Influenza and Respiratory Illness Management · Web viewAvian Influenza is a disease of birds caused by type A strain of the influenza virus. In humans it is acquired directly from

CHHS16/078

Canberra Hospital and Health ServicesClinical ProcedureInfluenza and Respiratory Illnesses management - Adults and ChildrenContents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Scope........................................................................................................................................ 2

Alert.......................................................................................................................................... 2

Section 1 – Background Information: Influenza-including Seasonal, Pandemic and Avian.......2

Clinical Feature......................................................................................................................2

Symptoms.............................................................................................................................2

Section 2 – Measures to prevent the spread of Influenza.........................................................4

Section 3 – Initial management, assessment and testing of a patient with suspected Influenza.................................................................................................................................................. 4

Section 4 – Management of an inpatient with suspected or confirmed Influenza and respiratory illnesses..................................................................................................................7

Section 5 – Management of a patient requiring contact tracing...............................................8

Implementation........................................................................................................................ 9

Related Policies, Procedures, Guidelines and Legislation.........................................................9

Definition of Terms and Abbreviations...................................................................................10

Search Terms.......................................................................................................................... 10

Attachments............................................................................................................................11

Attachment 1 – Bed allocation for Adult Patients with Suspected Influenza......................12

Attachment 2 – Bed Allocation for Paediatrics....................................................................13

Attachment 3 – Contact Tracing Flowchart.........................................................................14

Doc Number Version Issued Review Date Area Responsible PageCHHS16/078 1 17/06/2016 01/09/2018 CSS – Infection

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS16/078

Purpose

The purpose of this document is to outline clinical procedures and processes for Canberra Hospital and Health Services (CHHS) staff when managing patients with suspected or confirmed Influenza or transmissible respiratory illness.

It outlines bed management including cohorting of patients with suspected or confirmed Influenza, or transmissible respiratory illness to ensure or reduce the possible spread of the infection.

Scope

This procedure applies to all CHHS staff including students and trainees undertaking clinical placement.

Back to Table of Contents

Alert

For information on the CHHS operational response to a territory wide infectious threat/pandemic due to Influenza and respiratory illnesses please refer to the CHHS Operational Procedure-Infectious Threat Management: Influenza and Respiratory Illnesses preparedness.


Section 1 – Background Information: Influenza-including Seasonal, Pandemic and Avian

Clinical FeatureInfluenza (or "the flu") is an acute viral illness caused by infection with influenza viruses A, B and rarely C. It mainly affects the throat and lungs, but can also cause problems with the heart and rest of the body, especially in people with other health problems. Avian influenza commonly causes lower respiratory infection and may present as severe pneumonia that rapidly progresses to acute respiratory distress syndrome (ARDS).

SymptomsSymptoms usually occur one to three days after exposure to the virus, and may include sudden onset of: Fever, chills or sweats Muscle and joint aches and pains Exhaustion/lethargy Headache Light sensitivity Frequent coughingDoc Number Version Issued Review Date Area Responsible PageCHHS16/078 1 17/06/2016 01/09/2018 CSS – Infection

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Sneezing Sore throat Chest pains Gastro intestinal disturbance e.g. nausea, vomiting or diarrhoea.

Most people recover within a week. Compared with many other infections (like the common cold), influenza tends to cause more severe symptoms and complications.

Complications/RisksAll people in contact with asymptomatic influenza persons are at risk of the disease. Immunosuppressed persons may be of particular concern. Complications can include pneumonia, heart failure, or worsening of other illnesses.

Infectious Agent Three types of influenza virus are recognised: type A, B and C. Influenza type A is further

sub typed i.e. H1N1, H3N2, H1N1 (Swine) and H5N1(Avian). Minor changes in the virus are responsible for annual epidemics and major viral

changes, occurring infrequently, result in pandemics. Avian Influenza is a disease of birds caused by type A strain of the influenza virus. In

humans it is acquired directly from birds and is not thought to spread person to person.

Reservoir Humans are the primary reservoir for human influenza viruses. Aquatic birds are the natural reservoir for subtypes of type A Influenza and these can

infect a range of mammals. Pigs are the reservoir for swine influenza.

Mode of Transmission Aerosolized respiratory secretions are the main source of person to person

transmission, but the virus can be transmitted by direct contact with contaminated objects or surfaces. The virus may persist on surfaces for a few hours.

Avian Influenza acquisition from birds requires direct contact with respiratory secretions and faeces of infected birds. Undercooked poultry may also be a source.

Incubation periodShort, usually 1-4 days. Avian influenza is 2-4 days, though can be up to 8 days or more.

Period of CommunicabilityIn adults, communicability is greatest from one day before symptoms and for the first 3-5 days of illness. In children it is thought to be for up to 7-10 days after onset of illness. Communicability may be longer in severely immunocompromised individuals. Avian Influenza patients may remain infectious for up to 3 weeks.

Section 2 – Measures to prevent the spread of Influenza


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Annual vaccination particularly for those groups most at risk. Refer to Placeholder document Australian Immunisation Handbook, 10th Edition, 2013 located on the Policy Register.

Health care workers should receive an annual flu vaccination. Influenza vaccination for Canberra Hospital staff is available during advertised periods throughout the year through the Occupational Medicine Unit (OMU).

The time from vaccination to protective antibody response is approximately 2 weeks. Avian Influenza prevention includes avoidance of sick birds and their faeces, good

personal hygiene and antiviral therapy if exposed.


Section 3 – Initial management, assessment and testing of a patient with suspected Influenza

Assessment and triage of patients presenting with an influenza-like illness (ILI) enables the clinician to order testing and treatment. Patients are then placed in additional precautions to prevent the transmission of illness and disease.

AlertOnly take swabs from patients with acute symptoms (onset within preceding 72 hours).Do not use bacterial swabs for specimen collection. If in doubt contact the CHHS laboratory or Population Health (available through Canberra Hospital switch) for advice

Swab Collection ProcedureInitial preparation and considerations Choose an area to carry out the swab collection procedure where the patient can rest

their head supported by a wall or on a high backed chair with sufficient room for you to stand beside (not in front of) the patient/client.


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Ensure the area is well lit and that hand washing facilities and appropriate infectious waste disposal facilities area available.

Remember to wash and dry hands before and after the procedure. Gloves, respiratory protection and eye protection must be worn when collecting nose

and throat swabs. Masks should not be touched during wear and should not be worn around the neck at

any time. When the masks are removed they should be handled by the ties or elastic of the mask only.

Gloves, gowns and masks should be disposed of in an infectious waste bag.

Obtain required materials Personal Protective Equipment (PPE) for the Health Care Worker taking the swab,

including gown, gloves, eye protection (goggles or face shield) and a P2/N95 mask. One orange-top, dry, sterile, flocked swab for nasal procedure. One green-top, viral culture swab with viral culture medium for throat swab.

Performing the swabPreparation: Explain the procedure to the patient and obtain consent. Perform hand hygiene. Don PPE in the order of surgical mask, eye protection, gown and gloves. Place patient standing or sitting with head resting supported against a wall.

Deep nasal swab procedure: Stand at the side of the patient’s head and place your non-dominant hand on the

patient’s forehead with your thumb at the tip of the nose. With the other hand, insert the flocked end of the orange-top, dry, sterile swab

horizontally into the patient’s nostril, approx 2-3 cm. Place lateral pressure on the swab in order to collect cells from the midline nasal

septum. Rotate the swab twice (2 x 360 degree turns) against the turbinate in the nostril to

ensure the swab contains epithelial cells (not mucus) from the nostril. Withdraw the swab from the nostril. Place the swab back in its labelled tube.

Throat swab procedure:


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Stand at the side of the patients head and ensure their head is resting against a wall or supporting surface.

Place your non-dominant hand on the patient’s forehead. Ask the patient to open his/her mouth widely and say “aaah”. Use a wooden spatula to press the tongue downward to the floor of the mouth. This will

avoid contamination of the swab with saliva. Insert a green-top viral culture swab into the mouth, avoiding any saliva. Place lateral pressure on the swab in order to collect cells from the tonsillar fossa at the

side of the pharynx. Rotate the swab twice (2 x 360 degree turns) against the tonsillar fossa to ensure the

swab contains epithelial cells (not mucus). Remove the swab, and place it directly in its labelled tube.

Labelling and storage of specimen: Label the swabs with the patient’s full name, date of birth, specimen type and date of

collection. The specimen container and/or the accompanying request form should include the name of the facility.

Remove PPE in order as follows: remove gloves, perform hand hygiene, remove goggles or face shield, gown and mask and perform hand hygiene again.

Refrigerate the specimen until it is sent to the laboratory. Do not freeze the specimen. The specimens should be packaged in a small insulated bag/box (with ice bricks) for transport to the pathology laboratory. Specimens should preferably be sent on the day of collection or the following day.

Pathology notes: Ensure the request form states tests required e.g. Influenza, Respiratory syncytial virus

(RSV) or Pertussis. RSV and rapid flu testing: performed on specimens received in lab between 8am – 8pm,

Monday – Friday. (Results available 4 hours after specimens reach microbiology lab.) Overnight specimens are not processed until after 8am. Flu PCR testing will be done in batches up to twice daily. PCR is not available on

weekends outside 1st April to 30th October (flu season). Pertussis PCR is performed as required.


Section 4 – Management of an inpatient with suspected or confirmed Influenza and respiratory illnesses

Refer to Attachment 1 Flowchart for Bed allocation of Adult patients with suspected or confirmed Influenza.

Refer to Attachment 2 Flowchart for Bed allocation of Paediatric patients with Respiratory tract infections.


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AlertAn admitted patient who has been diagnosed with influenza and has been in a shared room for more than one day must stay in that room. Do not move the patient.

For the management of other patients in the shared room who have already been exposed, see Box 3 of Attachment 1.

If however an immunocompromised patient is in a room with a patient who has been diagnosed with influenza it is appropriate to move the patient with suppressed immunity. Do not move the patient with influenza.

Patients who present with acute onset febrile respiratory illness or ILI during influenza season require infection prevention and control management when the availability of isolation beds is limited.

Cohorting of patients requires the direction of Infection Prevention and Control (IPC). Any area/ward where patients have suspected influenza may require outbreak management strategies and bed containment to prevent the spread of illness or disease. It is the responsibility of the team leaders and CNCs to contact IPC if a cluster of cases of suspected disease occurs. If this occurs after hours, it is the responsibility of the nursing team leader to contact the afterhours CNC. The afterhours CNC must then contact the Infectious Diseases on call medical officer to report the cluster of cases on the ward.

Laboratory confirmed Influenza – Contact Infection Prevention and Control Place hospitalised patient in Droplet precautions with the door closed where possible. Staff and visitors are to wear a surgical mask. Hospitalised patient’s room and environment should be cleaned daily and receive an

infectious discharge clean. If transporting the patient from the Emergency Department (ED) or for a procedure, the

patient MUST wear a surgical mask, unless they are in respiratory distress then the patient should have an oxygen mask in place, and the healthcare worker must wear a mask.

For Paediatric Patients In Paediatrics the cohort room patients and beds / cots spaces must be greater than 1

metre apart. This does not apply to children with chronic lung or heart disease, malignancies or

immunosuppression where cohorting would place them at risk of more severe disease. Such patients with respiratory illness will need to be isolated in a single room and not cohorted.

Patients with confirmed diagnoses of diarrhoea and/or Pertussis-like symptoms are also excluded from this plan. Such patients can be isolated in single rooms or cohorted following advice from Infection Prevention and Control.


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Section 5 – Management of a patient requiring contact tracing

Contact Tracing Staff who identify a patient with a diagnosed or suspected infectious disease or illness are required to contact the team leader of OMU and the Infection Prevention and Control Unit (IPCU).

If a patient is identified with an infectious illness, suspected or diagnosed, in the ‘after hours’ time period, the afterhours CNC must be contacted by the ward or area.

The afterhours CNC is responsible for checking the particular guidelines relating to the identified infectious illness. Examples are Influenza, meningococcal disease or in the case of maternity patients and newborn infants, guidelines for the management of perinatal infections. This will assist in identifying if follow up of staff and patients can wait until the following day, when IPCU and OMU are onsite, or whether contact tracing needs to be undertaken immediately.

Patients are to be placed in the correct additional precautions and the CNC of the ward or area (or after hours CNC) is to compile a list of contacts of the index case (infected person) including clinical and non-clinical staff. Patients presenting to the emergency department may have been in the waiting room in which case the EDIS administrator needs to be contacted to provide a list of patients who were seen in the ED at the same time as the index case. The list must include persons who presented to ED up until one hour after the infected person has left the department or is moved to isolation.

If the patient is identified with a notifiable disease, it is the responsibility during business hours of the infection prevention and control unit to notify the public health officers within communicable diseases. Afterhours it is the responsibility of the Infectious Diseases physician on call or the admitting officer.

Please see Attachment 3.


Implementation

This procedure is to be communicated to all CHHS staff via the Deputy Director General email alerts notifying staff of new Policy. Staff will be reminded by email each year of the procedure around the management of respiratory illnesses. In addition this will be forwarded to the Bed Access Unit to allow appropriate bed management of admitted patients.



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Related Policies, Procedures, Guidelines and Legislation

Procedures Canberra Hospital and Health Services Clinical Procedure Healthcare Associated

Infections Canberra Hospital and Health Services Clinical Procedure-Adult Nebulisation Therapy Australian Immunisation Handbook, 10th Edition, 2013 Place holder document

Guidelines Guidelines for the Prevention and Public Health management of Influenza Outbreaks in

Residential Care Facilities in Australia ; Communicable Disease Network of Australia (CDNA) August 2015

CHHS -NSW Kids and Families Children and Infants: Acute Management of Bronchiolitis Clinical Practice Guideline (Paediatrics)

Related Legislation and Policies All documented information has been aligned against the National Safety and Quality Health Service (NSQHS) Standards actions list for Healthcare Acquired Infections (HAI)

Medicines Poisons and Therapeutic Goods Act 2008 http://www.legislation.act.gov.au/a/2008-26/current/pdf/2008-26.pdfPublic Health Act (1997) https://www.tga.gov.au/scheduling-medicines-poisons

Health Protection Services, Communicable Disease Control http://www.health.act.gov.au/public-information/public-health/communicable-diseases

Communicable Diseases Network Australia, Series of National Guidelines – Hepatitis A, Measles, Pertussis, Avian Influenza, Legionellosis http://www.health.gov.au/cdna

ACT Public Health Act, Public Health (Infectious and Notifiable Diseases) Regulations 2007 http://www.legislation.act.gov.au/sl/1998-6/default.asp

Intensive Care Pandemic Guideline (Policy) in the ACT during an Influenza Pandemic June 2013-available on the Policy Register (no number)


Definition of Terms and Abbreviations

Cohorting is the placement of individuals with the same infectious illness in a shared setting or room.

Epidemic, a disease that spreads and affects a large number of people at the same time with a common, localised demographic feature.

Index case: the first case of an illness


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http://www.legislation.act.gov.au/sl/1998-6/default.asp

http://www.health.gov.au/cdna

http://www.health.act.gov.au/public-information/public-health/communicable-diseases

https://www.tga.gov.au/scheduling-medicines-poisons

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Infectious diseases are transmissible illnesses caused by infectious agents. Patients with an infectious disease (confirmed or suspected) require isolation and infection prevention and control management.

Infection Prevention and Control, the policies and procedures of a hospital or other health facility to minimise the risk of spreading of healthcare- or community-acquired infections to patients or members of the staff.

Nebuliser, a device for producing an aerosol. Notifiable disease, an illness or disease which by law must be reported to governmental

agency. NSAID: Non-steroidal anti-inflammatory drug Pandemic, occurring throughout the population of a country, a people or the world. PCR: Polymerase chain reaction, a laboratory technique of molecular biology used to

amplify and simultaneously quantify a targeted DNA or RNA molecule Pertussis, whooping cough PPE is personal protective equipment worn by healthcare workers to prevent the

transmission of infectious microorganisms. P2/N95 mask is a particulate filter personal respiratory protection device, capable of

filtering 0.3 micrometre particles. Tamiflu, (oseltamivir phosphate) an antiviral medicine for treatment of flu in

people 2 weeks of age and older and for prevention of flu in people 1 year of age and older.


Search Terms Influenza, Flu, Children, cohorting, Emergency Department, Infection Control, Paediatrics, Respiratory, Bronchiolitis, Influenza like illness, contact tracing, respiratory


Attachments

Attachment 1 – Management of Patients with Suspected InfluenzaAttachment 2 – Bed Allocations for PaediatricsAttachment 3 – Contact Tracing Flowchart

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair


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Attachment 1 – Bed allocation for Adult Patients with Suspected Influenza

List 1 Underlying co-morbid conditionsHaematological malignancy, Oncology treatments, Radiation oncology treatments, Chemotherapy treatmentsEnd stage lung disease, Home oxygen therapy, Cystic fibrosis, Non-invasive ventilationSolid organ transplantModerate or severe cardiac diseaseHigh dose corticosteroids, Immunosuppressive therapy

Other underlying conditions While acknowledging that pregnancy is not a co-morbid condition, pregnant women are

to be managed as those in List 1.


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Attachment 2 – Bed Allocation for Paediatrics


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Attachment 3 – Contact Tracing Flowchart


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Documents

Influenza and Respiratory Illness Management · Web viewAvian Influenza is a disease of birds caused by type A strain of the influenza virus. In humans it is acquired directly from