staff, patients, and family members from the flu and its complications. This policy will also provide guidelines for the management of pandemic influenza, planning and decision-making structures for responding to a pandemic influenza.

I. DEFINITIONS

A. Influenza

Commonly called “the flu” is caused by the influenza virus, which infects the respiratory tract (nose, throat, lungs). Unlike many other viral respiratory infections, such as the common cold, the flu can cause severe illness and life-threatening complications in many people. Symptoms of the flu include fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches.

B. Avian Influenza

Avian influenza is an infection caused by avian (bird) influenza viruses. These flu viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick. However, avian influenza is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them. Bird flu viruses do not usually infect humans, but more than 100 confirmed cases of human infection with bird flu viruses have occurred since 1997. Most cases of avian influenza infection in humans have resulted from direct or close contact with infected poultry or surfaces contaminated with secretions and excretions from infected birds.

C. H1N1 Influenza

2009 H1N1 influenza (sometimes called “swine flu”) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. This virus is spreading from person-to-person

Effective Date: 02/25/16 #20-8035



worldwide, probably in much the same way that regular seasonal influenza viruses spread. Influenza A viruses are found in many different animals, including ducks, chickens, pigs, whales, horses and seals. Pigs can be infected with both human and avian influenza viruses in addition to swine influenza viruses. Infected pigs get symptoms similar to humans, such as cough, fever and runny nose. Because pigs are susceptible to avian, human and swine influenza viruses, they potentially may be infected with influenza viruses from different species (e.g., ducks and humans) at the same time. If this happens, it is possible for the genes of these viruses to mix and create a new virus. This type of major change in the influenza A viruses is known as antigenic shift. Antigenic shift results when a new influenza A subtype to which most people have little or no immune protection infects humans. If this new virus causes illness in people and can be transmitted easily from person to person, an influenza pandemic can occur.

II. Stages of a Pandemic (CDC, 2005)

A. Interpandemic period: Phase 1: No new influenza virus subtypes have been detected in humans.

An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low.

Phase 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.

B. Pandemic alert period: Phase 3: Human infection(s) with a new subtype, but no human-to-human

spread, or at most rare instances of spread to a close contact. Phase 4: Small cluster(s) with limited human-to-human transmission but

spread is highly localized, suggesting that the virus is not well adapted to humans.

Phase 5: Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk).

NOTE: During the pandemic alert period, patients with confirmed infection with a novelinfluenza strain should be isolated from patients with seasonal influenza, in order to decrease the risk of co-infection and viral genetic reassortment.

C. Pandemic period: Phase 6: Pandemic; increased and sustained transmission in general

population.

Effective Date: 02/25/16 #20-8035



D. Altered Standards of Care in Mass Casualty Events – when to consider: 1. Volume of flu like symptoms to the Medical Center.

2. Increase in in-patient census.3. Staff shortages.

III. POLICY

1. During the flu season and as needed, TRMC routinely conducts internal surveillance of all patients in the emergency department and patient care areas, exhibiting flu like symptoms.

2. Enhanced surveillance for additional influenza trends will be conducted when directed by the Tulare County Health and Human Services (TCHHS).

3. The following patients should be evaluated for possible infection with influenza, following guidelines from the Centers for Disease Control & Prevention (CDC):

A. Hospitalized patients with:1) Radiographically confirmed pneumonia, acute respiratory distress

syndrome (ARDS), or other severe respiratory illness for which an alternate diagnosis has not been established, AND

2) History of travel within 10 days of symptoms onset to a region or country with documented influenza, OR

B. Hospitalized or ambulatory patients with:1) Documented temperature of >100°, AND2) One or more of the following: cough, sore throat, shortness of

breath, AND 3) History of contact with a known or suspected human case of

influenza from an affected region or country within 10 days of onset.

C. When both clinical and epidemiologic criteria for suspected influenza infection have been met by increased volume and altered standards of care, the hospital will immediately proceed with the following actions:1) Implement infection control precautions. See Season Influenza

Plan, policy #20-8034.2) Infection Prevention office will report cases, as requested, to

TCHHS.3) Obtain clinical specimens for influenza infection and submit them to

Tulare County Public Health laboratory, as per guidelines.4) Initiate antiviral treatment, if available, per physician’s orders.5) Triage to the appropriate level of care.6) Evaluate alternative diagnoses.7) Provide necessary clinical evaluation and management services,

including monitoring the patient appropriately for complications.8) Assist TCHHS with the identification of potentially exposed contacts

including healthcare workers, as requested.

Effective Date: 02/25/16 #20-8035



D. Prepare to activate hospital pandemic influenza plan as necessary.E. Identify and isolate all potential patients with pandemic influenza.F. All health care workers will be offered vaccination against influenza per

Seasonal Influenza policy and TCHHS collaboration. All appropriate patients will be given vaccination against influenza per physician’s order.

G. Antiviral drugs for influenza are an adjunct to influenza vaccine for controlling and preventing influenza and will be given as available per physician’s order.

H. In the event of pandemic influenza, the administrator will discuss with local health department whether, how, and when an “Altered Standards of Care in Mass Casualty Events” will be invoked.

I. Organization wide disaster plan and HICS system may be activated by volume of flu like symptoms, increase in in-patient census and or staff shortages.

J. If necessary, cohort pandemic influenza patients.K. Infection prevention education will be provided on a regular basis.L. Enhanced assessment of drugs, supplies, PPE, and equipment inventory

will be conducted, including free standing tents. M. Refrigeration of deceased patients will be provided until plans with local

public health department are implemented.

IV. PROCEDURE

1. HICS with responsibility for pandemic influenza preparedness and response will include the following:

a) Safety Officerb) Administrator(s) – COO, CNO, CMOc) Infection Prevention including Infection Control Officerd) Emergency Departmente) Material Managementf) Educational Servicesg) Marketingh) Facilities/Plant Operationsi) Laboratoryj) EVSk) Pharmacyl) Patient Care Departments Representativesm) Respiratory Therapyn) Any other TRMC entities as necessary

2. If pandemic influenza is noted in local area:a) Infection Prevention Staff will establish contact with TCHHS, Tulare

County’s Epi Center program, CDPH and CDC as needed. We will also utilize California Department of Health Services Pandemic Influenza Preparedness and Response Plan. (September 8, 2006).

Effective Date: 02/25/16 #20-8035



b) Conduct hospital surveillance for influenza.c) Monitor healthcare personnel who might be infected with a pandemic

strain of influenza. Department director/manager will monitor all employee sick calls.

d) Reinforce infection control measures and respiratory etiquette throughout facilities, including visitors.

e) Accelerate staff education.f) Implement activities to increase capacity:

1) Consider revising admissions criteria and working with home care agencies.

2) Plan to shift some patients to other facilities or identify space that could be vacated for use as a supplemental hospital.

3) Plan for isolation zones to prevent further spread of the disease.4) Consider how to handle, treat, and isolate patients with no influenza

illness.5) Consider how decisions will be made about patient priorities for

admission. 6) Emergency department will segregate waiting areas for persons with

symptoms of influenza.7) Limit number of visitors to those essential for patient support.8) Defer elective admissions and procedures until local epidemic wanes.9) Discharge patients as soon as possible.10) Cohort patients admitted with influenza.11) Monitor for Healthcare Associated Infection transmission.12) Consider furlough or reassignment of pregnant staff and other staff at

high risk for complications of influenza.

13) Consider re-assigning non-essential staff to support critical hospital

services or placing them on administrative leave.

14) Consider assigning staff recovering from influenza to care for influenza patients.

15) Screen staff reporting for duty.

16) Provide staff with antiviral prophylaxis according to HHS

recommendations and physician’s orders.

17) If widespread transmission in community and hospital:a) Redirect personnel resources to support patient care.b) Recruit community volunteers.c) Consider placing on administrative leave all non-essential

personnel who cannot be reassigned to support critical hospital services.

d) Consider cross-training programs.

Effective Date: 02/25/16 #20-8035



e) Explore options for alternative healthcare workers (e.g., retirees, trainees, family members, or others) as supplemental staff.

f) Prepare for just-in-time training of non-clinical staff.g) Consider that you might need to replace high-risk

personnel, including pregnant women and immune-compromised workers, during an outbreak.

h) See also Plan to Manage the Influx of Potentially Infectious Patients, policy #21-2014.

i) Consider the use of free standing tents if volume exceeds capacity. Follow state mandates as required.

3. Infection Prevention General Guidelines Refer to Isolation Precautions for Infection Control, policy #20-8003. Hand Hygiene policy will be utilized as is normal for TRMC, see CDC

Hand Hygiene Guidelines, policy #20-8025. Soiled linen/laundry, environmental cleaning and solid waste disposal are

performed in the usual manner as defined in Environment of Care: Cleaning & Disinfection, policy #20-8030.

Respiratory hygiene/cough etiquette as described in the Seasonal Influenza policy. Additional signage may be indicated per direction of the team.

Isolation Precautions: place patients with influenza in a private room or cohort with other patients with influenza as per CDC guidelines. Keep door closed. During the early stages of a pandemic, infection with influenza should be laboratory confirmed, if possible. Wear a surgical mask for entry into patient room or a N95 per recommendations from CDC and Isolation Precautions for Infection Control, policy #20-8003.

Patient Transport: limit patient movement outside of room to medically necessary purpose; have patient wear a surgical mask when outside the room.

Aerosol-generating procedures: during procedures that may generate small particles of respiratory secretions, healthcare workers should wear gloves, gown, face/eye protection, and a fit-tested N 95 respirator (Enhanced Airborne Precautions).

4. Post Emergency Event ActionsA. Recover normal facility, personnel and patient operations.B. Dissolve the Emergency Operations Center.C. Resume usual use of space and clinical areas.D. Resume normal practice for supplies, medications and equipment.E. Resume usual staffing patterns.F. Conduct post-evaluation and review of performance and operations.G. Debriefing.

Effective Date: 02/25/16 #20-8035



5. Laboratory procedures: Collect and handle all clinical specimens from suspect patients while

wearing gloves, face and eye protection and a laboratory coat following CDC guidelines and per policy.

Collect a nasal and / or throat swab and place each swab into a separate vial of transport media, following TRMC laboratory procedures. For H1N1 see Swine Flu PCR Testing, policy # 20-8032.

Label each specimen with the following information: patient’s name, date collected, and type of specimen. Please note “suspect case of ________” on the forms and specimens, or as directed by our laboratory.

Contact Tulare County Public Health Lab for specimen transport instructions.

Questions concerning any aspect of this policy/guideline should be referred to Administration.


Effective Date: 02/25/16 #20-8035

iv. procedureedutracker.com/trktrnr/presentation/trmc_tulare_ca/n9i… · web viewfor h1n1 see...

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