H1N1 Influenza 09 Guidance fr Residential Aged Care 11 June 2009 As knwledge abut H1N1 Influenza 09 develps, further advice will be prvided. Please check www.healthemergency.gv.au fr the latest infrmatin. This updated infrmatin sheet is designed t assist yu t manage any utbreaks that may ccur in residential aged care hmes. Outbreak preventin and cntrl measures fr H1N1 influenza 09 are similar t thse required fr seasnal flu utbreaks. Aged care hmes shuld make themselves familiar with the guidance prvided in the Influ-Inf Kit frm http://health.gv.au/intemet/main/publishing.nsf/cntent/ageing-publicatinfluinf.htm and the recently updated Cmmunicable Diseases Netwrk Australia A Practical Guide t Assist in the Preventin and Management f Influenza Outbreaks in Residential Care Facilities. http://www.health.gv.au/internet/main/publishing.nsf/cntent/cda-cdna-cdna.htm Residents f aged care hmes are identified as a high risk grup fr influenza infectins and cmplicatins during utbreaks. PART 1: Backgrund Infrmatin n H1N1 Influenza 09 The H1N1 Influenza 09 virus strain causing the current utbreaks is a new virus that has nt been seen previusly in either humans r animals. Current infrmatin suggests that the H1N1 Influenza 09 virus is mre cntagius than seasnal influenza, s that each new case is mre likely t spread the infectin t thers. A large number f cases have been reprted t ccur in children and yung adults. That is similar t the age distributin that ccurs with seasnal influenza. Nevertheless, there have been cases reprted in all age grups. When peple are living in clse prximity t ne anther, infectin can spread rapidly and mre widely. Staff and visitrs mving between residents can make the situatin wrse unless strict infectin cntrl measures are in place. An utbreak f influenza may cause rapid and significant illness and death and pssible utbreaks shuld therefre be investigated and managed prmptly. This is true during the nrmal seasnal influenza seasn but is especially s during the present H1N1 influenza 09 utbreaks. It shuld be nted that Public Health Units (PHUs) will wrk clsely with residential aged care hmes that have cnfirmed cases f H1N1 influenza 09 t prvide advice regarding case management. Specific advice prvided by PHUs shuld be fllwed.
Symptms The symptms f H1N1 Influenza 09 infectin are similar t the symptms f human seasnal influenza and include Fever. Cugh. Sre thrat. Headache. Tiredness. Runny r stuffy nse. Bdy aches. Diarrhea, and vmiting. Like seasnal flu, H1N1 Influenza 09 infectin in humans can vary in severity frm mild t severe. When severe, pneumnia, respiratry failure and death are pssible. Dehydratin has als been a feature f sme hspitalised patients and shuld be mnitred in the elderly. Transmissin This new influenza virus is thught t be transmitted in the same way as seasnal influenza which is thrugh respiratry and cntact spread. Respiratry spread When an infected persn cughs, their cntaminated respiratry drplets can spread int the eyes, nse and muth f an uninfected persn. The uninfected persn needs t be relatively clse by usually at a distance f less than a metre. Cntact spread if an uninfected persn has virus n their hands and they tuch their wn eyes, nse r muth they can infect themselves. Cntaminatin f hands is mst likely t ccur fllwing cntact with freshly siled items and hard surfaces. PART 2: Preventing Influenza Outbreaks (including H1N1 Influenza 09) The key t preventing influenza utbreaks is t prevent intrductin f the disease t a residential aged care hme and t ensure gd infectin cntrl. Preventin measures include: Screening measures in place t prevent entry f the virus int the hme Services shuld have signage at entry pints explaining t visitrs abut the need t restrict entry t peple wh have been expsed t r have symptms f influenza-like illness. Have clear cmmunicatin guidelines prepared t ensure cnsistent, timely cmmunicatin with: State & Territry Public Health Units. Residents and families. Care staff. Cleaners, kitchen staff and vlunteers. Screen all new admissins fr influenza symptms. Mnitr residents and visitrs fr influenza symptms. All staff and vlunteers shuld reprt t their supervisr if they have influenza symptms. Residential aged care hmes shuld establish clear expectatins with staff abut nt cming t wrk when ill with influenza symptms. In areas where there has been cmmunity spread f the virus request that schl age children avid visiting the hme. 2
Everyne shuld be made aware f the need t practise gd hand and respiratry hygiene This includes hand washing with either plain r antimicrbial sap and ht water, r the use f alchl based hand prducts (gels, rinses, fams) that d nt require water. Gd cugh and sneeze etiquette - cvering nse and muth when cughing and sneezing, and dispsing f tissues in the nearest bin, then washing hands. A very simple way f reducing the chance f being infected with influenza r passing the infectin n is t maintain a ne metre distance frm ther peple in public r in the wrkplace. Surveillance and Detectin Early recgnitin f suspected utbreaks and swift actin, including the ntificatin t Public Health Units in a timely manner, is crucial. The earlier an infectin is identified and cnfirmed the quicker an utbreak can be cntained and further spread prevented. Hmes shuld mnitr all residents and staff fr new respiratry symptms daily. Usually three new cases r febrile respiratry disease in three days suggest an utbreak f seasnal influenza and shuld be reprted t a Public Health Unit. In additin, in the current situatin residential aged care hmes shuld reprt any cnfirmed influenza cases as sn as pssible t their lcal Public Health Unit. The CDNA guideline A Practical Guide t Assist in the Preventin and Management f Influenza Outbreaks in Residential Care Facilities prvides recmmendatins regarding cllectin f specimens and influenza screening. Advice n Influenza Vaccinatin The current seasnal flu vaccine is designed t prtect against seasnal H1N1 and ther seasnal influenza viruses that are likely t circulate at the same time as H1N1 influenza 09. There are n vaccines currently available that are able t prtect against H1N1 influenza 09. It cntinues t be strngly recmmended that pneumcccal and seasnal influenza vaccinatin be given t all residents in accrdance with advice in the Australian Immunisatin Handbk. Mst residents will have received r be receiving seasnal influenza vaccine cntaining a seasnal H1N1 strain but this shuld NOT be cnfused with the current Influenza A H1N1 Influenza 09. It is als strngly recmmended that all staff in residential care hmes receive seasnal influenza vaccine annually fr their wn prtectin, t prtect residents, and t help the hme retain a fit wrkfrce. PART 3: Outbreak management Once a cnfirmed H1N1 influenza 09 case r a cluster f cases with influenza-like illness is identified and the Public Health Unit has been cntacted, it is imprtant t review infectin cntrl and fllw utbreak management plans. The Influ-Inf Kit prvides advice regarding management f an utbreak f influenza. 3
Residents general advice Enhanced surveillance: All residents shuld be mnitred fr elevated temperatures, respiratry symptms and dehydratin. Infectin cntrl: Residents shuld be prvided with apprpriate infectin cntrl equipment, such as tissues, sap and/r alchl-based hand rub. Residents shuld be educated in cugh and sneeze etiquette. Thrugh cleaning with detergent f surfaces which may be cntaminated. Review the management plan fr infected care recipients: Islate residents wh have an influenza-like illness t reduce the spread f infectin. Cnsider if it is pssible t islate infected individuals in single rms. If islatin in single rms is nt pssible, symptmatic residents shuld be cared fr in areas well away frm residents withut symptms. If the design f the hme and the numbers f symptmatic residents invlved permits, it is preferable t islate residents int separate flrs r wings f the hme. Mvement f symptmatic residents shuld be minimised. Use f facemasks by affected residents (if this can be tlerated) when they are within ne metre f ther peple. New admissins r transfers shuld be stpped. Whether this is the whle establishment r a unit r wing will depend n the feasibility f establishing selfcntained areas fr symptmatic and expsed residents and the staff caring fr them. The length f clsure t new admissins and transfers is largely dependent n the incubatin perid f influenza and s shuld be fr 7 days in the first instance. The lcal Public Health Unit will prvide guidance. Spatial separatin shuld be prmted in cmmn areas t limit cntact between symptmatic and asymptmatic peple. Clsing cmmn areas shuld be cnsidered. Mre frequent cleaning f surfaces such as tables, chairs, telephnes shuld be cnsidered, especially thse items lcated within ne metre f a symptmatic persn. Infrm residents abut the reasns fr restrictins n visitrs, and the measures t limit cntact with infected care recipients that have been put in place. Influenza Antiviral treatment The Public Health Unit will liaise with the facility cncerning the prvisin f antiviral medicatin t cases and clse cntacts. It is imprtant that these antivirals are used exactly as directed and dcumented accrdingly. Antivirals have been shwn t be mst effective when administered within 24 48 hurs f a persn shwing symptms, and the entire curse must be taken. Staff general advice The facility shuld have clear cmmunicatin prtcls t make sure that all staff are quickly infrmed. Staff shuld be reminded that gd infectin cntrl practices can effectively stp the virus spreading. Staff shuld be mnitred daily fr the symptms f influenza and advise their supervisr if they develp symptms while at wrk. Staff shuld clean their hands thrughly with sap and water r an alchl base handrub. Cnsideratin shuld als be given t placing handrub dispensers at the residents bedsides fr use by visitrs and staff. Staff shuld undertake apprpriate cugh and sneeze etiquette as rutine practice. 4
Symptmatic staff shuld be excluded frm wrk until they are n lnger symptmatic, r until released frm perids f islatin defined by the PHU. The lcal PHU shuld als be cntacted with the details f these individuals. The lcal Public Health Unit will liaise cncerning the treatment and management f affected staff and perids f exclusin frm wrk. If pssible, aged care staff shuld wrk either with symptmatic r asymptmatic residents - but nt bth - and this arrangement shuld be cntinued fr the duratin f the utbreak. Nursing Agency and temprary staff wh are expsed during the utbreak shuld be advised nt t wrk elsewhere. Staff shuld wear single-use surgical facemasks, gwn and glves when in clse cntact (within 1 metre) with a persn an influenza-like illness, whether r nt cnfirmed as being influenza. Any healthcare wrker identified as a clse cntact f a cnfirmed case f H1N1 Influenza 09 shuld remain in hme quarantine fr the prescribed perid (3 days if taking antiviral medicatin; 7 days if nt). If well with n symptms, the healthcare wrker can then return t wrk. Visitrs general advice Visitrs shuld clean their hands thrughly with sap and water r an alchl based hand rub. Visitrs with influenza-like symptms shuld be excluded frm the hmes until they are n lnger symptmatic. Visits shuld be discuraged during an influenza utbreak where this is feasible. If visitrs d need t enter the hme, visitrs shuld avid all physical cntact and be at least at a ne metre distance frm residents thught t have influenza and wear a single use face mask. Vaccinatin It is recmmended that pneumcccal and seasnal influenza vaccinatin be given t all aged care residents in accrdance with the Australian Immunisatin Handbk. Mst residents will have received r be receiving seasnal influenza vaccine cntaining a seasnal H1N1 strain (this shuld NOT be cnfused with the current Influenza A H1N1 Influenza 09). The current seasnal flu vaccine is designed t prtect against seasnal H1N1 and seasnal influenza viruses that are likely t circulate at the same time as Influenza A H1N1 Influenza 09. Further infrmatin can be btained frm: Aged Care Influ-Inf Kit http://www.health.gv.au/internet/main/publishing.nsf/cntent/f954a8bbc7bd2231ca25701a000 4E724/$File/influinf.pdf A practical guide t assist in the preventin and management f influenza utbreaks in residential care facilities April 2009 (sn t be psted) http://www.health.gv.au/internet/main/publishing.nsf/cntent/cda-cdna-cdna.htm Current Department f Health and Ageing advice regarding H1N1 Influenza 09 http://www.healthemergency.gv.au/internet/healthemergency/publishing.nsf/cntent/healthswine_influenza-index.htm Interim recmmendatins fr facemask use. http://www.healthemergency.gv.au/internet/healthemergency/publishing.nsf/cntent/healthprf 5