To: VCUHS Employees From - Virginia Commonwealth University ...

To:
From:
VCUHS Employees
VCU Health System Administration
Date: May 5, 2009
Subject:
Fourth Update on VCUHS Preparations for H1N1 Flu
VCUHS should be very proud of the extensive planning for disasters and other emergencies that have allowed us to be
well prepared for the outbreak of H1N1. In the past we have conducted several mock emergency preparedness drills to
prepare for a pandemic event; as a result, we have many plans in place.We will continue to provide regular updates to
VCUHS staff and providers. Please refer to the VCUHS intranet site - see “VCUHS Response to H1N1 Flu” for
additional background and information.
This update includes the following topics (again please refer to intranet site as well):
A. Current Status in Virginia F. Guidelines for Pregnant Women
B. Recommendations for Symptomatic Staff G. Specimen Collection and Testing
C. Communication to Patients and Visitors H. VCUHS Epidemiology Treatment Recommendations
D. Preventive Transmission: Isolation and Use of PPE I. Quick Guide to References
E. N95 Fit-testing on hold until further notice
A) Current Status: Cases of H1N1 have been confirmed in Virginia. The Centers for Disease Control and Prevention
(CDC) updates its website regularly and is a good resource for information, www.cdc.gov/swineflu and we will continue
to monitor the status of the outbreak. Just as the CDC continues to refine its recommendations, we may continue to refine
our response and planning to this outbreak
B) The VCUHS Departments of Epidemiology (Epi) and Employee Health Services (EHS) have developed the
following guidelines for VCUHS staff who are currently exhibiting flu–like symptoms, Remember, regardless of
whether we are dealing with a flu outbreak or not, if you have a fever, with cough, sore throat, body aches, headache,
chills, fatigue, diarrhea or vomiting, stay home until symptoms have subsided for at least 24 hours. However, during
this time of H1N1 flu, please call EHS to report these symptoms as this will help us with our tracking and planning.
1) The main symptoms of influenza, include but are not limited to, a fever (>/= 100 F or 37.8C), cough and/or a
sore throat, aches/myalgia
2) Employees with the above symptoms should call EHS (828-0584 during business hours, 7:30 a.m. to 5:00 p.m.
M-F, or pager #9118 after hours or on weekends), or Epidemiology (at 828-2121, pager #4085 after hours and on
weekends) to report these symptoms.
3) EHS will evaluate the need for the employee to be tested for H1N1 flu.
4) Should a symptomatic employee have to come into the health system for evaluation he/she will don a surgical
mask upon arrival at EHS prior to any contact with providers, visitors, or staff.
5) If deemed appropriate by EHS, the employee will be offered chemoprophylaxis (e.g., tamiflu).
6) Symptomatic employees with confirmed (or suspected) H1N1 will be told to stay home for 7 days from the
onset of symptoms or until symptoms have resolved, whichever is longer. Employees will use PTO and/or sick
time according to policy during this absence (refer to policy for guidelines).
7) If you see your primary care physician for these symptoms, you must still contact EHS or Epi to report your
symptoms and the findings- this will help us with tracking efforts and planning.
C) Communication to patients and visitors: Signs have been posted to remind the public that it is not advisable to visit
patients if the visitor is experiencing flu-like symptoms. Further, the VCUHS website for patients has been updated to
reflect current recommendation. We have translated signs into Spanish as well.
D) Recommendations for prevention of transmission, isolation and compliance with Personal Protective
Equipment (PPE) when caring for patients with flu like symptoms:
• CDC continues to recommend handwashing as one of the most effective tools to prevent transmission of
H1N1. VCUHS has installed more soap dispensers and provided tissues in more locations.

• Place the patient in droplet and contact precautions. This requires that the patient be placed in a
private room and that persons entering the room wear a standard surgical mask, gowns, gloves and
goggles. Handwashing following removal of PPE is imperative.
• Procedures that are likely to generate aerosols (e.g., bronchoscopy, elective intubation, suctioning,
administering nebulized medications, etc.) should be done in a negative pressure room and those in the
room should wear N95 masks. In addition, patients requiring ICU care should be cared for under airborne
+ contact precautions.
• Please limit the members of the health care team who are caring for patients with flu-like symptoms
to only those who are essential to the care of that patient.
E) Due to the recently announced national shortage of N95 masks and our inability to acquire a large supply at this time, it
is necessary to conserve our cache of N95 masks for the care of patients requiring airborne precautions. Therefore,
N95 fit-testing will be suspended until further notice; please assign staff who have already been fit tested to care for
these patients. If you have a particular need please contact Robin Luffman directly at 628-4595 to discuss options.
F) Guidelines for pregnant women: The CDC has issued guidelines for pregnant women (posted on the VCUHS
intranet).We recommend that pregnant employees are re-assigned so that they do not care for patients with suspected or
confirmed H1N1 flu. Pregnant women who demonstrate flu-like symptoms should consult their obstetrician as some
treatment options are available.
G) VCUHS Guidelines on Specimen Collection and Testing: The protocol for collection and submission of specimens
for the detection of suspected Swine-origin Influenza A (H1N1) and novel influenza strain types by PCR at VCUHS has
been revised. (Note: PCR testing is performed once a day, Monday-Friday.)
TWO specimens must be collected on each patient and submitted to the VCU Clinical Microbiology Laboratory
using standard protocols
• Nasal swab: collect and submit in Universal Transport Medium to the clinical laboratory on ice.
• Nasal washing or nasal aspirate: collect and submit to the clinical laboratory on ice for direct testing for
influenza A, influenza B and RSV by PCR.
If you have question about which patients should be tested, please see the CDC web site at www.cdc.gov or contact the
Infectious Disease consult service via Telepage (828-0951) or Epidemiology at 828-2121.
Questions regarding the collection and processing of specimens should be directed to the Clinical Pathology Laboratory at
828-7284 (828-PATH).
H) VCUHS Epidemiology Recommendations for Treatment:
(1) If empiric treatment is indicated, use: (a) zanamivir OR (b) oseltamivir + rimantidine for 5 days [note:
rimantidine alone is not effective].
(2) Contact the Epidemiology nurse on call to report the case and for any questions regarding isolation.
(3) For patients not requiring hospital admission, advise the patient to stay at home until further notice regarding
their test results.
(4) The Infectious Diseases consultation service is available to assist in case management.
I) Quick Guide to References
The VCUHS Intranet site will contain the following resources and other information:
• Emergency plan for Dr. Orange: Staff should review and become familiar with Dr. Orange procedures in the
event this emergency action plan is activated
• Infection Control policy on Pandemic Influenza
• Links to the VCUHS internet site for information to the public (www.vcuhealth.org), CDC website
(www.cdc.gov/swineflu), Virginia Department of Health (www.vdh.state.va.us) and others
Important Phone Numbers
• VCU Employee Health Services 828-0584
• VCUHS Epidemiology 828-2121 or pager #4085 (828-4999, enter pager ID 4085)
• Staff may call the inclement weather hotline (628-7669) to learn if an emergency plan was implemented.
VCUHS will continue to follow CDC guidelines when making decisions about our plans of action.
Please stay tuned to massmail or the VCUHS intranet for further updates.