Infection control recommendations

Infection control guidelines

Health Care Workers at increased risk of complications from pandemic (H1N1) 2009 infections

Health care workers who are at increased risk of complications from pandemic (H1N1) 2009 and who are likely to be in direct contact with patients who have pandemic (H1N1) 2009 infections, should be considered for redeployment to lower risk activities.

If redeployment is not possible, health care workers who are at increased risk of complications from pandemic (H1N1) 2009 infection should maintain a distance of one metre from pandemic (H1N1) 2009 patients and not participate in procedures with these patients that may generate small particles or aerosols of respiratory secretions.

Surveillance and management of healthcare personnel

Health care workers should be monitored for illness and those who develop acute respiratory illness (ARI) should be instructed not to report to work, or if at work, should cease patient care activities and notify their supervisor and infection control personnel.

It is also important to identify health care workers who may be considered vulnerable i.e. in whom pandemic (H1N1) 2009 may be severe (e.g. pregnant women) and manage as appropriate (see section Health Care Workers at Increased Risk of Complications from pandemic (H1N1) 2009 Infections).

Management of ill health care workers

Health care workers who develop ARI should be tested if capacity exists and excluded from work for 7 days or until fever has resolved, whichever is longer (unless on antivirals for 72 hours and fever resolved for 24 hours).

Hand Hygiene

Health care workers and visitors must perform hand hygiene regularly, including when removing gloves.
Patients with ARI should be encouraged to perform hand hygiene frequently.

Personal Protective Equipment (PPE)

General advice

Anyone with an ARI should wear a surgical mask when not in isolation in a single room and stay at least a metre distant from others.

Advice for use during procedures (including collection of swabs for influenza diagnosis)

Health care workers should consider any guidance available from their State or Territory health department before making a decision to collect clinical swabs from a patient for influenza diagnosis, including pandemic (H1N1) 2009.

Health care workers should routinely wear a surgical mask, protective eyewear and disposable gloves if they are undertaking an examination of an individual with ARI that may lead to coughing (e.g. collecting nose and/or throat swabs).

All health care workers in the same room when aerosol-generating procedures are undertaken on ARI patients should use P2 respirators, protective eyewear, a disposable gown and disposable gloves. Aerosol-generating procedures include endotracheal intubation, nebulized medication administration, airway suctioning, bronchoscopy, diagnostic sputum induction, positive pressure ventilation via facemask, and high frequency oscillatory ventilation. These procedures should only be performed in a single room with the door closed.

Administration of medication via nebulisers is not recommended. Use spacers where possible.

Health care workers in the vulnerable category should not administer to patients during aerosol generating procedures or collection of nose and throat swabs.

In- patient isolation

Single room accommodation should be used for pandemic (H1N1) 2009 inpatients and people with ARI presenting in clinical settings, wherever possible.
If single rooms for pandemic (H1N1) 2009 inpatients are not available, cohorting of pandemic (H1N1) 2009 patients should be practised wherever possible.

Management of visitors

Limit visitors for patients who are in isolation to those persons who are necessary for the patient's emotional wellbeing and care.

Duration of precautions

Persons with pandemic (H1N1) 2009 infection should be considered potentially contagious from one day before to 7 days following illness onset. Persons who continue to be ill longer than 7 days after illness onset should be considered potentially contagious until fever has resolved. Children, especially younger children, might be contagious for longer periods.

Isolation precautions should be continued for 7 days from symptom onset or until the resolution of fever, whichever is longer.

Isolation precautions may also be discontinued when patient has had 72 hours of influenza antiviral treatment provided they have no fever for 24 hrs in the absence of antipyretics.

Cleaning pandemic (H1N1) 2009 in-patient rooms

Daily and on discharge - clean with a neutral detergent. The room can be used immediately following cleaning.
Management of laundry and utensils should be performed in accordance with procedures followed for seasonal influenza.

Waste

Treat waste as general medical waste.
Used tissues are disposed of in general waste.

Face mask information

Surgical Masks

The term ‘surgical mask’ refers to a disposable fluid-repellent, paper filter mask that complies with the Australian standard for single-use masks for use in health care (AS 4381-2002). This may include masks labelled as surgical, dental, medical procedure, isolation, or laser masks.

It is important to ensure that surgical masks are worn and disposed of correctly. Make sure the mask is correctly fitted by ensuring that it covers your nose and mouth and that it is secured at the back of your head.

Avoid touching your face while wearing the mask. Replace the mask whenever it is moist. A mask that has been removed should not be reused.

Remove the mask by only touching the straps and put the used mask in a bin. Wash your hands well with soap and water straight away and dry with a paper towel.

P2 Respirators

P2 respirators (P2 masks) are designed to provide high-level protection to the wearer’s respiratory tract from small infectious particles. They are particulate filter, personal respiratory protection devices which, when tested against the Australian standard for Respiratory Protective Devices (AS/NZS 1716:2003), filter out at least 95% of particles of 0.3 micrometres diameter.

Testing is required so that P2 masks fit properly. Fit Checking for staff wearing a P2 mask is the appropriate minimum standard for health care workers each time they need to use a P2 mask for dealing with potentially infectious cases. Formal Fit Testing is recommended where available.

Fit Checking should be done in accordance with the mask manufacturer’s instructions to ensure there is no air leakage around the mask. This is usually done after the mask is compressed over the nose and across the cheeks and face to create a firm seal. The wearer then gently inhales - the mask should draw in slightly towards the face and collapse – and then gently exhales - the mask should fill up with air. A fit check should be done each time a P2 mask is worn.

In some areas formal Fit Testing for health care workers is provided and required prior to wearing P2 masks in clinical settings. Health care workers should consult with their OH&S or infection control practitioners for specific guidance.