The Canadian Pandemic Influenza Plan for the Health Sector

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(b) (c) washing. Antiseptic hand rinses are especially useful when time for hand washing or access to sinks is limited. BIII iv. When there is visible soiling, hands should be washed with soap and water before using waterless antiseptic hand rinses. If soap and water are unavailable, cleanse hands first with detergent-containing towelettes. BIII v. Wearing gloves does not eliminate the need for proper hand hygiene after care is rendered. As soon as feasible, hands must be washed after the removal of gloves. AI Hygiene Measures to Minimize Influenza Transmission i. Emergency Responders should be encouraged to minimize potential influenza transmission through good hygienic measures, i.e., use disposable, one-use tissues for wiping noses; covering nose and mouth when sneezing and coughing; handwashing/hand antisepsis after coughing, sneezing or using tissues; and the importance of keeping hands away from the mucous membranes of the eyes and nose. AIII Personal Protective Equipment i. Masks 1. Masks may be worn to minimize the transmission of influenza when face-to-face with coughing individuals in the early phase(s) of the pandemic but are not practical or helpful when influenza transmission has entered the community. BIII 2. Masks should be worn to prevent the transmission of other organisms when HCWs are face-to-face with undiagnosed coughing patients. BIII 3. Masks and eye protection, or face shields should be worn to prevent HCW exposure to sprays of blood, body secretions or excretions. Surgical masks are considered adequate for this purpose 9,44,45 . BIII 4. HCWs should avoid touching their eyes with their hands to prevent self-contamination with pathogens. 5. Masks should be worn, as outlined in Section 2.6. ii. Gloves 1. Gloves are not required for the routine care of patients suspected or confirmed to have influenza. Meticulous handwashing with soap and water or performing hand antisepsis will inactivate the virus. AIII 2. Gloves should be worn to provide an additional protective barrier between the HCWs hands and blood, body fluids, secretions, excretions and mucous 34 The Canadian Pandemic Influenza Plan for the Health Sector
(d) (e) membranes to reduce the potential transfer of microorganisms from infected clients to HCWs. AII 3. Gloves are necessary for HCWs with open lesions on their hands when providing direct patient care. AII 4. Gloves should be used as an additional measure, not as a substitute for hand hygiene 46,47 . AII 5. Gloves should not be reused or washed 47 . AII iii. Gowns 1. Gowns are not required for the routine care of patients with ILI. AI 2. Long sleeved gowns should only be used to protect uncovered skin and prevent soiling of clothing during procedures and patient care activities likely to generate splashes or sprays of blood, body fluids, secretions or excretions 9,45 . BIII 3. HCWs should ensure any open skin areas/lesions on forearms or exposed skin is covered with a dry dressing at all times. Intact skin that has been contaminated with blood, body fluids, secretion or excretions should be washed as soon as possible, thoroughly, but gently, with soap and warm running water. BIII Patient Triage Whenever feasible, personnel responsible for answering emergency calls related to influenza-like-illness (ILI) should triage patients according to an ILI Assessment Tool (see Appendix IV). AIII Environmental Control (Housekeeping, Laundry, Waste) i. Emergency Responders should adhere to the recommendations for housekeeping, laundry and waste management, as outlined in the Health Canada Infection Control Guidelines Handwashing, Cleaning Disinfection and Sterilization in Health Care 3 and Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care 5 . AIII ii. Equipment and surfaces contaminated with secretions from patients suspected or confirmed to have influenza should be cleaned before use with another patient. BIII iii. Special handling of linen or waste contaminated with secretions from patients suspected of having or confirmed to have influenza is not required. AII Annex F 35
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INFORMATION NOTICE The Canadian Pan
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Organization of Contents Preface Se
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Foreword and Acknowledgements The C
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Alternate Dr. Ross Findlater Chief
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Dr. Anne Roberts Department of Heal
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Past Surveillance Working Group Mem
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With special thanks to the : • Ad
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Preface Influenza A viruses periodi
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Section One INTRODUCTION
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ii The Canadian Pandemic Influenza
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Given that an influenza pandemic is
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The federal government, through Pub
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Table of Contents 1.0 Epidemiology
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Background 1.0 Epidemiology of Pand
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Based on past pandemics, when the p
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historical relationship between sic
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The Pandemic Influenza Committee wi
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4.0 Terminology On April 8, 2005, t
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4.1.2 Pandemic Alert Period Phase D
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4.1.5 Post-Pandemic Period A recove
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public of the risk from a pandemic,
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Section Three PREPAREDNESS
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2.6 Communications . . . . . . . .
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The changes are now resulting in em
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2.1.1 Current Status The national F
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2.2.1 Current Status The annual inf
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At the time of a pandemic, it is as
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The objectives of the antivirals in
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amantadine, which is not currently
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2.4.2 Planning Principles and Assum
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census, high intensive-care unit ce
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2.5.2 Planning Principles and Assum
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iii) Federal Federal communications
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Section Four RESPONSE
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Other unknown factors (e.g. age dis
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However if no other pandemic activi
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Canadian Phase 1.1 No new virus sub
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6.2 Pandemic Alert Period Canadian
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Canadian Phase 3.1 Sporadic human i
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Canadian Phase 3.1 Sporadic human i
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Canadian Phases 4.0 and 5.0 Cluster
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Canadian Phases 4.0 and 5.0 Cluster
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Canadian Phases 4.1 and 5.1 Sporadi
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Canadian Phases 4.2 and 5.2 Localiz
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6.3 Pandemic Period Canadian Phase
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Canadian Phase 6.0 Outside Canada,
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Canadian Phases 6.1 and 6.2 Pandemi
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Canadian Phases 6.1 and 6.2 Pandemi
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Component Focus Actions Response Le
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Table of Contents Annexes
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Annex A Planning Checklists Date of
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Consider how special studies, ident
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Purchase in bulk and stockpile extr
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Develop a list of essential communi
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B Pandemic Influenza Planning Consi
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Clear protocols for on-reserve FNs
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2. FNIHB Regions 2.1 Develop FNIHB
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5. Centre for Emergency Preparednes
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C Pandemic Influenza Laboratory Pre
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The Pandemic Influenza Laboratory P
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The NML currently performs testing
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and manipulation of viral cultures.
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3. Communication Information such a
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as appropriate, and the provision o
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3. Communication As in Phases 1.0 t
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8. Allow the swab to sit in place f
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Disease Surveillance Liaison Jeanne
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Annex D Recommendations for the Pri
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D Recommendations for the Prioritiz
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1. Priorities for Vaccination Prior
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Group 3: Persons at High Risk of Se
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Annex E Planning Recommendations fo
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3.0 Classes of Antiviral (Anti-Infl
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3.2 M2 Ion Channel Inhibitors (Cycl
Page 167 and 168: There are ethical obligations to pr
Page 169 and 170: ) Neuraminidase inhibitors can be u
Page 171 and 172: At a national Influenza Research Pr
Page 174 and 175: F Infection Control and Occupationa
Page 176 and 177: helpful when transmission has enter
Page 178 and 179: Glossary of Terms Antiseptic hand r
Page 180 and 181: Infectious waste Influenza Intermed
Page 182 and 183: Statement.......
Page 184 and 185: Part C: Pandemic Influenza in Non-T
Page 186 and 187: 1.1 World Health Organization Phase
Page 188 and 189: practices are the infection prevent
Page 190 and 191: 3.0 Occupational Health and Infecti
Page 192 and 193: health care workers (see glossary f
Page 194 and 195: (b) (c) (ii) they have been immuniz
Page 196 and 197: (l) the importance of being immuniz
Page 198 and 199: 5. Inform the public to avoid publi
Page 200 and 201: Part B. Management of Pandemic Infl
Page 202 and 203: (d) 3. Masks and eye protection, or
Page 204 and 205: Note: *Immune are those recovered f
Page 206 and 207: C. Infection Control Practices 1. U
Page 208 and 209: (e) Sterilization in Health Care 3
Page 210 and 211: 3.0 Management of Pandemic Influenz
Page 212 and 213: (d) or using tissues; and the impor
Page 214 and 215: B. Management of Staff 1. Provide e
Page 216 and 217: to generate splashes or sprays of b
Page 220 and 221: (f) Patient Care Equipment (Cleanin
Page 222 and 223: procedures is imperative to minimiz
Page 224 and 225: (b) Control of Pandemic Influenza 1
Page 226 and 227: 3. Workers and their household memb
Page 228 and 229: Planning for Pandemic Influenza 1.
Page 230 and 231: Part C. Infection Control and Occup
Page 232 and 233: supplies and soap and towel dispens
Page 234 and 235: c. Gowns vii. Single-use disposable
Page 236 and 237: d. Laundry (linen) i. When reusable
Page 238 and 239: C. Infection Control Practices To p
Page 240 and 241: 3. Environmental Control (Housekeep
Page 242 and 243: 3.2 Control of Pandemic Influenza A
Page 244 and 245: v. before preparing, handling, serv
Page 246 and 247: c. Gowns i. Gowns are not required
Page 248 and 249: 3. Disinfection a. Reuseable items
Page 250 and 251: (equipped with exhaust filter) rath
Page 252 and 253: . Collection and handling i. There
Page 254 and 255: 3. Waste vi. All caregivers and lau
Page 256 and 257: Appendix I. Guideline Rating System
Page 258 and 259: Phase 4: Second or later waves of t
Page 260 and 261: B. Decontaminating Hands with an Al
Page 262 and 263: Appendix V. Tables Table A. Cleanin
Page 264 and 265: Reference List 1. Boyce JM, Pittet
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67. Wade JJ, Desai N, Casewell MW.
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100. Orth B, Frei R, Itin PH, Rinal
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133. Korniewicz DM. Barrier protect
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Annex G Health Services: Clinical C
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Chapter 2. Patient Management I 2.1
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Chapter 6. Special circumstances 6.
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Pathogenesis of influenza The major
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dysfunction and less than 80 pg/mL
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influenza viruses supplant all othe
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maternal age 189 . Only four of the
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developed severe infections, one ch
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1.2.3 Cardiovascular Sudden death o
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High-risk conditions: (Co-morbidity
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Chapter 2. Patient Management I 2.1
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Legend: 1) Triage centres may be lo
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Initial influenza illness assessmen
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Microbiologic Diagnostic tests Micr
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2.2 Pediatric Triage This algorithm
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Initial influenza illness assessmen
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Secondary assessment (15% Platelets
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Clinical assessment for evidence of
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Appendix 2.I. Caring For Your Self
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B. Protect Yourself Against Influen
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C. Plan Ahead Spend a little time t
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Read the label to be sure that the
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D. When A Child Is Unwell Older chi
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Attachments A) How To Take A Child
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Squeeze and hold down the button fo
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C) Self-care Algorithms, Adults Sta
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Does Your Infant or Young Child (Bi
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Does Your Older Child (Age Six Year
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Appendix 2.II. Assessment Forms 1.
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Clinical features on history YES NO
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) Children ≤ 18 years: Identifica
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Symptoms (children 18 years) Date a
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Provisional Diagnosis Please Tick a
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Provisional Diagnosis Please Tick a
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Investigations Complementary labora
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If not admitted: Sent to: Home car
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measurements and minimize false ala
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2. Trans cutaneous PO2 monitoring
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3.2. Assessment and management of l
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3.2.2.1 Symptoms consistent with fl
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c) Specific therapy: Specific thera
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Appendix 3.I. Influenza-Like Illnes
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Chapter 5. Patient Management IV Ho
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5.3.3 General management Fluid the
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Appendix 5.I. Admission form 171 Id
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Symptoms Date and time of onset of
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Investigations (Not all tests will
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Provisional Diagnosis Please tick a
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Appendix 5.II. Rapid Virologic Diag
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Appendix 5.III. Antiviral Drugs for
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susceptible Staphylococcus aureus.
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Table 5.7. Antimicrobials for the t
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Chapter 6. Special circumstances 6.
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3. Education of all medical and non
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Legend for Table 6.1.2 1) This algo
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6.1.5 Management of influenza patie
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6.2 Correctional and penal institut
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Legend for Table 6.2.3 1. A special
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) General management: Specific aspe
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15. Barrett MJ, Hurwitz ES, Schonbe
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50. Duchini A, Viernes ME, Nyberg L
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85. Govaert TM, Dinant GJ, Aretz K,
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119. Kim HW, Brandt CD, Arrobio JO,
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152. NACI August 1, 2001, posting d
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182. Ruff RL, and Secrist D. 1982.
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217. Van Caeseele, Macaulay A, Orr
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Annex H Resource Management Guideli
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3.2.4 Consider Insurance and Licens
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1.0 . . . . . . . . . . . . . . . .
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2.0 . . . . . . . . . . . . . . . .
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Various options to increase bed cap
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addition, provinces and territories
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3.2 Human Resource Management Durin
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technicians (laboratory, radiograph
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Clerical skills in terms of patient
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3.2.5 Immunization of Health Care W
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workers, as well as the public will
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Appendix A Evaluation of Bed Capaci
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Inventory of Beds (Work Sheet) Type
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Emergency Ventilatory Capacity Cons
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Annex I Guidelines for the Manageme
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Steps Requirements Limiting Factors
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In order to deal with the increase
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1.6 Capacity of and Access to Vault
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As a result of these special requir
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Annex J Guidelines for Non-Traditio
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Section 2: Human Resource Issues 2.
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Section 1: Non-Traditional Sites 1.
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timely distribution. The NESS shoul
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most likely the local medical offic
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1.6.4 Assess Locations for Potentia
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Security and Safety The safety of b
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intravenous equipment (e.g., needle
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1.7.4 Coordinate Procurement of Sup
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2.2.1 Appoint a Human Resource Mana
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For each site the essential functio
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FUNCTIONS SKILL SETS/PERSONNEL F Mo
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2.2.5 Plan for Salaries or Payments
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c. Develop job descriptions and ski
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Based on the Checklist of Functions
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Malpractice/Liability Insurance of
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c. Volunteer screening Volunteers i
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Annex K Canadian Pandemic Influenza
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Interpandemic Phase - National Comm
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Health Canada Primary Communication
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Primary Communications Roles Primar
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Pandemic Alert Phase - National Goa
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Health Canada Primary Communication
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L Federal Emergency Preparedness an
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1. The Federal System Traditionally
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National Response Structure Nationa
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2. Public Health Agency of Canada a
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Public Health Agency of Canada, Hea
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Technical Response Group Structure:
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M Public Health Measures Table of C
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1.0 Introduction As an influenza pa
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Individuals who recover from illnes
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In March 2004, WHO hosted an intern
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5.1 Recommendations Encourage all
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As previously noted, antiviral trea
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Except when visiting a health care
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aseline data on these indicators sh
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Recommendations for Management of C
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The availability of antiviral drugs
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7.1 Strengthen recommendations to s
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7.3 Restrict indoor public gatherin
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7.5 Implement hand-sanitizing stati
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7.7 Other Measures NOT Recommended
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Increase awareness of the “travel
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initially at Customs, and within 4
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Contact management logistics Althou
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References 1. Department of Communi
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A.2 Community-Based Disease Control
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N Pandemic Influenza Surveillance G
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Introduction The overall goals of i
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Special Studies Protocols for speci
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Surveillance Objectives/Roles and R
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Pandemic Alert Period Table 2, belo
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Surveillance Objectives/Roles and R
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Canadian Pandemic Phase 4.1 Single
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Table 4: Post-Pandemic Period Canad
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Study design Two types of surveys c
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Table 2 Sample size of each group (
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Household data How many total indiv
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Poultry and Other Animal Exposures
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Collected environmental swabs from
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Appendix 2: National FluWatch Influ
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Glossary of Terms and List of Acron
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Bed (Institutional Bed) Case weight
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Health Care Worker (HCW) without cl
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LICO (Low income cutoff point) LPN
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Pandemic Pandemic Alert Period Pand
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R Raw data Measurements and observa
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Vaccination Vaccine Virology Virus
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