Ministry f Health and Lng-Term Care Infrmatin n Nvel H1N1 Influenza A - Frequently Asked Questins fr Primary Care Practitiners May 7, 2009 This infrmatin is subject t change based n evlving infrmatin n the current H1N1 situatin. 1. Hw shuld I screen patients wh may have influenza-like illness (ILI) at my ffice? Passive screening is being recmmended in ambulatry settings at this time. This invlves psting a sign at yur ffice entrance asking patients wh have a new/wrsening cugh and fever r respiratry illness t perfrm hand hygiene and wear a surgical mask. It is nt necessary t pst an individual at the ffice entrance t cnduct active screening f patients. Fr resurces t help implement screening in yur ffice, visit the Ministry f Health and Lng-Term Care s Imprtant Health Ntice website at www.health.gv.n.ca/english/prviders/prgram/emu/ihn.html 2. My ffice staff are wrried abut getting the nvel H1N1 Influenza A. What can I d t prtect them frm getting the nvel H1N1 Influenza A? Occupatinal health and safety measures and infectin preventin and cntrl measures can help prtect bth health wrkers and patients frm being expsed t the influenza virus in health settings. Prtectin f wrkers frm infectius diseases invlves mre than persnal prtective equipment, and may be best achieved thrugh a strategy knwn as the hierarchy f cntrls. This invlves a range f actins at the surce f a ptential expsure, alng the path, and with the wrker. Persnal prtective equipment is ne cmpnent f the hierarchy, and shuld be used when ther measures such as engineering and administrative cntrls aren t able t cmpletely mitigate risks. Reducing the risk f influenza transmissin in the wrkplace requires a cmprehensive strategy that includes: Engineering cntrls that make wrk envirnment r setting safer e.g. prper ventilatin, ffice layut t supprt scial distancing r use f measures like plexiglass barriers Administrative and wrk practices that reduce the risk f infectin e.g. respnsible absenteeism plicies, staff educatin prgrams Persnal prtective equipment used by health wrkers Other infectin preventin and cntrl measures that prtect patients and visitrs as well as health wrkers. Sme infectin preventin and cntrl measures may include: Screening patients and staff fr ILI symptms Practicing prper hand hygiene (washing yur hands with sap and warm running water fr at least 15 secnds r using a 60 90 per cent alchl-based hand sanitizer) whenever yu cme int cntact with an bject r surface that may be cntaminated with influenza (e.g., after tuching a patient s Ontari Health Insurance Plan card, after ging t the washrm, after having cntact with frequently tuched surfaces such as dr knbs, etc.) Practicing prper cugh and sneeze etiquette Scial distancing (e.g., keeping tw metres away frm a cughing/sneezing persn)
Apprpriate use f surgical masks and fit-tested N95 respiratrs Thrugh cleaning f surfaces. 3. Peple are shwing up at my ffice requesting a letter t give their emplyer r t their schl prving that they are healthy and dn t have the nvel H1N1 Influenza A. What shuld I d? Current advice frm the Ministry f Health and Lng-Term Care is that peple wh are asymptmatic d nt need t self-islate immediately upn their return frm cuntries that have travel health warnings. Therefre, the ministry has nt recmmended that emplyees r students btain a letter t cnfirm they are healthy befre they return t wrk/schl. Hwever, individuals shuld mnitr their health fr seven days fllwing their return t Canada and cntinue t practice prper hand hygiene and cugh/sneeze etiquette. If they develp symptms f nvel H1N1 Influenza A during that perid, they shuld cntact their health care prvider fr advice. 4. Wh shuld I be testing fr the nvel H1N1 Influenza A? Althugh yu may want t test all patients wh present with ILI, this is nt necessary and will result in verburdening the public health labratry system. It is currently recmmended that nly the fllwing patients be tested in the cmmunity setting: Patients wh have an ILI within seven days f travel t Mexic; r Patients wh have ILI within 7 days f clse cntact with a persn wh is a cnfirmed case f nvel H1N1 Influenza A. Please d nt request tests fr asymptmatic patients even if they have travelled t Mexic r had clse cntact with a cnfirmed case f the nvel H1N1 Influenza A, as the labs will nt prcess these tests due t large vlumes. The Ministry f Health and Lng-Term Care is reassessing these testing criteria based n current H1N1 activity in Ontari and available infrmatin frm ther jurisdictins. 5. What tests shuld I carry ut n patients? The tests recmmended fr patients wh meet the criteria fr nvel H1N1 Influenza A are: naspharyngeal swab (in viral transprt medium)* bld in cltted tube (red tp) (ptinal) bld in ETA (purple tp) (ptinal) * Nte: Naspharyngeal swabs shuld nly be dne by practitiners wh have the capacity and expertise. 6. Hw d I cllect specimens and send them t the lab? Guidelines are available n the Ontari Agency fr Health Prtectin and Prmtin website at www.ahpp.ca. Click n the link t the H1N1 Flu Virus [Human Swine Influenza] and then click n the Updated Guidance fr Labratry Testing Ambulatry Setting dcument. 7. If I take a swab, des it need t be transprted immediately? Naspharyngeal swabs can be stred vernight as lng as they are kept at fur degrees Celsius. 2
8. I ve sent a specimen t the lab fr testing, when can I expect t get the result? The public health labratries are receiving a large number f specimens daily and are priritizing them based n clinical infrmatin (i.e., hspitalizatin with severe illness, signs/symptms AND recent travel histry r cntact with a cnfirmed case). As a result, selected samples frm persns tested in the ambulatry/utpatient setting with ILI but n histry f travel t Mexic r cntact with a cnfirmed case f nvel H1N1 influenza A will be tested as resurces allw. Samples frm nn-hspitalized patients with n clinical infrmatin prvided n the labratry requisitin frm will nt underg labratry testing. Requisitins apprpriately cmpleted with relevant clinical infrmatin will expedite the testing prcess. 9. The Ministry f Health and Lng-Term Care prvided me with an Emergency Infectin Cntrl Kit (EICKS). Can I pen up my EICK t access persnal prtective equipment when seeing patients wh present with ILI? Cmmunity health centres, abriginal health access centres, midwives, nurse practitiners, and cmmunity-based physicians in Ontari received Emergency Infectin Cntrl Kits (EICKs), which cntain infectin cntrl prducts fr drplet spread diseases. The kits were intended fr large-scale infectius disease emergencies, such as an influenza pandemic, when supply chains may be disrupted. As indicated in the Imprtant Health Ntices, fr the current H1N1 utbreak health care prviders shuld use apprpriate infectin preventin and cntrl prcedures when seeing individuals with influenza-like illness that are suspected t have the nvel H1N1 Influenza A. At this time, practitiners shuld cntinue t use their existing supply chains t access apprpriate persnal prtective equipment. EICKs shuld be used nly when existing supply chains can n lnger prvide health care prviders with apprpriate persnal prtective equipment, r cannt prvide supplies in a timely way. 10. I ve used up my EICK, hw can I rder a new ne? At the current time, there is n plan t autmatically replenish yur EICK nce yu have used it up. Any larger stckpiling initiatives will be cmmunicated t yu via yur cllege r assciatin. 11. I m a new practitiner and never received an EICK, can I still rder ne? Cmmunity health centres, abriginal health access centres, midwives, nurse practitiners, and cmmunity-based physicians wh are newly qualified/new in practice (i.e. within the last 18 mnths) can rder a new EICK as lng as supplies last. Visit the ministry s website fr mre infrmatin at www.health.gv.n.ca/english/prviders/prgram/emu/emerg_kit/emerg_kit_mn.html 12. Are all the supplies in my EICK still useable? There are tw items in the EICK that have an expiry date: The surface cleaner/disinfectant wipes (tw cylinder cntainers); and, Hand sanitizer (package f six) T identify the expiry dates n these prducts: The surface cleaner/disinfectant wipes expiry date shuld be labelled n the cylinder wrapping, fllwing the term EXP. The hand sanitizer expiry date shuld be fund n the bttm f each hand sanitizer bttle in black type set, fllwing the term EXP. 3
If the labelled expiry date f the prduct is befre the current date, discard the prduct(s) in accrdance with prper dispsal practices. Please nte that if yu discard r use yur EICK cntents, yu shuld restck the supplies: The surface cleaner/disinfectant wipes shuld be replaced with the same r similar grade prduct with an expiry date f 2011 r later. The hand sanitizer shuld be replaced with the same r similar prduct, which has a 60 per cent t 90 per cent alchl cncentratin, is scent free, and has an expiry date f 2011 r later. 13. Is there any assistance available t supprt primary care practitiners wh need infectin cntrl and persnal prtective supplies and equipment? In rder t supprt the establishment f stckpiles f persnal prtective equipment in the health and brader public sectr, the ministry has launched an initiative t ffer access t the ministry s cntracted cmpetitive pricing with supply vendrs. This pricing can be used by health care settings/prviders t prcure infectin cntrl and persnal prtective supplies and equipment at a cmpetitive rate, slely fr the purpse f building their fur-week stckpile fr use during a health emergency. General infectin cntrl supplies and persnal prtective equipment such as gwns, glves and respiratry prtectin are f highest pririty in develping a health emergency stckpile. These are the types f items which can be accessed thrugh this initiative. Brader public sectr and healthcare clients must enter int a cntractual relatinships with the vendrs based n the ministry s pricing. Fr mre infrmatin, visit www.health.gv.n.ca/english/prviders/prgram/emu/bps/bps_mn.html 14. Will the Ministry f Health and Lng-Term Care be distributing equipment and supplies fr use during an influenza pandemic? Since 2006, the Ministry f Health and Lng-Term Care has been wrking t put in place a health emergency stckpile f supplies and equipment fr use during an influenza pandemic r ther health emergency. This stckpile is intended t supprt health care settings and prviders t prtect the health and safety f health wrkers if/when their wn stckpiles are exhausted r supply chains are interrupted. There are n plans t activate the ministry stckpile at this time. Althugh we have heard frm sme vendrs that supplies and equipment are in shrt supply, supplies are currently being replenished. Shuld the decisin be made t activate this stckpile, infrmatin n hw t access it will be prvided thrugh the ministry website. 15. Why are yu recmmending N95 respiratrs fr emergency department settings and nly surgical masks fr ambulatry settings? Cnsistent with the precautinary principle, the Ontari Health Plan fr an Influenza Pandemic recmmends N95 respiratrs fr health care prviders managing patients with pandemic influenza. Currently, the clinical guidelines fr bth ambulatry and emergency care settings n the ministry s Imprtant Health Ntice website recmmend the use f N95 respiratrs fr care f patients with ILI and travel t Mexic r cntact with a cnfirmed case f nvel H1N1 Influenza A. Hwever, if an N95 respiratr is unavailable, the prvider and patient shuld wear surgical masks. The Ministry f Health and Lng-Term Care is reassessing these criteria based n current H1N1 activity in Ontari and available infrmatin frm ther jurisdictins. 4
16. When shuld I prescribe Tamiflu? Cmmunity based physicians shuld nly prescribe Tamiflu (seltamivir) fr patients: wh fulfill the clinical descriptin; wh are at high risk f cmplicatins f ILI (e.g., chrnic cnditins, residents f lng-term care hmes, peple ver age 65, children between six and 23 mnths, and healthy pregnant wmen); and, wh are within 48 hurs f nset f symptms. It is NOT recmmended that cmmunity-based physicians prescribe Tamiflu fr mild cases f ILI (wh are nt at high risk f cmplicatins) r fr prphylaxis. Fr mild cases, prvide supprtive care and advice n islatin and infectin cntrl precautins and n symptm treatment the way yu wuld fr seasnal influenza. 17. Hw d I access Tamiflu? Yu wuld access Tamiflu the same way yu wuld access any ther prescriptin medicatin in the cmmunity, thrugh yur cmmunity pharmacy. See the clinical guidelines fr ambulatry care settings n the ministry s Imprtant Health Ntice website t access treatment recmmendatins fr individuals wh are identified as pririties t receive Tamiflu. 18. Hw d I get mre infrmatin abut what s ging n in my lcal jurisdictin with respect t the nvel H1N1 Influenza A? There are 36 lcal public health units in Ontari. All public health units are wrking in partnership with the Ministry f Health and Lng-Term Care t cnduct surveillance and manage the activities needed t respnd t the nvel H1N1 Influenza A. Therefre, public health units have the mst up t date infrmatin n what is ccurring within their bundaries. Fr infrmatin n hw t cntact yur lcal public health unit see: www.health.gv.n.ca/english/public/cntact/phu/phu_mn.html 19. Hw can I get n the distributin list t directly receive the Imprtant Health Ntices frm the Ministry f Health and Lng-Term Care? Visit www.publichealthntari.ca and click n the link t Sign up fr Imprtant Health Ntices n the right-hand menu. Yu will have the ptin t have ntices sent t yu sent t yu by fax and/r by email. 5