Prevention and Control of Influenza during a Pandemic for All Healthcare Settings

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Table of Contents

• I. Executive Summary
• II. List of Abbreviations
• III. Glossary of Terms
• IV. Introduction: Prevention and Control of Pandemic Influenza in Healthcare Settings
• V. Foundations for a Pandemic Influenza IPC/OH Plan for all Healthcare Settings
  • 1. Public Health Assumptions
  • 2. Infection Prevention and Control Assumptions used in Annex F
  • 3. Occupational Health Assumptions
  • 4. Principles of Influenza Exposure and Transmission in Healthcare
    • 4.1. Basic Principles of Infectious Disease Epidemiology
      • 4.1.1. Infectious Agent/Infected Source
      • 4.1.2. Susceptible Host
      • 4.1.3. Environment
    • 4.2. Epidemiological Triangle Applied to Pandemic Influenza
      • 4.2.1. Pandemic Influenza: Infectious Agent/Infected Source
      • 4.2.2. Pandemic Influenza: Susceptible Host
      • 4.2.3. Pandemic Influenza: Environment
    • 4.3. Pandemic Influenza: Modes of Exposure and Transmission
      • 4.3.1. Pandemic Influenza: Exposure
      • 4.3.2. Pandemic Influenza: Transmission
    • 4.4. Modes of Exposure to Pandemic influenza
      • 4.4.1. Pandemic Influenza: Contact Exposure and transmission
      • 4.4.2. Pandemic Influenza: Droplet Exposure and Transmission
      • 4.4.3. Pandemic Influenza: Airborne Exposure and Transmission
      • 4.4.4. Pandemic Influenza: Aerosol-Generating Medical Procedures
      • 4.4.5. Pandemic Influenza: Continuum of droplet and airborne exposures
  • 5. Literature Reviews that Examine the Modes of Transmission of Influenza
    • 5.1. Transmission of Influenza A in Human Beings by Brankston et al.
    • 5.2. Expert Panel on Influenza and Personal Protective Respiratory Equipment by the Council of Canadian Academies
    • 5.3. Interventions for the Interruption and Reduction of Respiratory Viruses by Jefferson et al.
    • 5.4. Synthesis of Assumptions Used in this Annex to Describe the Risks of Pandemic Influenza Virus Transmission in Healthcare
      • 5.4.1. Assumptions About the Impact of Pandemic Influenza on Healthcare Organizations
      • 5.4.2. Assumptions about Pandemic Influenza Transmission
      • 5.4.3. Assumptions About the Potential Spread of Pandemic Influenza in Healthcare Settings
  • 6. Hierarchy of Controls in the Inter-pandemic and Pandemic Periods
    • 6.1. Background on the Hierarchy of Controls
      • 6.1.1. Engineering Controls
      • 6.1.2. Administrative Controls
      • 6.1.3. Personal Protective Equipment
    • 6.2. Application of the Hierarchy of Controls in the Inter-pandemic and Pandemic Periods
      • 6.2.1. Organizational Risk Assessment
      • 6.2.2. Administrative Controls: Fitness-for-work
      • 6.2.3. Administrative Controls: Work Evaluation
      • 6.2.4. Administrative Controls: An Active Respiratory Protection Program
      • 6.2.5. Administrative Controls: Routine Practices and Additional Precautions
      • 6.2.6. Administrative Controls - Pandemic Influenza Precautions
        • 6.2.6.1 Hand Hygiene
        • 6.2.6.2 Appropriate Use of Personal Protective Equipment
        • 6.2.6.3 Masks and Respirators
        • 6.2.6.4 PPE - Eye Protection and Face Shields
        • 6.2.6.5 PPE - Gloves
        • 6.2.6.6 PPE - Gowns
        • 6.2.6.7 Environmental Hygiene Programs (Housekeeping, Laundry and Waste)
    • 6.3. Use of Personal Protective Equipment to Ensure Availability of Supplies During an Influenza Pandemic
  • 7. Risk Assessment – A Method to Prevent/Minimize Pandemic Influenza Exposure and/or Transmission in Healthcare Settings
    • 7.1. Background
    • 7.2. Performance of Organizational Risk Assessments
      • 7.2.1. Performance of Organizational Risk Assessments in the Inter-Pandemic Period
      • 7.2.2. Performance of Organizational Risk Assessments in the Pandemic Period
    • 7.3. Performance of Point of Care Risk Assessments
      • 7.3.1. Point of Care Risk Assessments for Routine Practices During the Inter-Pandemic Period
      • 7.3.2. Point of Care Risk Assessments During the Pandemic Period
      • 7.3.3. Integration of Information From the PCRA with the Knowledge About the Organization's Pandemic Influenza ORA.
• VI. Planning for an Influenza Pandemic – Using the Organizational Risk Assessment to develop the Pandemic Influenza Infection Prevention and Control and Occupational Health Plan
  • 1. Performing an Inter-Pandemic ORA to Evaluate Existing IPC/OH Programs
    • 1.1. Evaluation of the Existing OH Program for the ORA
      • 1.1.1. Pre-Placement Screening, Assessment, and Immunization of HCWs
      • 1.1.2. Workplace Infectious Hazard Assessment
      • 1.1.3. Respiratory Protection Program.
      • 1.1.4. Identification of HCWs With Acute Infections
    • 1.2. Organizational Evaluation of the Existing IPC Program for the ORA
    • 1.3. Deficiencies in OH and IPC Programs Identified by the ORA
  • 2. Establishing a Pandemic Influenza IPC/OH Plan for the Management of Pandemic Influenza in All Healthcare Organizations
    • 2.1. Developing the Pandemic Influenza IPC/OH Plan
    • 2.2. Planning for the Accommodation and Cohorting of Patients/Residents/Clients
      • 2.2.1. Use of Patient Rooms During the Pandemic Period
      • 2.2.2. Planning Airborne Infection Isolation Rooms During a Pandemic Period
      • 2.2.3. Temporary Healthcare Settings
    • 2.3. Planning for Transfer/Transport of Patients with ILI symptoms Within and Between Healthcare Settings
    • 2.4. Planning for Visitors: Responsibilities and Restrictions
  • 3. Planning for the Identification and Management of HCWs with ILI Symptoms
  • 4. Planning and Providing Pandemic Influenza Education and Skills Training for HCWs in All Healthcare Organizations
• VII. Pandemic Period: Recommendations to prevent the spread of pandemic influenza in existing healthcare settings
  • 1. Pandemic Period Recommendations for Acute Care Settings
    • 1.1. Implementation of the Pandemic Influenza IPC/OH Plan for the Acute Care Setting
    • 1.2. Acquisition of Up To Date Information on this Pandemic Influenza Viral Strain
    • 1.3. Implementation of Pandemic Influenza Precautions in Acute Care Settings
    • 1.4. Triage and Assessment
      • 1.4.1. Upon Entry Into the Healthcare Setting, Patients Should Be Separated (Triaged) Into Those Requiring Assessment For
      • 1.4.2. Influenza Assessment
    • 1.5. Admission Process
      • 1.5.1. Open Separate Influenza and Non-Influenza Inpatient Care Areas
      • 1.5.2. Use of Single Rooms
      • 1.5.3. Use of Airborne Infection Isolation Rooms
      • 1.5.4. Urgent AGMPS
      • 1.5.5. Placement of Patients WITHOUT ILI symptoms
      • 1.5.6. Placement of Patients WITH ILI symptoms
      • 1.5.7. Placement of Patients WITH ILI symptoms and Another Medical Condition
      • 1.5.8. Placement of Patients Immune to Influenza
    • 1.6. Transfer/Transport of Patients with ILI symptoms Within (i.e., Intra-Facility) and Between (i.e., Inter-Facility) Healthcare Settings
    • 1.7. Visitor Responsibilities and Restrictions
      • 1.7.1. Visitors and Influenza Assessment
      • 1.7.2. Visitors With No Symptoms of Influenza Visiting a Patient With ILI symptoms
      • 1.7.3. Exceptional Circumstances for Visitors With ILI symptoms
    • 1.8. Pandemic Period: Work Assignments during the Pandemic Period
    • 1.9. Pandemic Period: Pandemic Influenza Education and Skills Training for Healthcare Workers in Acute Care Settings
    • 1.10. Influenza Outbreak Detection and Management for Acute Care Settings
      • 1.10.1. Detection of a New Influenza Case Among Cohorts of Non-Influenza Patients
      • 1.10.2. Separate Patients Who Develop ILI symptoms From Non Influenza Patients
      • 1.10.3. Outbreak Declaration
      • 1.10.4. Isolation of New Influenza Patients
      • 1.10.5. Contact Tracing of Roommates
      • 1.10.6. Limit Transfers of Exposed Patients
      • 1.10.7. Outbreak Visitor Restrictions
      • 1.10.8. Declaring the End of an Influenza Outbreak
  • 2. Pandemic Period Recommendations for Infection Prevention and Control Activities in Long-Term Care (LTC) Settings
    • 2.1. Implementation of the Long-Term Care Organization’s Pandemic Influenza IPC/OH Plan
    • 2.2. Influenza Monitoring for all LTC Residents
    • 2.3. Acceleration of Pandemic Influenza Education and Skills Training for HCWs in LTC Organizations
    • 2.4. Implement Pandemic Influenza Precautions
    • 2.5. Implementation of General Source Control Plans
    • 2.6. Activities Outside the Long-Term Care Facility
    • 2.7. Admission Area for New Admissions
    • 2.8. Influenza Isolation Area
    • 2.9. Resident Care Areas
    • 2.10. Visitor Restrictions and Exemptions
      • 2.10.1. Visitors and Influenza Assessment
      • 2.10.2. Visitors With No Symptoms of Influenza Visiting a Resident With ILI symptoms
      • 2.10.3. Exceptional Circumstances for Visitors With ILI symptoms
    • 2.11. LTC HCWs : Fitness-for-Work
    • 2.12. Pandemic Influenza Outbreak Detection and Response in LTC Facilities
  • 3. Ambulatory Care Clinics and Settings
    • 3.1. Implementation of the Pandemic Influenza pandemic IPC/OH Plan
  • 4. Community Settings with Infirmaries
    • 4.1. Implementation of the Pandemic Influenza IPC/OH Plan
  • 5. Home Care Settings Where Care or Service is Provided by Regulated and Unregulated HCWs
    • 5.1. Implementation of the Pandemic Influenza IPC/OH Plan
• Appendix A - Influenza Self Assessment Tool
• Appendix B - Recommended Steps for Putting on and Taking off PPE
• Appendix C - Check List - Organizational Risk Assessment for Pandemic Influenza
• Appendix D - Point of Care Risk Assessment Tool for Pandemic Influenza
• Reference List