The following information is provided
to assist fire fighters and emergency medical personnel to prepare for a
potential influenza pandemic and to advise all first responders with potential
influenza exposure to use proper infection control precautions to protect their
own health and that of the public. Regardless of an influenza pandemic event,
all first responders should receive an influenza vaccine each year to protect
themselves, their families and the public they serve.
An influenza pandemic could
potentially result in widespread illness and deaths globally. Because all
disasters and emergencies are dealt with locally, each local fire and emergency
medical department must collaborate with their local government, public health
department, and community stakeholders to establish an action plan. A lesson
learned from hurricane Katrina and Rita disasters is that preparation for
emergencies requires advanced planning if the response is to be effective and
efficient.
The latest updates on an Influenza
Pandemic may be found on:
http://www.pandemicflu.gov/.
To review and save this document in Adobe
PDF, click here.
Influenza (the
“flu”) is a seasonal respiratory illness caused by flu viruses. The viruses can
cause mild to severe illness sometimes resulting in death. It is important to
note that the flu is different from a common cold or seasonal allergies.
Generally, the onset of the flu is sudden and symptoms include fever (usually
high), headache, chills, sore throat, runny or stuffy nose, dry cough, severe
exhaustion, muscle aches and stomach symptoms, such as nausea, vomiting and
diarrhea.
The flu season
typically starts in late November and lasts through early spring. The flu
affects about 30-50 million Americans each year. The flu differs from the
common cold in that it lasts longer (about two weeks) and can be temporarily
debilitating even in healthy individuals. There are three types of Influenza
viruses – A, B, and C. Influenza A is further categorized into subtypes based
on the type of two surface proteins – hemagglutinin (H) and neuraminidase (N).
Source:
http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/I/Influenza.html
While types A and B cause an outbreak in
most years (seasonal flu), type C causes mild to no disease. Minor genetic
changes called antigenic drift may give rise to new Influenza A
subtypes and Influenza B viruses. The circulation of these viruses causes an
outbreak each year, and thus the need for a new flu vaccine each year.
After an infection with an influenza virus or inoculation with an influenza
vaccine, the body develops immunity to that specific type of influenza virus.
However, due to the viral ability to mutate, new vaccines for potential new
types of viruses must be developed and given each year to those most susceptible
for infection (i.e. first responders, healthcare workers, the elderly, etc).
Influenza A can also undergo a major genetic
change called antigenic shift resulting in a novel influenza A
with a new H or H+N protein combination for which there is little or no immunity
among the majority of people. If this new strain of Influenza A easily
spreads from person to person and causes serious illness, then a pandemic is
likely to occur.
Epidemic
refers to
the onset of a disease that occurs in an unusually high number of individuals in
a community at the same time and is clearly in excess of normal expectancy in a
defined community, geographical area or season. The U.S. Centers for Disease
Control (CDC) says “that to epidemiologists the terms ‘epidemic’ and ‘outbreak’
basically mean the same thing.”
Pandemic
refers to a widespread, usually global spread of a disease, while an epidemic
is localized to a geographic region. According to the World Health
Organization, “an influenza pandemic occurs when a new influenza virus appears
against which the human population has no immunity, resulting in epidemics
worldwide with enormous numbers of deaths and illness.”
The World Health Organization (WHO) is coordinating the global response to human
cases of swine influenza A (H1N1) and monitoring the corresponding threat of an
influenza pandemic. WHO revised the phase descriptions in 2009 and has retained
the use of six phases in regards to pandemics to allow for the incorporation of
new recommendations and approaches into existing national preparedness and
response plans. Currently the pandemic threat is at Phase 5, which means that a
pandemic is imminent.
One way for a new pandemic flu strain to arise is through the mixing of
different types of influenza A viruses. For instance, the influenza viruses
that caused the Avian Flu and the Hong Kong Flu pandemics are believed to have
come from the mixing of human influenza and avian (bird) influenza viruses in
another animal such as a pig. The new strain was then able to cause a much more
severe illness in humans. The Spanish Flu pandemic, on the other hand, is
thought to have started from an avian flu that directly infected humans; the
mixing of the avian influenza with the human influenza within a human led to the
new deadly strain of influenza A virus.
The
current influenza outbreak of swine flu is a result of an influenza virus
species that infected pigs, then reassort (swap genes) and the new virus
emerging. Currently there are four main influenza type A virus subtypes, but
the most recent influenza virus from pigs causing the outbreak have been H1N1
viruses. This new virus that has emerged is a mixture of swine, human and avian
influenza viruses.
The
influenza A virus can mutate in two different ways; antigenic drift, in which
existing antigens are subtly altered, and antigenic shift, in which two or more
strains combine. Antigenic drift causes slight flu mutations year on year, from
which humans have partial, but not complete, immunity. By contrast, the new
strain of H1N1 appears to have originated via antigenic shift in Mexican pigs.
Source: BBC
News. “US reports first swine flu death.”
http://news.bbc.co.uk/2/hi/health/8021958.stm
During the 20th century, new strains of Influenza A viruses resulted in three
influenza pandemics:
-
Spanish Flu
(1918-1919)
– Influenza H1N1 caused an estimated
20-50 million deaths worldwide and accounted for 675,000 deaths in the
United States. The most striking characteristics of the 1918 pandemic were
the unusually high death rate among the otherwise healthy age group of 15-34
year olds. Healthy people, as well as those
in frail condition, were equally affected, and many died within the first
few days after infection.
-
Asian Flu (1957-58)
–Influenza H2N2 started in China in February 1957; by June 1957 it spread to
United States, causing 70,000 deaths.
The initial outbreak occurred during the summer of 1957 and again during
January/February 1958. This is an example of a second wave of infections
that can develop during a pandemic.
-
Hong Kong
Flu (1968-1969) –
Influenza
H3N2 started in Hong Kong in early 1968. Later in the year, it spread to
the United States and caused 34,000 deaths. The Hong Kong Flu was the
mildest pandemic of the 20th century.
The U.S. Centers for Disease Control and Prevention (CDC), the Public Health
Agency of Canada (PHAC) and the World Health Organization (WHO) have a large
surveillance system for detecting possible pandemic flu stains around the
world.
The CDC has activated its emergency operations center to coordinate the agency’s
emergency response. The goals of the CDC are to reduce transmission and illness
severity, and to provide information to health care providers, public health
officials and the public to address the current outbreak of the swine influenza
virus. WHO is coordinating the global response to human cases of swine
influenza A and is also monitoring the corresponding threat of a pandemic. PHAC
is currently working with federal, provincial and international governments to
address the swine influenza outbreak.
The most common method for diagnosing influenza is the Rapid Flu
Test. Depending on the type of test used, it can identify influenza A and B.
Proper sample collection is critical for testing. Because the
tests rely on detecting the virus shed in the respiratory secretions of the
infected person, the test must be done during the first few days of illness when
there is viral shedding. The best sample is a nasal aspirate, but
nasopharyngeal swabs are most frequently used. With the patient's head tilted
back, a Dacron swab (like a very long Q-tip) is inserted into a nostril until
there’s resistance (1-2 inches) and then rotated several times.
The major advantages of the Rapid Flu Test are that it can be
done in an outpatient setting and the results return within 30 minutes to two
hours. The major disadvantages are that true influenza cases will be missed up
to 30 percent of the time (false negative result) and some without influenza
will be misdiagnosed as having influenza (false positive result).
The gold standard for diagnosing influenza is a viral culture.
The virus from the nasal secretion is grown and identified in the
laboratory. The advantage of a viral culture is that the specific viral strain
and type can be identified. Such detailed information is critical in detecting
influenza outbreaks (including surveillance for the pandemic strain) and for
developing vaccines. The major disadvantages are that the results take about
three to ten days and not all labs are equipped to perform a viral culture.
In response to
the current outbreak of swine influenza, the U.S. Food and Drug Administration
(FDA) has issued Emergency Use Authorizations (EUAs) at the request of the CDC.
The FDA will make available to public health and medical personnel important
diagnostic and therapeutic tools to identify and respond to the swine flu virus
under certain circumstances. The EUAs are for the use with certain Relenza and
Tamiflu antiviral products and for the rRT-PCR Swine Flu Panel diagnostic test.
In authorizing
an EUA for the rRT-PCR Swine Flu Panel diagnostic test, the FDA has determined
that it may be effective in testing samples from individuals diagnosed with
influenza A infections and whose virus subtypes cannot be identified by test
that are currently available. This EUA will allow the CDC to distribute the
swine flu test to public health and other qualified laboratories that have
personnel and equipment trained to perform and interpret the results.
Influenza is spread from person-to-person by contact with
respiratory secretions from an infected person. When an infected person coughs
or sneezes, the viruses are carried in large droplets which settle on the
surfaces of the upper respiratory tracts of persons who are nearby (i.e. within
three feet of the infected person). The viruses can also spread by direct or
indirect contact with respiratory secretions – touching contaminated surfaces
and then touching the eyes, nose or mouth.
Influenza is more infectious than SARS. Infected adults can
spread the virus from the day before exhibiting symptoms to five days after
symptoms start (two days on average); whereas, the transmission timeline for
SARS is six to eight days. Infected children can spread the virus for 10 days
or longer. Due to the highly contagious nature of influenza virus, first
responders who may be exposed to or are taking care of persons suspected of
influenza should wear appropriate protection (discussed later in this article).
The swine
influenza A (H1N1) virus is likely to be transmitted in the same manner as the
seasonal flu spreads. The main transmission of flu viruses from person to
person is through coughing or sneezing. Transmission can also occur by touching
something with flu viruses on it and then touching the mouth or nose. Persons
with swine flu should be considered potentially contagious as long as they are
symptomatic and possibly for up to seven days following illness onset. Children,
especially younger children, can potentially be contagious for a longer period.
People infected
with the swine flu may be able to infect others on day one before symptoms
develop and up to seven or more days after becoming sick. This means that you
may be able to pass on the flu to someone else before you know you are sick.
Viruses and bacteria can live up to two hours or longer on surfaces such as
cafeteria tables, doorknobs and desks. Washing hands frequently will help reduce
the chance of getting contamination from common surfaces.
One concern with
this recent strain of swine influenza A (H1N1) virus is that there is a real
threat to persons with seemingly healthy immune systems. The danger is that
healthy people have no defenses built up to this influenza virus and causing a
healthy immune system to overreact and attack the body’s healthy organs and
systems – this makes a healthy 15-60 year old individual more likely to succumb
to this new virus.
Treatment.
Four antiviral medications are approved by the U.S. Food and Drug Administration
(FDA) for treatment and prevention of influenza – Tamiflu (oseltamivir), Relenza
(zanamivir), Symmetrel (amantadine) and Flumadine (rimantadine). While
antivirals taken at the onset of the illness may decrease the severity and
duration of the illness, there is no definitive treatment for influenza. If
antiviral treatment is given within 48 hours, it may reduce the severity of
symptoms and the duration of illness. Treatment of infected persons does not
prevent further spread of infection, but it may reduce the viral shedding and
thus the degree of contagion.
Antivirals do not help if given beyond 48 hours of onset and will
not work against other viruses or against bacterial infections that may occur as
a complication of influenza.
A patient may develop resistance to one or all antivirals. The
bird flu (Influenza A H5N1) identified in humans in Asia in 2004 to 2005 is
already resistant to amantadine and rimantadine, and higher doses of oseltamivir
must be given for a longer period to be effective. Observational studies
indicate that early intervention and an extended regime of oseltamivir may help
increase the chance of survival, but results are inconclusive due to limited
data.
For the swine
flu specifically, the CDC recommends the use of Tamiflu (oseltamivir) or
Relenza (zanamirvir) to treat and prevent
infection.
Prevention. An
effective vaccine could potentially thwart an epidemic before it becomes a
pandemic. However,
once the potential pandemic strain is identified, it takes several months for
the vaccine to be developed and mass produced for wide distribution.
For the current outbreak and imminent pandemic, fire fighters
must continue to practice preventive measures, such as respiratory hygiene,
cough etiquette and annual flu vaccination. As with all biological hazards,
universal precautions should be practiced.
Influenza epidemics result in about 35,000 deaths each year in
the United States. Contributing to the high death rate is the inadequate level
of vaccination among health care workers who unknowingly transmit the virus to
persons susceptible for a serious illness from influenza. Data from several
studies indicate that vaccination of health care workers significantly reduces
the influenza death rate among the patients for whom they provide care.
Currently there is no vaccine available for this strain
of the swine flu. However, there are actions people can take every day to help
prevent the spread of germs that cause respiratory illnesses such as influenza.
These steps can protect your health:
-
Cover your nose and mouth with a tissue when
you cough or sneeze. Throw the tissue in the trash.
-
Wash your
hands often with soap and water, especially after a cough or sneeze.
Alcohol-based hand sanitizers are also effective.
-
Avoid touching
your eyes, nose or mouth.
-
Try to avoid
close contact with sick people.
-
If you get
sick with influenza, the CDC recommends that you stay home from work or
school and limit contact with others to keep from infecting others.
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In preparation for any emergency,
organizations should follow the principals of emergency preparedness. These
principles include:
-
A pre-tested Plan of Action that is developed
in advance of the emergency event.
-
Defined roles and responsibilities for key
organizations and individuals who will be involved in the emergency
response.
-
Routine communication among key organizations
and individuals established as part of the planning process.
-
Identification of resources, including
financial.
-
Dissemination of educational materials to all
first responders.
As with any preparation for an
emergency, all organizations should plan for the pandemic flu. To assist state,
provincial and local governments in the planning process, the CDC has developed
a checklist which can be found at
http://www.pandemicflu.gov/plan/statelocalchecklist.html. A
planning checklist was also released for use by medical, dental, podiatric and
chiropractic offices, ambulatory surgery
centers, hemodialysis centers and outpatient clinics,
which can be found at
http://www.pandemicflu.gov/plan/medical.html.
Also, the IAFF has developed a checklist specific to the fire service that is
based on NFPA 1500 Standard on Fire Department Occupational Safety and Health
Program; NFPA 1581 Standard on Fire Department Infection Control Program;
and NFPA 1600 Standard on Disaster / Emergency Management and Business
Continuity Programs which can be found at
/PDF/IAFF Influenza Pandemic Checklist.pdf.
In addition to simulation exercises, computer models can be used
to assist in estimating the impact of a pandemic flu. To this end, the CDC has
developed FluAid, software to assist state, provincial and local planners:
http://www.cdc.gov/flu/tools/fluaid/index.htm.
The World Health Organization also has
developed a pandemic influenza draft
protocol for rapid response and containment and can be found for review and
download at:
http://www.who.int/csr/disease/swineflu/en/index.htm.
The U.S. Department of Health and
Human Services (HHS) issued a report in 2007 that outlines how U.S. federal
funding is being used to help achieve HHS’s five primary objectives;
-
Monitoring disease spread to support rapid response.
-
Developing vaccines and vaccine production capacity.
-
Stockpiling antivirals and other countermeasures.
-
Coordinating federal, state and local preparation.
-
Enhancing outreach and communications planning.
This report can be found at
http://www.pandemicflu.gov/plan/pdf/panflu20060313.pdf.
Updates of the federal plan can be found at
http://www.hhs.gov/pandemicflu/plan/.
The CDC has issued Interim Guidance for Emergency
Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs)
for Management of Patients with Confirmed or Suspected Swine Influenza A (H1N1)
Virus Infection in response to the current swine flu outbreak. This document
can be found at the following link:
http://www.cdc.gov/swineflu/guidance_ems.htm.
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Vaccination
The IAFF is advising and strongly urges members be vaccinated against both
seasonal flu and H1N1.
Both H1N1 vaccines are produced in
the exact same way as the seasonal flu vaccination. Inactivated 2009 H1N1
vaccine can be administered at the same time as any other vaccine, including
pneumococcal polysaccharide vaccine. Live 2009 H1N1 vaccine (nasal mist) can
also be administered at the same time as any other live or inactivated vaccine
except seasonal live attenuated influenza vaccine. There is also an age
limitation on nasal mist for individuals under 50; anyone 50 and over needs to
get the inactivated vaccine.
It is the U.S. federal government’s
position that first responders be provided the H1N1 vaccination in the first
tier. This includes fire fighters in all capacities (first responders, EMTs,
paramedics) who will be responding to emergencies, including medical calls,
during this pandemic. Being in this first tier will help protect all fire
fighters with critical skills, experience or licensure status whose absence
would create bottlenecks or collapse of critical function. The Department of
Homeland Security supports this vaccination effort of all fire fighters and has
already calculated that Emergency Services Sector first responders include law
enforcement, fire fighters and emergency medical services (EMTs and paramedics).
In Canada, prioritization of H1N1 vaccine is governed partially by the federal
government guidelines found at FightFlu.ca;
however at least one provincial governments has now prioritized firefighters as
tier one.
In the U.S., the federal
government’s website http://www.flu.gov/
provides the latest information on where the vaccine is available in your
jurisdiction.
The best protection
against the global swine influenza A (H1N1) virus
outbreak is vaccination and strict adherence to infection control procedures. Follow universal
precautions and the latest updates issued by the CDC, PHAC and WHO.
Additionally, fire departments should
have an Infection Control program that meets the minimum requirements of
NFPA
1581 (chapters 5
and 6), Standard on Fire Department Infection Control Program (http://www.nfpa.org).
In response to the intensifying outbreak, the World
Health Organization raised the worldwide
pandemic alert level to Phase
6. Phase 6
is the pandemic phase, is characterized by community level outbreaks in at least
one other country in a different WHO region in addition to the criteria defined
in Phase 5. Designation of this phase indicates that a global pandemic is
under way.
The following are the
guidelines adopted in part from documents developed by the IAFF from Avian Flu,
Smallpox and SARS preparation and experience.
Only use a P-100 disposable respirator as a minimum
respiratory protection or a respirator with a higher level of respiratory
protection, including a full or half facepiece air purifying respirator (APR) or
powered air purifying respirator (PAPR) with a HEPA filter/canister .
When properly fitted, maintained and used, a P-100 respirator (or
an APR or PAPR with a HEPA filter) provides protection from inhalation of
infectious airborne droplets. The P-100 respirator provides the highest levels
of aerosol protection as compared to respirators rated only for particulate
(aerosol) protection. However, there are NO safe exposure levels (i.e. the
amount you can inhale without adverse health effects) for biological aerosols.
Respirators can reduce inhalation exposures but cannot eliminate the risk of
contracting infection or developing illness or disease. Additionally, the type
of respirator facepiece and filter class required varies depending upon one's
activities and risk of exposure. For public and hospital use, many have
suggested that N-95 respirators. The IAFF does not believe that this type of
respirator will afford fire fighter and emergency medical personnel proper
protection. Accordingly, the IAFF recommends that emergency responders use, at a
minimum, a P-100 respirator.
The IAFF’s P-100 filter efficiency recommendation is consistent
with NIOSH recommendations for emergency response to biological agent incidents:
http://www.cdc.gov/niosh/docs/2009-132/.
Additionally the IAFF's
recommendation is consistent with federal OSHA regulations that state “where
workers are exposed to a hazard that would require the use of a respirator with
HEPA filtration, the appropriate class of respirator under the
42 CFR Part 84
certification is the Type 100 (N-100, R-100, or P-100).”
The IAFF recommendation is also
consistent with the specifications contained in the World Health Organization’s
Hospital Infection Control Guidance for SARS
(http://www.who.int/csr/sars/infectioncontrol/en).
Additionally, disposable respirators must have seal enhancing
elastomeric components (e.g. rubber or plastic respirator to face seals) and
must be equipped with two or more adjustable suspension straps. The IAFF
believes, and research has demonstrated, that without these components it is
difficult, if not impossible, to obtain and maintain a seal in the
workplace.
All disposable respirators, as well as APRs and PAPRs, must also
be certified by the National Institute for Occupational Safety and Health
(NIOSH). NIOSH-approved disposable respirators are marked with the
manufacturer’s name, the part number (P/N), the level of protection provided by
the filter (e.g., P-100), and “NIOSH.” This information is printed on the
facepiece, exhalation valve cover, or head straps. If a NIOSH marking is not on
the respirator, it is not certified by NIOSH and should not be used.
An P-100 respirator is one of nine types of disposable
particulate respirators. Particulate respirators are also known as
“air-purifying respirators” because they protect by filtering particles out of
the air as you breathe. These respirators protect only against
particles—not gases or vapors. Since airborne biological agents such as
bacteria or viruses are particles, they can be filtered by particulate
respirators.
Respirators that filter out at
least 95% of airborne particles during “worse case” testing using a
“most-penetrating” sized particle are given a "95" rating. Those that filter out
at least 99% receive a “99” rating. And those that filter at least 99.97%
(essentially 100%) receive a “100” rating.
Respirators in this family are rated as N, R, or P for protection
against oils. This rating is important because some industrial oils can degrade
the filter performance so it does not filter properly.* Respirators are rated
“N,” if they are not resistant to oil, “R” if
somewhat resistant to oil, and “P” if strongly
resistant (oil proof) or if
conditions unknown. The IAFF bases its recommendation for "P" rated
disposable due to the fact that emergency response is usually to "unknown
condition" environments. Currently there are no NIOSH approved R-99, P-99 or
R-100 disposable particulate respirators.
Since respirator classes are designated for use in certain
environments with the P-100 being the most universal, NIOSH has designated only
the P-100 respirator with magenta color coding and markings.
A list of manufacturers/suppliers and model numbers of P-100
disposable respirators is maintained by NIOSH at
http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/p100list1.html.
The effectiveness of any respirator is
highly dependent on having respirators that are well-fitted to fire fighters'
faces. Respirators that leak may offer essentially no respiratory protection.
All respirator use must be administered as part of a comprehensive Respiratory
Protection Program (RPP), according to the Occupational Safety and Health
Administration (OSHA). The RPP contains provisions for training respirator
users, selecting and maintaining respirator equipment, conducting fit-checks and
conducting fit tests. For additional information, see the Respiratory
Protection Standard (29CFR 1910.134), under the Laws and Regulations link at
http://www.osha.gov.
A respirator is not a guarantee of
protection against any disease. However, if a high-filtration respirator is worn
with eye protection and medical gloves by a trained individual, a high degree of
protection should be conferred.
P-100 Respirator
In the event that an influenza
pandemic occurs, the availability of disposable respirators may be severely
strained and demand may far exceed current manufacturer production capability.
The U.S. Department of Health and Human Services (DHHS) has charged the
Institute of Medicine (IOM) of the
National Academies
(which provides science-based advice on matters of biomedical science, medicine,
and health) with making recommendations on the development of reusable
respirators for use during an Influenza pandemic in healthcare settings and for
the general public. The IAFF has participated in this process to ensure
protection is not compromised and will continue to push for the highest level of
protection for first responders. Fire and EMS departments must assess their
supply of disposable respirators and determine whether there is a need to
stockpile adequate supply before the demand becomes overwhelming for the current
production system. For more information on the IOM projects, click on the link
below
http://www.iom.edu/CMS/3740/32033/34200.aspx.
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Hand Care
Remember, one of the easiest ways to
transmit a viral infection from one person to another is through a handshake,
which transfers virus from the hand of one person who may have rubbed his nose
to another person's hand. The second individual then touches his/her nose, eyes,
or mouth and later develops an infection. In situations where the patient has a
high fever and any respiratory signs, take the following precautions:
-
Don disposable medical gloves, certified to
NFPA 1999, Standard on Protective Clothing for Emergency Medical
Operations, prior to making any patient contact.
-
Station wear should be washed at the station,
not at home.
-
Use of such disposable gloves should be
considered for any direct contact with body fluids of an infected patient.
However, these gloves are not intended to replace proper hand hygiene.
Immediately after activities involving contact with body fluids, gloves
should be removed and discarded and hands should be cleaned. Gloves must
never be washed or reused.
-
The use of gloves does not eliminate the need
for hand hygiene. Likewise, the use of hand hygiene does not eliminate the
need for gloves. Gloves reduce hand contamination by 70 percent to 80
percent, prevent cross-contamination and protect both patients and health
care personnel from infection. Antiseptic handrubs should be used before and
after each patient, just as gloves should be changed before and after each
new patient. When soap and water become available, thoroughly wash hands.
Avoid touching hands to face until such a thorough washing of hands takes
place.
-
Wash with soap and warm water. Wash for 15 to
20 seconds.
-
When using an alcohol-based handrub, apply the
product to the palm of one hand and rub your hands together, covering all
surfaces of your hands and fingers, until your hands are dry. Note the
volume needed to reduce the number of bacteria on hands varies by product.
-
Personnel should avoid wearing artificial
nails and should keep natural nails less than one quarter of an inch long,
particularly if they come in contact with patients at high risk of acquiring
infections.
In situations where the patient has a
high fever or any respiratory illness symptoms, take the following precautions:
·
Don protective eyewear, certified to NFPA 1999, Standard on
Protective Clothing for Emergency Medical Operations, in situations where
bodily fluids may be splashed. Splash-protective eyewear must be worn within 6
feet of the patient. Corrective eyeglasses alone are not appropriate protection.
·
Do not rub eyes before or after using eyewear or after handling
patients or equipment.
In situations where the patient has a high fever or any respiratory illness
symptoms, take the following precautions:
·
Apply a disposable surgical mask (or disposable respirator without
an exhalation valve if surgical mask is not available) to all persons suspected
of having an infection (except for those receiving oxygen therapy through a
facemask).
·
Each patient with suspected infection should be advised to cover
his or her mouth and nose with a facial tissue when coughing or sneezing. If
possible, a patient should wear a surgical mask during close contact with
uninfected persons to prevent spread of infectious droplets. When an infected
patient is unable to wear a surgical mask, household members should wear
surgical masks when in close contact with the patient.
·
When a patient requires rescue breathing, use a bag-valve-mask --
NEVER use direct mouth-to-mouth or mouth-to-mask resuscitation.
·
When transporting persons suspected of having a highly contagious
respiratory infection, do not allow air to recirculate within the vehicle,
especially do not use the recirculation (Maximum Level) control on the vehicle's
heating/air conditioning system. When possible, open windows/vents for improved
ventilation.
·
Respirators may not be removed to eat or drink while in the
transport vehicle. Personal activities that require removal of respirators
should not be performed in the patient-care cabin.
·
The patient may wear a paper surgical mask to reduce droplet
production, if one can be tolerated.
·
Oxygen delivery with simple and non-rebreather facemasks may be
used for patient oxygen support during transport.
·
A full facepiece APR or PAPR with a HEPA filter or a P-100
respirator with goggles (or face-shields) must be worn for all patient care
within 6 feet of the patient. Corrective eyeglasses alone are not appropriate
protection.
·
Patient care personnel should not wear leather or other
non-medical gloves while transporting patients.
·
Eating, drinking, application of cosmetics and handling of contact
lenses should not be done in the immediate patient care area.
·
Handling or storage of medication or clinical specimens should not
be done in areas where food or beverages are stored or prepared.
·
Dispose of disposable respirator, respirator filters, gloves and
other disposable equipment/supplies used at the scene as bio-hazardous waste.
·
Non-disposable respirators shall be cleaned and disinfected in
accordance with manufacture’s recommendation.
·
For decontamination of non-disposable equipment, follow
manufacturer and departmental standard operating procedures.
·
If the turnout gear is visibly contaminated by bodily fluid, it
should be placed in a biohazard bag at the scene and washed following prescribed
laundry procedures. Chlorinated beach shall not be used with any fire fighter
protective clothing.
·
Vehicles used to transport persons suspected of having H1N1 (swine
flu) should be cleaned with a disinfectant cleanser by staff wearing protective
equipment, using a disinfectant cleanser.
·
When possible, in advance of a patient evaluation, healthcare
providers should be informed that the individual is a close contact of a
pandemic flu patient. Patients presenting to health care facilities who require
assessment for pandemic flu should be diverted to a room designated for
respiratory isolation.
·
Sharing of eating utensils, towels, and bedding between pandemic
flu patients and others should be avoided, although these items can be used by
others after routine cleaning (e.g., washing with soap and hot water).
Environmental surfaces soiled by body fluids should be cleaned with a household
disinfectant according to manufacturer’s instructions; gloves should be worn
during this activity.
·
Household members or other close contacts of pandemic flu patients
who develop fever or respiratory symptoms should seek healthcare evaluation.
·
At this time, in the absence of fever or respiratory symptoms,
household members or other close contacts of pandemic flu patients need not
limit their activities outside the home. Within an affected household, facial
tissues and other waste from pandemic flu patients may be discarded as normal
household waste.
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The CDC
and PHAC may provide travel restriction to countries with cases of pandemic
flu.
Since pandemic flu situations can change at any moment, check the CDC alert site
at
http://www.cdc.gov/travel/diseases.htm,
the WHO International Travel and Health alerts at
http://www.who.int/ith/updates/2009_04_28/en/index.html
or the PHAC alert site at
http://www.phac-aspc.gc.ca/tmp-pmv/2006/h5n1060112_e.html
prior to any travel.
Pandemic flu can be quarantinable communicable diseases under the U.S. Public
Health Service Act. As the risk for pandemic flu rises, the list will likely
be updated. The most recent U.S. Executive Order on quarantinable diseases can
be found at:
http://www.cdc.gov/ncidod/sars/executiveorder040403.htm.
PHAC, under its Quarantine and Migration Health Program (QMHP), is responsible
for implementing the
Canadian Quarantine Act and Regulations.
Additional information on the QMHP can be found at:
http://www.phac-aspc.gc.ca/cepr-cmiu/ophs-bssp/quar_e.html.
Many levels of government (federal,
provincial, state and local) have basic authority to compel isolation of sick
persons to protect the public. In the event that it is necessary to compel
isolation of a sick passenger, CDC
and PHAC will work with appropriate state, provincial and local officials
to ensure that the passenger does not infect others.
Health authorities around the world are watching closely so that they may
respond promptly in the identification and reporting of suspect cases.
The World Health Organization will issue a
Global Alert should the need arise.
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Updated information on pandemic flu is
available on the following web sites:
Updated information on pandemic flu is available on the following web sites:
International
World Health Organization
(WHO) -
http://www.who.int/csr/disease/avian_influenza/updates/en/index.html
WHO
Pandemic Preparedness -
http://www.who.int/csr/disease/influenza/pandemic/en/index.html
European Influenza Surveillance Scheme
-
http://www.eiss.org/index.cgi
Canada
·
Canada -
http://www.phac-aspc.gc.ca/influenza/pandemic_e.html
United States
·
Official U.S. government website on Pandemic and Avian Influenzas
- http://www.pandemicflu.gov/
·
Centers for Disease Control
(CDC) - http://www.cdc.gov/flu/weekly/fluactivity.htm
Preparation Checklist
·
http://www.nfpa.org/
-
NFPA 1600 – Standard on Disaster/Emergency Management and Business
Continuity Programs
-
NFPA
1500 – Standard on FD Occupational Safety and Health Program
-
NFPA 1561 – Standard on Emergency Services Incident Management System
-
NFPA 1999 – Standard on Protective Clothing for Emergency Medical
Operations
·
http://www.pandemicflu.gov/plan/statelocalchecklist.html
·
http://www.pandemicflu.gov/plan/businesschecklist.html
·
http://www2.cdc.gov/od/fluaid/default.htm#Sectiona
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