1. No category

Infection
Control
Resource
Manual
INFLUENZA
(Grey Base Hospital)
West Coast
District Health
Board
Greymouth
West Coast
New Zealand
Version 11
PLEASE NOTE: THE INFORMATION CONTAINED WITHIN THIS
GUIDEBOOK IS SUBJECT TO CHANGE AND UPDATING AS FURTHER
INFORMATION AND DIRECTION COMES FROM THE MINISTRY OF
HEALTH (MOH), WORLD HEALTH ORGANISATION (WHO) AND
CENTRE FOR DISEASE CONTROL (CDC)
REVISION HISTORY
Ver.
Description of Change
Author
Date
1
Initial release
Infection Control
06/05/03
2
Changes to Sections 1.5 & 1.7
Infection Control
08/05/03
3
Addition of Appendices
Infection Control
13/05/03
4
Alteration To Section 1.8
Infection Control
14/05/03
5
Annual Review
Quality & Risk
April 04
6
Annual Review
Quality & Risk
April 05
7
Annual Review
Quality & Risk
April 06
8
Annual Review
Quality & Risk
April 07
9
Annual Review
Quality & Risk
April 08
10
Changed to reflect Swine Flu Outbreak
Quality & Risk
April 09
11
Last Review
Infection Control
Committee
Sept 2014
Infection Control Guidebook – Influenza
Version
11
TABLE OF CONTENTS
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.
11.
12
13
14
15
PAGE
Introduction ....................................................................................................... 3
Scope ................................................................................................................. 3
General information .......................................................................................... 3
Definition of Influenza like illness.................................................................... 3
Laboratory testing for Influenza..................................................... ......... ........3
Infection Prevention and Control measures……………………………………..4
Antiviral chemotherapy..................................................................................... 6
Staffing guidelines ............................................................................................ 6
Visitor restriction and information .................................................................. 6
Outbreaks .......................................................................................................... 7
Cleaning ....................................................................................................... ….14
Information for Service Support, Trades & Technical support staff.…........16
Contacts…..…………………………………………………………………………...17
Reference………………………………………………………………………………18
Appendix……………………………………………………………………………….19
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11
INTRODUCTION
These guidelines describe the steps which must be taken to manage patient treatment in order to
minimize risk, and is based on national and international guidelines for the prevention of
influenza and the agreed clinical management.
2.
SCOPE
All staff involved in the care of patients with possible or confirmed influenza.
3.
GENERAL INFORMATION
•
•
•
•
•
•
•
•
4.
Influenza viruses are spread from person to person primarily through large- particle
respiratory droplet transmission ( e.g. when an infected person coughs or sneezes near a
susceptible person)
Transmission via large-particle droplets requires close contact between source and
recipient person, as larger droplets generally travel only a short distance (1 metre or less)
through the air.
Contact with respiratory-droplet contaminated surfaces is another possible source of
transmission.
Airborne transmission (via small-particle residue 5um or less of evaporated droplets that
might remain suspended in the air for long periods of time) also is thought to be possible
particularly during and after aerosol generating activities, although data supporting
airborne transmission is limited
The typical incubation period for influenza is 1-4 days ( average: 2 days)
Adults can be infectious from the day before symptoms begin through approximately 7
days after illness onset.
Young children also might shed virus several days before illness onset, and children can be
infectious for 10 days or more after onset of symptoms
Severely immune-compromised persons can shed virus for weeks or months.
DEFINITION OF INFLUENZA LIKE ILLNESS
Includes the following criteria:
• Fever 38 degrees Celsius or above
• At least one respiratory symptom- cough, sore throat, nasal symptoms such as a runny
nose
• At least one systemic symptom- headache, myalgia( aches/pain), sweats/chills ( feeling
feverish), lethargy ( fatigue)
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*Children and elderly patients may not present with classical symptoms:
• Elderly may only present with classical symptoms
• Influenza presents in infancy and childhood as a wide variety of clinical syndromes including
vomiting and diarrhoea.
.
LABORATORY TESTING FOR INFLUENZA
All inpatients or those admitted with a diagnosis of suspected influenza should have respiratory
viral swabs taken. Contact WCDHB Laboratory if further advice required.
NB: ONLY people who meet the case definition and are admitted to Hospital with suspected
Influenza are to be swabbed
6.
Infection Prevention & Control Measures
Standard Precautions
•
During the care of any patient, health care personnel should adhere to Standard
precautions ( refer WCDHB Infection Prevention & Control Manual)
Droplet Precautions
•
•
•
•
•
•
In addition to Standard Precautions, healthcare personnel should adhere to Droplet
Precautions during the care of a patient with suspected or confirmed influenza.
A surgical mask should be worn when entering the patients room/bed space. Remove the
mask when leaving the patients room and dispose of the mask into the hazardous waste.
Perform hand hygiene. Aprons and gloves are worn if required as part of Standard
Precautions and changed between each patient.
In a cohort situation, staff may wear a mask when caring for more that one patient. Hand
Hygiene must be performed according to The 5 Moments for Hand Hygiene protocol.
Alcohol-based hand rub or soap and water may be used for hand hygiene.
Several influenza strains may be in circulation during the influenza season. Therefore in a
cohort room, “privacy curtains” should be pulled 1m from patient head level between bed
spaces where influenza like illness is suspected or confirmed to provide some protection.
Pulling curtains between patients as described must not compromise patient safety.
If patient movement or transport is necessary, have the patient wear a surgical mask, if
possible.
Do not use nebulizers in Multi-bed rooms. If required, nebulizers can be used in a single
room with the door closed whilst in use. Personal protection for aerosol generating
procedures must be used.
Precautions for high-risk aerosol generating procedures
High-risk aerosol generating procedures are defined as invasive procedure that may aerosolize
respiratory secretions containing influenza virus.
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For high risk procedures wear a N95 mask, gown/apron, gloves and eye protection. NB: N95
masks are NOT required when taking a viral swab.
Aerosol generating procedures
bronchoscopy
suctioning
ventilation
intubation/extubation
cardiopulmonary resuscitation
tracheotomy care
autopsy or surgery involving high speed
devices
cough inducing procedures
chest physiotherapy
nebulisation ( not in multi-rooms)
Respiratory Hygiene/Cough Etiquette
All patients shall receive education in Respiratory Hygiene/Cough Etiquette (refer to Infection
Prevention & Control Manual)
Patient Placement
Refer to Appendix A – Inpatient Influenza Flow chart
• Place patient in a single room where possible.
• If single room is not available, cohort patients with suspected influenza or influenza-like illness
with other patients admitted with suspected influenza like illness. Use privacy curtains to
minimize cross infections or influenza or other influenza like illness between cohorts until
diagnosis is made
• Confirmed influenza patients may be cohorted with other patients confirmed to have influenza
• If the symptomatic patient has already been in a multi-bed room and is unable to move to a side
room, apply Droplet Precautions to all patients in this room. If symptoms develop in any
patients in the room, the room stays in Droplet Precautions until 7 days after the last patients
developed symptoms ( See flowchart Appendix A). Non-symptomatic patients must not be
admitted to the room and it is advisable to withhold all admission to the multi-bed room in
this situation.
• If the symptomatic patient is discharged or moved to a side room, the original patients in the
room should remain in Droplet Precautions until 72 hours has passed and there are no further
cases. Non-symptomatic patients must not be admitted to the room and it is advisable to
withhold all admission to the multi-bed room in this situation
• In the event that the contacts are prescribed antiviral prophylaxis, the room should remain in
Droplet Precautions until 72 hours has passed. Non-symptomatic patients must not be
admitted to the room and it is advisable to withhold all admission to the multi-bed room in
this situation
• Children aged 5 years and under, Droplet Precautions should be maintained for 5 days after
commencing treatment
• The Droplet Precautions signs are to be positioned at the entrance to the patient’s room.
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Surveillance
Surveillance of inpatients with influenza is undertaken by the Infection Prevention & Control Service during the
influenza season.
7.
ANTIVIRAL CHEMOTHERAPY
•
•
•
•
Antiviral drugs are an important line of defense in the prevention of seasonal influenza
Antiviral drugs can be used either to treat influenza or prevent influenza (Prophylaxis)
Antiviral drugs as a prophylaxis should be considered for exposed patient contacts of
confirmed influenza case
Antiviral drugs should not be considered a substitute of influenza vaccination
Refer to preferred Medicine List (Pink Book)
8.
Staffing Guidelines
Staffing of isolation Ward/Areas/Rooms
•
Staff are expected to wear the recommended PPE when looking after patients with suspected or
confirmed influenza
Management of Staff
•
•
•
•
Staff are advised to NOT self diagnose by sending a swab to the laboratory
There are no plans for Occupational Health to prescribe Tamiflu to staff
The internationally recognized best practice for protection of patients and staff against influenza
is a seasonal influenza vaccination for healthcare workers. These are offered free of charge each
year through out the WCDHB during the annual staff vaccination campaign
For further advice, contact Occupational Health.
9. Visitor Restriction and information
• It is recommended the following people not visit:
• Infants ( under 1 year)
• Visitor with influenza – like - illness
• Pregnant women
• Others susceptible to infection
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10. Outbreaks
Control of Influenza Outbreaks in WCDHB facilities
When influenza outbreaks occur in acute care settings, the flowing measures should be taken to
limit transmission:
• Contact Infection Prevention & Control Service
• Restrict staff movement from areas of the facility having outbreaks
• Consider influenza antiviral chemoprophylaxis treatment for patients and cohorts
• Implement Outbreak Response as per Outbreak Management Guideline (Refer Infection
Prevention & Control Manual)
11. Cleaning
•
Full terminal clean of room, toilet & shower is required following the discharge of a suspected
or confirmed influenza patient.
•
Personal Protective Equipment (PPE) is to be worn when cleaning the room. Ensure cleaning
staff are aware of correct PPE
•
All surfaces and non-disposable equipment is to be washed using disposable cloths water and
precept. Dispose of waste into the yellow clinical waste rubbish bag double bagged at point of
exit
•
Ensure door handles are cleaned once the patient leaves.
•
Dispose of rubbish and linen from the Isolation Room into the appropriate bags for transport.
Used linen is bagged into white impervious bag with yellow stripe double bag at point of exit
into same colour bag.
•
Clinical waste is to be placed into yellow rubbish bags and sent for incineration.
•
Follow sharps disposal procedures.
•
Disinfect or destroy magazines and toys if there is any possibility that they may have been
contaminated and cannot be cleaned.
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Influenza patients at Greymouth Hospital
1.00
Introduction
1.01
Signs are to be placed on all Hospital entrances directing possible Influenza patients to
the ED Department.
1.02
A supply of surgical masks is to be kept inside the main Hospital entrance and the
entrance to the ED Department.
1.03
The sign on the main Hospital entrance and the entrance to the ED Department is to
advise people suspected to have Influenza to take a mask from the supply inside the
door.
2.00
SERIOUSLY ILL PATIENTS ARRIVING FROM GPs, RURAL
NURSE CLINICS OR BULLER/REEFTON HOSPITALS
2.01
If the patient has been seen at a GP practice, Rural Nurse Clinic or Buller or Reefton
Hospitals, meets the current case definition, and is seriously ill (e.g. pneumonia),
Greymouth Hospital will be notified in advance that St Johns is transferring a suspected
Influenza patient. St Johns is to be informed that the ambulance is to take the suspected
Influenza patient to the Emergency Dept Triage Isolation room
2.02
Staff designated to manage the patient are to meet the ambulance. They are to be
wearing mask, gowns and eye protection.
2.03
Staff designated to manage the patient are to triage and then admit to the Medical ward
Negative Pressure Isolation Room
3.00
PERSONS ARRIVING AT ED DEPARTMENT
3.01
If a person who suspects they may have Influenza approaches the ED Reception, the
Receptionist is to ensure that the person wears a mask and then the receptionist is to
notify the ED Nurse, who is to immediately triage and assess the person.
3.02
The ED Nurse is to apply a Surgical Mask, gown, gloves
3.03
The person is to be taken to the Isolation Room for assessment.
3.04
Before entering the Isolation Room ensure staff wear personal protective equipment
(PPE).
3.05
When taking the patient’s temperature avoid standing directly in front of the patient.
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3.06
Leave window open and door shut.
3.07
Avoid touching your face with your hands if adjusting your mask
3.08
If using the phone during the consultation, take your gloves off and wash hands first.
After the phone call has been completed, re-glove.
3.09
At all times TAKE EXTREME CARE TO AVOID CONTAMINATION.
4.00
Swabbing the Patient
4.01
Put on PPE in this order:
i) Gown (Disposable with cuffed sleeves)
ii) Surgical Mask
iii) Goggles (Ordinary spectacles are not sufficient)
iv) Gloves (Ensuring glove wrist goes over cuff of sleeve)
4.02
Nasopharyngeal swabs are to be used – plain wire swab & UTM = Universal Transport
Medium - contact WCDHB laboratory for this.
4.03
Stand BEHIND or to the side of the patient when taking the sample
4.04
Clearly label specimen with patient details and complete clinical details on requisition
form.
4.05
Bag the sample
4.06
Send sample to Grey Base Hospital Laboratory
4.07
Samples will be tested by Canterbury Health Laboratories for RT-PCR
5.00
MANAGEMENT OF SERIOUSLY ILL INFLUENZA IN MEDICAL WARD
5.01
ED staff is to notify medical staff regarding admission of the seriously ill
Influenza patient.
5.02
Nursing /medical staff are to organize and carry out transfer of any existing patients and
necessary equipment to other wards immediately. (call for assistance from other wards as
required)
5.03
ED staff are to notify Medical Ward Clinical Nurse Managers (CNM) and or Duty Nurse
Manager (DNM) regarding admission.
5.04
Staff are to set up as Respiratory isolation room immediately and arrange appropriate
staffing. (DNM, to ring CNMs if any problems arranging staffing).
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5.05
Once Ward is set up, (ideally within 30-45 minutes of initial notification) contact ED and
ask them to transport the patient to Medical ward (Negative Pressure Isolation room)
5.06
When exiting the infectious area staff will remove their PPE in the correct manner and
dispose of appropriately. Rubbish is to be placed in double yellow rubbish bags and
incinerated. Linen is to be double bagged into a white impervious bag with yellow stripe.
Notify Laundry for extra supply of Isolation bags.
5.07
Nursing staff to wear theatre scrubs under their PPE, at the end of their shift they can
shower, change into their own clothes and leave the hospital via the external doors near
the entrance. Staff should avoid moving around the rest of the hospital as much as
possible.
5.08
Visitors should be kept to an absolute minimum. All visitors must wear PPE.
5.09
Hand Hygiene according to the 5 Moment of Hand Hygiene protocols when having
contact with Influenza or suspected Influenza patients.
5.10
Staff who are pregnant, have pre-existing lung conditions or are immuno-suppressed
should not care or Influenza or suspected Influenza patients.
5.11
If the patient requires mechanical ventilation this will be done in Isolation Room off
CCU. Use the LTV 1000 ventilator with disposable tubing. When setting up the circuit
includes a MDI insert and a bodai peep safe connector. (use of the bodai peep safe
connector reduces the aerosol risk during suctioning)
5.12
Use of the fixed wall suction units is safe providing a hydrophobic filter has been place
between the suction gauge and the rest of the circuit.
5.13
Staff who wears glasses should not use the P100 or P3 masks, as they will not seal
effectively. Staff with glasses should use the N95 mask with a full-face visor.
5.14
Staff who will be entering the infectious area for a short time, eg. Radiology or
laboratory staff should wear the N95 and visor
6.00 Patient Masking and Staff Protection for Transport (Ambulance or Internal
Transport) and Essential Short Visits to Other Clinical Departments (Eg.
Radiology)
6.01 Patient movement outside negative pressure rooms should be avoided as much as possible.
6.02 A N95 mask must be placed over the patient's mouth and nose for transport through
corridors and public areas (eg. between clinical areas such as Emergency Department and
Radiology wards/units) or for investigation in departments.
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6.03 Attending and transport staff must continue full use of all barrier protection i.e. mask, eye
protection, gloves and gown for direct contact with the patient, with blood or body fluids or
with patient equipment.
6.04 Receiving departments and the Orderly service should be advised of the patient's isolation
status when transfer or investigations are ordered and patients must be escorted during
transport between negative pressure areas to ensure that appropriate precautions are
maintained.
7.00 Safe Removal & Disposal of PPE
7.01 It is crucial that PPE is removed without accidental contamination of facial skin, mucous
membranes, clothing and hands.
7.02 Outside the Isolation Room in the anteroom:
i) If wearing visors and N95 mask, remove visor and cap
ii) Remove gloves, wash hands, put on clean pair of gloves
iii) Remove N95 mask by tapes and dispose of into yellow rubbish bag
iv) Remove shoe covers, dispose of into yellow rubbish bag
v) Grasp gown at shoulders and peel off so that it is turned inside out.
vi) Roll up gown and dispose of into yellow rubbish bag
vii) Peel off gloves turning them inside out and dispose of in yellow rubbish bag
viii) Wash hands thoroughly using 20 seconds standard hand washing process.
8.00 Cleaning Procedure for Non-Disposable Goggles & Visor
8.01 In a sink in a suitable area:
i) staff member cleaning goggles/visor is to wear gloves and surgical mask (plastic
apron can also be worn);
ii) Place goggles/visor into adequately sized container;
iii) Fill container with clean warm water and precept;
iv) Using a disposable cleaning cloth and working under the surface of water wipe all
surfaces of the goggles/visor;
v) when goggles/visor have been washed:
- discard the cloth into yellow rubbish bag;
- drain washing water out of container and fill again with clean warm water and
rinse well;
- drain again;
- dry the clean goggles/visor and container with dry paper towel (dispose of in
yellow rubbish bag;
- wipe goggles/visor and container with Isowipes.
9.00 Infection Control Advice For Discharged Patients
9.01 Patient is to stay indoors and keep contact with other persons to a minimum until
10 days after resolution of symptoms
9.02 Hand washing with liquid soap instead of bar soap, and or use alcohol hand gel for hand
hygiene. Use disposable tissues instead handkerchief for respiratory secretions.
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9.03 Family members are to practice frequent handwashing and avoid touching eyes, nose,
and mouth with their hands.
9.04 Patient is to wear a mask and avoid close contact (hugging, kissing etc) with others
9.05 Household facilities (especially furniture and toilet) are to be daily washed with diluted
bleach (10ml to 1 litre water), rinsed and then wiped dry
9.06 If facilities become contaminated with vomit or body secretions from patient, they are to
be wiped/washed using domestic bleach (200mls to 1 litre water) immediately.
9.07 Good ventilation is to be maintained.
EQUIPMENT AND SUPPLIES FOR INFLUENZA PATIENTS
10.00 General
10.01 Disposable equipment should be used wherever possible in the treatment of seriously ill
patients with influenza
10.02 Disposable, impermeable isolation gowns are recommended
10.03 A range of sizes of non-sterile gloves must be available inside and at the entrance to the
Isolation Room. Gloves must be changed as clinically indicated and removed and disposed
of in the yellow rubbish bags each time staff leaves the isolation room.
10.04 Gowns/aprons are single use items and may not be kept for reuse - they must be removed
and disposed of in the yellow rubbish bags when staff leaves the isolation room and a new
gown must be worn for re-entry.
MASKS ARE SINGLE USE ITEMS AND MUST BE REMOVED AND DISPOSED OF
IN THE YELLOW RUBBISH BAGS EACH TIME STAFF AND VISITORS LEAVE
THE ISOLATION ROOM AND A NEW MASK MUST BE WORN FOR RE-ENTRY.
10.05 Equipment and supplies necessary for patient treatment, safety and comfort must be
available in the isolation room but storage of supplies and equipment within the room
must be kept to a minimum and be replenished daily if necessary.
10.06 All non-disposable equipment (eg. blood pressure cuffs, stethoscopes and including
mobile units such as X-ray machines, IV pumps etc.) that are taken into the room must be
decontaminated immediately after removal from the isolation room and before it may be
reused in the care of other patients. At a minimum, items will require cleaning by surface
wiping with a disposable cloth, detergent and water (or specialist products if these are
normally used) and usual disinfection and sterilisation processes should be used for items
normally reprocessed by these methods.
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10.07 It is recommended that some dedicated items of non-disposable equipment (eg. blood
pressure cuffs) are left in the room for the duration of the patient's isolation so that
discharge/terminal cleaning only is likely to be required.
10.08 Bedpans and urinals should be emptied and reprocessed (immediately after use) by the
usual method in sanitisers.
10.09 The isolation nurse may need assistance from other nursing staff outside the isolation
room to facilitate this (these staff should use gloves, disposable aprons and facial
protection when handling used toilet items and plan the transfer of items so that minimal
contamination of environmental surfaces occurs).
10.10 Metal surgical instruments requiring sterilisation by CSSD can be placed in a clear plastic
bag, the opening secured and then returned in the usual container to CSSD for routine
decontamination (full body and facial protective equipment is worn routinely in the CSSD
decontamination area).
10.11 A designated sharps container must be available in the room.
10.12 For bed sponges disposable bath washes can be utilized
11.00
FOOD SERVICE FOR INFLUENZA PATIENTS
11.00 After use, waste food should be disposed of within the isolation room and the trays and
utensils wiped with soap and disposable paper towels and Precept and placed in clear
plastic bag then returned directly (with assistance from staff working outside the isolation
area) to the Food Services trolley for return to the kitchen for reprocessing.
11.01 Usual meal trays, plates and cutlery may be used.
Trays with crockery and utensils are collected last and are placed into clear plastic bags
so that Dish-wash process Isolation dishes last.
11.02 Staff in this area are to wear protective clothing and the usual machine dishwashing
process is adequate to decontaminate the trays and utensils.
12.00
LAUNDRY SERVICE FOR INFLUENZA PATIENTS
12.00 All linen used by an Influenza patient is to be treated as infectious. Used linen is to be
double bagged into white impervious bag with yellow stripe. Care should be taken not to
shake or flap the bed linen.
12.01 Bed linen is to be changed completely each morning shift and carefully scoop and fold
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used linen to place it in the used linen container.
12.02 Linen bags are to be replaced at least daily or when 2/3 full. Nursing staff are
responsible for the closure and replacement of bags. Bags are to be placed at ante-room
door into sluice room for transport to Laundry.
12.03 When linen bags arrive at the laundry, the LINEN IS NOT TO BE SORTED but the
linen bag is to go directly into container for pickup by Canterbury Linen Service.
12.04 Laundry Staff are to wear gloves, N95 masks, eye protection and impervious gowns at all
times when handling Influenza patient linen. Hands must be washed and gloves
replaced before and after activities involving handling of contaminated items.
13.00
WASTE SERVICE FOR INFLUENZA PATIENTS
13.01 All waste from Influenza patients is to be placed into yellow rubbish bags at source, and
then double bagged at point of exit
13.02 Yellow rubbish bags are to be secured when 2/3 full.
13.03 Nursing staff are responsible for the closure and replacement of yellow rubbish bags.
13.04 Yellow rubbish bags are to be collected as per normal procedure, and incinerated as per
normal procedure.
13.05 Staff are to wear gloves at all times when handling Influenza patient yellow rubbish bags.
Hands must be washed and gloves replaced before and after activities involving handling
of waste. Hands must be washed after removal of gloves using alcohol based hand
gel/rub or soap and water.
13.06 At no time are Influenza patient yellow rubbish bags to be opened or punctured once
they have been secured.
13.07 All sharps are to be discarded into sharps containers as per standard procedure.
14.00
CLEANING
14.00 General Information
14.01 The Isolation Room is to be cleaned daily.
14.02 Under the direction of the Registered Nurse /Duty Nurse Manager , the cleaner must
be directed and shown how to use full protective clothing (gown, gloves, mask and eye
protection).
14.03 Disposable cleaning cloths must be used for cleaning.
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14.04 The cleaner must dust to a height of 6 feet the door, bed frame, bed light, window sills
and furniture, shelves and ledges, trolleys and equipment. Dust must not be shaken out
of cleaning cloths but must be contained by folding inwards.
14.05 Locker tops, washbasins, taps and door handles must be cleaned with clean cloths, fresh
water and detergent, and disinfected with Precept.
14.06 The floor must be wet mopped with clean warm water detergent and then disinfected
with Preset.
14.07 Isolation bathroom areas must be cleaned following the isolation room, using the same
precautions.
14.08 Dispose of all cleaning cloths in the yellow rubbish bags in the Isolation Room. The
disposable squezzy mop is disposed off after each use. Ensure replacements are available
14.09 The bucket is to be washed thoroughly with hot water and detergent, wiped with
Precept, and turned upside down to dry.
14.10 The cleaner must be shown how and where to take off protective clothing in a safe
manner, dispose of it into a Biohazard container and instructed to wash their hands
immediately.
Terminal cleaning (on patient discharge)
14.11 Infection Prevention & Control advice must be sought for the decontamination of
complex equipment.
14.12 Nursing staff are responsible for supervising the safe stripping and cleaning of the
isolation room and bathroom including instructing and supervising the cleaner in putting
on protective clothing.
14.13 The bed is to be stripped of linen. Check for breaks in the impervious covering of the
pillow and mattress are to be made. Only when breaks are detected - dispose of these
items as biohazard waste (pillows can be placed in a yellow rubbish bag; if mattresses are
to be disposed of they must be contained within clean large plastic bags, clearly labelled
as intended for biohazard waste and Orderlies should be contacted to collect and place
them directly into a large yellow Biohazard waste bin for transport to the Incinerator
14.14 Dispose of disposable equipment (used or unused stock) and other waste into the yellow
rubbish bag.
14.15 Leave the waste and linen bags to be tied off by the cleaner once cleaning is completed
so that cleaning cloths and protective clothing can be discarded safely.
14.16 The cleaner must clean all the surfaces including isolation bathrooms and floors as listed
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in the daily cleaning requirements with clean disposable cloths, clean warm water,
detergent, and Precept.
14.17 All cleaning cloths must be disposed of into the Biohazard waste bag. Squezzy Mop is
disposed off after use.
Curtains
14.18 In the A&E Department ask for the curtains to be changed.
14.19 In the Ward or Unit setting, ask the cleaner to change the curtains. (New curtains must
not be put up until the room has been fully cleaned and aired for 1 hour following
completion of cleaning).
14.20 The cleaner must be shown how and where to take off protective clothing in a safe
manner, dispose of it into a Biohazard container and instructed to wash their hands
immediately.
14.21 The rooms should be left with the door closed for 1 hour before the bed is remade,
curtains are re-hung and the room is re-occupied. This is to allow for sufficient air
changes to occur to ensure removal of all possibly contaminated air. Ensure all surfaces
are dry.
15.00
INFORMATION FOR TRADES & TECHNICAL SUPPORT STAFF
15.00 Trade and Technical Support Staff are to contact CNL/DNM before entering Isolation
Rooms.
15.01 Trade and Technical Support Staff are to always work in pairs. I person is to assess the
situation wearing full PPE, while the other person is to remain in clean area outside the
Isolation Room.
15.02 Only the minimum amount of equipment is to be taken into the Isolation Room.
15.03 When using any electronic or technical equipment inside the Isolation Room, this
equipment is to be used inside a plastic bag (where practicable).
15.04 All equipment is to be washed in detergent and water after use, and then wiped with
Isowipes.
15.05 Plastic bags and clothes used to clean equipment are to be disposed of in double yellow
rubbish bags.
15.06 Hands must be washed or hand gel applied at the completion of all activities
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Infection Control Guidebook – Influenza
16.00
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11
RADIOLOGY FOR INFLUENZA PATIENTS
16.00 The patients must not present to the Radiology department, but rather are to be done as
a mobile procedure in the Isolation Room.
16.01 A nurse must be present with the patient at all times.
16.02 The Patient must wear a surgical mask at all times.
16.03 All staff must use full personal protective equipment i.e. mask, gloves, eye protection and
gown, for all direct patient contact.
16.04 Standard isolation 2 person Radiographic technique must be used i.e. one person touches
cassette and patient and one person positions equipment and takes exposure.
16.05 Hand washing is essential after examination is completed.
16.06 All linen used must be doubled in an Isolation bag (impervious with yellow stripe)
16.07 Minimum of 2 staff for any x-ray procedure, one may be a nurse although 2 MRTs is
ideal.
16.08 One MRT will remain the “clean” person and will operate the x-ray machine. The clean
person should still wear protective clothing etc as they will be in the room to operate
and position the machine.
16.09 The staff attending to the patient will don full protective gear for the procedure. While
preparing the patient they should not touch the x-ray equipment. They may retire to a
safe distance during the x-ray exposure but must not touch the x-ray unit’s console.
16.10 Handling film cassettes: the x-ray cassette is to be covered in plastic. If the “clean” MRT
is required to handle the cassette they will need to don full protective equipment to do
this. If the cassette becomes contaminated by blood or body fluids or any other potential
contaminant the cassette must be placed in another plastic bag to be removed from the
room.
16.11 Before returning to the x-ray department the cassette must be decontaminated by
swabbing with suitable detergent agents. The plastic can then be removed. With each
layer of plastic removed further decontamination swabbing is to take place. Once the
cassette is fully decontaminated the MRT can remove protective clothing and return to
the x-ray department to develop the film.
16.12 As the mobile x-ray machine will remain in the isolation unit no cleaning between
patients is necessary.
16.13 If the machine is to be removed from the isolation unit the following is to be followed:
i) When possible work in pairs to observe and assist each other to maintain safe
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Decontamination technique when removing equipment and protective clothing at
End of cleaning procedure.
ii) Staff cleaning x-ray machine must wear full protective clothing.
iii) Linen used goes into contaminated linen bag provided in the isolation unit.
iv) Remove protective clothing once outside the isolation unit and place into linen bag
provided. Then wash hands.
v) Leave clean x-ray machine in well ventilated area for half an hour before using for
any other procedure
ACCESSING ADDITIONAL PERSONAL PROTECTIVE EQUIPMENT (PPE)
Currently the District Health Board holds additional supplies of the following personal protective
equipment:
• N95 masks
• Surgical masks
• Gowns /apron ( impervious)
• Gloves
• Goggles) protective eye wear)
• Disposable thermometers
• Alcohol based hand rub/gel
All District Health Board GP Clinics, RNS Clinics Buller and Reefton Hospitals should have a
supply of PPE in stock.
An Annual audit of PPE supplies should be completed to ensure that stock is still within date and
these PPE supplies should be rotated through normal supplies to prevent waste of stock.
Additional supplies of these PPE items can be obtained from the Stores Department, Grey Base
Hospital.
14.
COMMUNITY & PUBLIC HEALTH CONTACTS
Office Hours -
03 7681160
After Hours -
03 7680499 and ask for the On Call Health Protection Officer.
Infection Prevention & Control Service Greymouth Hospital 03 7680499 ext 2651
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References
• Canterbury District Health Board Infection Prevention & Control Service (2013)
• NZ Ministry of Health 2011. accessed at: http://www.moh.govt.nz/influenza-a-h1n1
• National Influenza Strategy Group (NISG), Accessed at: www.influenza.org.nz
• Centre for Disease Control and Prevention. Prevention and Control of Influenza
Recommendation of the Advisory Committee on Immunization Practices (ACIP), 2007.
MMWR 2007 Jul 13:5(RR06); 1-54.
• http://www.medsafe.govt.nz/profs/Datasheet/tTamiflucapsusp.htm)
• Centre for Disease Control and Prevention. Seasonal influenza. Retrieved 5th July 2013
fromhttp://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm
•
Centre for Disease Control and Prevention Respiratory Hygiene/Cough Etiquette in
Healthcare
settings
retrieved
5th
July
2013
http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm
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CHDB Infection Prevention and Control Intranet Guideline
Appendix A
Influenza Guidelines 2013
Inpatient Influenza Flowchart - Management for Seasonal Suspected or Confirmed Influenza Patient
Suspected or Confirmed Influenza Patient
Patient in Single Room?
NO
NO
YES
YES
Patient moved to Single Room or
Discharged?
Place single room in Droplet
Precautions
Place contacts of symptomatic
suspected or confirmed
patient in Droplet Precautions
for 72 hours
Place entire Room in
Droplet Precautions
Prescribed anti-viral treatment
Droplet Precautions until 7
days after onset of illness of
last patient remaining in the
room or last patient
discharged
NO
If any contacts develop symptoms in the room within the 72 hours
consider the room an “Influenza Room”


Droplet Precautions for 7
days after onset of
illness
YES
Droplet Precautions
for 72 hours
(Children ≤ 5 years
for 5 days)
Contact with Influenza shall not result in delayed discharged from hospital.
No nebulisers in multi-bedrooms.
Authorised By: CDHB Infection Prevention & Control Committee
Page 7 of 7
Issue Date: April 2013
West Coast District Health Board
Te Poari Hauora a Rohe o Tai Poutini
Infection Control
High Street, Greymouth 7805
Telephone 03 769-7400 extn 2651
Fax 03 769-7792
Influenza Personal Protective Equipment
All healthcare staff that interacts with a patient with a confirmed, probable or suspected
case of Influenza should follow these infection prevention & control guidelines.
Hand Hygiene
Hand hygiene must be performed according to The 5 Moments of hand hygiene protocol
Alcohol-based hand rub or soap and water may be used for hand hygiene.
Summary of PPE requirements:
Entering room but no
close contact (>1
metre from patient
Close patient
contact (1 meter
from patient)
Aerosol generating procedure
being performed (including
nose /throat swabs)
No
No
Yes
Surgical mask
Yes
Gown, no sterile,
long sleeved/apron No
Yes
No
Yes
Yes
Gloves, non sterile
Yes
Yes
Yes
Eyewear protective No
No
Yes
N95 mask
Note
High-risk aerosol generating procedures are defined as invasive procedures that may
aerosolize respiratory secretions containing influenza virus and include: suctioning,
intubation, extubation, tracheotomy care, bronchoscopy, cardiopulmonary resuscitation,
chest physiotherapy, cough inducing procedures, nebulisation, ventilation, or surgery
involving high speed devices.
Isolation requirements
• Negative Pressure Isolation Unit to be used in the first instance
• Isolation rooms with Ensuite
• Single rooms with doors closed
• Confirmed Influenza patients may be cohorted with other patients confirmed to have
influenza.
Infection Prevention & Control (WCDHB)
September 2014
P.O Box 387, Greymouth 7840