Looking After Someone at Home with H1N1 Flu Virus in a Remote or Isolated Community

Updated January 2010-07-12

This guidance document is provided for public health officials and health care workers by the Public Health Agency of Canada in response to the pandemic (H1N1) 2009 influenza virus outbreak. This guidance is based on current available scientific information, combined with expert opinion from public health experts in the fields of community based disease control strategies, infectious diseases, emergency management, communications and ethics, and is subject to review and change as new information becomes available.

The following guidance should be read in conjunction with relevant provincial and territorial guidance documents. The Public Health Agency of Canada will be posting regular updates and related documents at www.phac-aspc.gc.ca.

Introduction

This guidance document has been adapted from the current national guidance document, How to look after someone at home with the H1N1 flu virus. This guidance outlines important messaging that health care workers in remote and isolated communities can provide to community members on how to look after someone at home who is infected with H1N1. This includes messages regarding how to prepare yourself with information, how to look after someone at home once they are sick, and the infection prevention and management tools that can be used to prevent transmission of infection to others living in the home. Health care workers may use these messages for the development of educational resources for their community. This document also includes a list of 10 things that people can do in the home (Appendix A).

Key Messages

1. Preparing Yourself with Information

• Plan ahead: Talk to family, friends, and neighbours before anyone close to you becomes ill so that you can be prepared to help each other before an H1N1 flu virus outbreak happens in your community. If you have family members who are pregnant, obese, diabetic or have other chronic medical conditions, it is recommended that they talk with a health care worker before H1N1 arrives to find out what special steps they can take.

• Be informed: Go to reliable sources for the most current and accurate information. Contact your health care provider or your local 24 hour health link if you have any questions or concerns. Information on H1N1 is located on these reliable websites:
  • Provincial/territorial Ministry of Health;
  • Public Health Agency of Canada
• Stay healthy: Eat well, exercise regularly and rest when tired.
• Stockpile supplies: Depending on how easy it is for you to get supplies to look after someone in your home with the flu, you might want to make sure you have enough supplies such as soap, household cleaning products, non-perishable food and fluids, tissues, fever and cough medications, and an adequate supply of routine prescriptions. If you have limited access to water for handwashing, you may also want to consider having a supply of alcohol-based hand rub.
• Get vaccinated: Getting the H1N1 flu vaccine is the best way to protect yourself and others from getting infected.

2. Caring for a Person with H1N1

H1N1 flu virus is a respiratory illness that causes symptoms (e.g. fever, cough, sore throat, joint pain, muscle pain, lack of energy) similar to the regular flu symptoms seen every year. Most people may be cared for at home, following the recommendations outlined below:

• Give lots of fluids (e.g. water, broth or other clear liquids) and healthy food.
• Encourage a smoke-free environment by asking others to smoke outside.
• Encourage the ill person to get plenty of rest.
• Clean your hands with either soap and warm water or an alcohol-based hand rub after touching items that the sick person has touched (such as dishes, towels and clothes), before you eat and before and after touching your eyes, nose or mouth.
• Keep a supply of fever and cough medicine at home if it is difficult to get these on short notice.
• If possible, have the sick person wear a surgical or high-quality procedure mask to control the spread of virus filled droplets. This is especially important, when someone is within 2 metres (6-7 feet) of a sick person. This may be difficult in some households, but keeping this distance is important in preventing transmission of the flu to others in the household. If the sick person cannot wear a surgical or high-quality procedure mask, encourage the use of a tissue when coughing and sneezing. Dispose of the tissue immediately.
• Give medication to reduce fever and/or chills. These can be obtained from the pharmacy or healthcare provider. Talk with the pharmacist or your healthcare provider for the best choice of medication for pain or fever and follow the directions for appropriate dosage(s). Acetaminophen (Tylenol^®) should be used to treat fever in children or teenagers instead of acetylsalicytic acid (Aspirin). Other ways to reduce fever are to bathe or sponge in lukewarm water.
• Give mild cough medicine. There may be some benefit to using a cough suppressant but these should be used carefully and not be used in children under 6 years of age.¹
• Speak with a health care provider if possible before giving medication. Follow the directions carefully when giving any type of medications, such as antivirals or fever/cough medicines.

Recommendations for Getting Well at Home

• Wash your hands often
• Stay at home until you are feeling well and able to fully participate in your regular (normal day-to-day) activities. If you have a medical condition that requires you to be assessed by your health care provider, it is recommended you call ahead, if possible, and go to the health care provider for assessment.
• It is recommended that contact with sick people within the home be restricted as much as possible. Consider discouraging visitors who are well from visiting while you or someone in your home is ill. If possible, have only one adult take care of the sick person. People at increased risk of severe illness from the H1N1 flu virus are recommended not to be chosen as the care giver.
• Keep the room where the sick person is resting well ventilated (i.e. open windows if temperature permits) with the door closed.
• It may be difficult to physically separate ill persons in the household. Although not scientifically based, possible solutions include placing a physical barrier (e.g. hanging a bed sheet from the ceiling) to separate an area in the room or to designate a specific household for sick people to go to until they recover. Your community may have thought of other practical solutions; phone your local clinic or health care provider for details.

3. When to Seek Immediate Medical Care

Sometimes complications, such as pneumonia or worsening of conditions like asthma, can occur and the ill person may need to have a health assessment.
It is recommended that an ill person seek immediate medical care if they have severe symptoms, such as:

• Shortness of breath, wheezing, rapid or difficulty breathing
• Chest pain
• Signs of pneumonia (e.g. decreased breath sounds)
• Sudden dizziness
• Confusion/disorientation
• Severe or persistent vomiting
• High fever lasting more than 3 days
• Hypotension (low blood pressure)
• Bloody or coloured sputum
• Bluish or greyish skin colour

Additional symptoms in children: Not waking up or interacting; not eating or drinking enough fluids; irritability; not wanting to play or be held If an ill person must leave home to seek medical care or for other critical reasons, it is recommended they take measures such as coughing or sneezing into a tissue or their sleeve and avoiding crowds (e.g. public transportation) to avoid exposing others to the virus. If the ill individual is unable to perform good cough etiquette, a surgical or high-quality procedure mask could be worn to reduce the risk of spreading the virus to others.

4. Reducing the Spread of the Virus

Performing hand hygiene, cough etiquette and avoiding close contact with ill persons are the best means to reduce the spread of the virus

Respiratory Etiquette

• Coughing and sneezing may produce airborne material that might cause infection in others. Large droplets that are coughed or sneezed into the air by a sick person can also land on surfaces and can stay for up to 2 days. Cleaning surfaces to remove this material is important to keep others from touching it and causing them to become sick. After blowing your nose, it is recommended that used tissues be placed in a plastic lined garbage container and that hands are washed.
• It is important that proper respiratory etiquette (e.g. coughing into the sleeve) and regular hand washing be performed by all household members.

Hand washing (also refer to Hand Hygiene Recommendations for the Remote and Isolated Community Settings)

• How to wash your hands:
  • roll up long sleeves and push up or remove wrist watch
  • wet hands up to the wrists
  • apply enough soap to cover all hand surfaces, and if a ring is worn, on and under the ring
  • work soap under the fingernails and around and between joints and fingers
  • rinse off every trace of lather with water
  • dry hands with a clean cloth or paper towel while taking special care to dry thoroughly between the fingers
  • turn off the tap/spout with a paper towel or cloth
  • If clean water or the means to clean the water is unavailable, an alcohol-based hand rub (60-90% alcohol) may be used.
• How to use a hand rub:
  • roll up long sleeves and push up or remove wrist watch
  • wash hands with soap and available water if hands are visibly dirty (e.g., contaminated with dirt, oil, blood, body fluids, etc.), and dry hands completely after washing as wet hands will dilute the alcohol
  • place enough alcohol-based hand rub into the cupped palm of one hand sufficient to wet both hands completely
  • rub the liquid into the palms, backs of hands, between fingers and under nails, and if a ring is worn, on and under the ring

Recommendations for cleaning and garbage disposal

• It is recommended that each sick person have his/her own towel, face cloth, toothbrush, and other items that are kept away from those who are well.
• Always clean your hands afterwards and avoid touching your eyes.
• Wash dishes, dirty laundry and towels with hot water and soap as soon as you take them out of the room of an ill person. Items belonging to those who are sick do not need to be cleaned separately, but it is recommended these items not be shared before they are clean.
• Clean door knobs and light switches with regular household cleaning products at least once a day. Clean the phone or other surfaces after use by the ill person. Typically, no special disinfectants or waste handling practices are required for influenza. Waste handling would be according to usual standards and many readily available household or commercial disinfectant cleaning products are effective against influenza viruses. Product specific information, including its effectiveness against the pandemic (H1N1) influenza virus, may be found on the cleaning product label and/or the manufacturer’s web site.² If household or commercial disinfectant cleaning products are not readily available, hard surfaces can be cleaned using a mixture of 1 part bleach and 9 parts water. Always use caution when using bleach as undiluted bleach is corrosive and could damage the skin, fabrics and others surfaces.
• Clean the bathroom daily.
• Line garbage with a plastic bag, so you don’t need to touch the contents.

Recommendations for airing out the house

• Fresh air is best: weather permitting, open windows to keep the room well ventilated.
• Clean and service furnace and ducts in the home regularly.

5. Wearing a Surgical or High-Quality Procedure Mask

Wearing surgical or high-quality procedure masks in the home is not thought to be helpful. However, it may help to prevent others from getting sick if the ill person wears a surgical or high-quality procedure mask when they are in a room with people who are well and they are unable to practice respiratory etiquette.

Family members without symptoms may choose to wear surgical or high-quality procedure masks when caring for someone with H1N1 who is not wearing a surgical or high-quality procedure mask. This may not provide any benefit unless strict adherence to proper mask use and good personal hygiene practices are followed, including regular hand washing.

Surgical or high-quality procedure masks may be available at pharmacies if there is one in your community. If you do not have a surgical or high-quality procedure mask, other options include covering your nose and mouth with a clean piece of material such as a bandana, which may provide protection. It is important that these be washed after each use. Wash your hands before putting on the mask.

How to use a surgical or high-quality procedure mask:

• Follow the instructions described on the packaging for putting on the mask.
• Replace the mask when it becomes wet or damp – a mask only works when it is dry.
• Avoid touching your face while wearing the mask.
• Do not let the mask hang around your neck – discard after use.
• Remove the mask by only touching the straps and place the used mask directly in the garbage. Masks should not be reused.
• Wash your hands before and after removing the mask.

Appendix A: Handout

10 Things you can do in the Home

1. Keep your distance: It may be difficult to restrict contact with sick people; however, encourage it as much as possible. If the sick person must stay in the same room with one or more healthy persons, consider a physical barrier such as hanging a bed sheet from the ceiling. If the ill person is sleeping in the same room as one or more healthy persons, maximize separation of beds and place beds head-to-toe.
2. Wash your hands: Encourage everyone in the household to wash their hands often or use alcohol-based hand rub (60-90% alcohol) if hands are not visibly soiled.
3. Cover coughs and sneezes: Sneeze and cough into your elbow or sleeve or use a tissue. If the sick person is unable to cover coughs or sneezes, consider having them wear a surgical or high-quality procedure mask when health care workers or others are present
4. Keep common surfaces clean: Clean door knobs and light switches with regular household cleaning products at least once a day. Clean the phone or other surfaces after use by the ill person.
5. Open the windows: Fresh air is best: weather permitting, open windows to keep the room well ventilated.
6. Take prescribed medications appropriately: If antiviral or other types of medications have been prescribed, ensure the medication is taken as prescribed, or follow the directions provided by the health care provider.
7. Stockpile household supplies: You may want to plan to have a sufficient supply of soap, household cleaning products, non-perishable food and fluids, tissues, fever and cough medications, and an adequate supply of routine prescriptions. In households with limited water access, you may also want to consider having a supply of alcohol-based hand rub for the household.
8. Get vaccinated: Immunization is recommended.
9. Stay connected: Talk with family, friends, and neighbours before anyone close to you becomes ill, to figure out how to help each other during an H1N1 flu virus outbreak.
10. Be informed: Different sources of reliable information are available, consider these sources together for the most current and accurate information. Contact your health care provider if you have any questions or concerns. Information on H1N1 is located on these reliable websites:
    • Your provincial/territorial ministry of health;
    • Public Health Agency of Canada

References