|Title:||Infection Prevention and Control of Influenza-like Illness (ILI)|
|Document ID:||Operational Directive OD 0213/09|
|Date of issue:||Saturday, 22 August 2009|
|Status:||NO LONGER APPLICABLE|
|Description:||Describes the minimum infection prevention and control precautions required for the management of Influenza to minimise transmission amongst vulnerable patient populations and healthcare workers (HCWs)|
|Applicable to:||All inpatient Healthcare Facilities|
|Period of effect:||from 1 July 2009|
|Review date:||1 July 2014|
|Authorised by:||Dr Peter Flett, DIRECTOR GENERAL, OFFICE OF THE DIRECTOR GENERAL, 14-Aug-2009|
|Print version:||View print version|
Infection Prevention and Control of Influenza-like Illness (ILI)1. Purpose
This Operational Directive describes the minimum infection prevention and control precautions required for managing patients with an Influenza-Like Illness (ILI) in a healthcare facility (HCF) in Western Australian (WA) to minimise the risk of transmission amongst vulnerable patient populations and healthcare workers (HCWs). All HCFs shall ensure their procedures are congruent with those outlined in the attached appendix Hospital Infection Prevention and Control Guidelines for Influenza-Like Illness (ILI).
In April 2009, the World Health Organisation (WHO) announced the emergence of a novel influenza A virus. The identified H1N1 virus had not previously circulated in humans. The WHO declared a global pandemic due to the novel H1N1 influenza virus (now known as pandemic (H1N1) 2009) on 11 June 2009. In recognition that this strain of influenza is not as severe as originally envisaged the Commonwealth Government adopted the PROTECT phase with a focus on identification and early treatment of those with moderate or severe disease and for those in high risk groups for severe complications of influenza infection.
The US Centres for Disease Control (CDC) reviewed data on HCWs who had acquired pandemic (H1N1) 2009 influenza in the workplace setting in June 2009. The review demonstrated that HCWs failed to comply with the required precautions, including the use of personal protective equipment (PPE). No infected HCW reported 100% adherence to the CDC guidelines for PPE use1. Locally, WA infection prevention and control professionals have reported non compliance by HCWs with standard and additional precautions, including droplet precautions required for the management of seasonal influenza.
Sub-optimal vaccination rates amongst HCWs for seasonal influenza and a population with no immunity to pandemic (H1N1) 2009 influenza virus creates a serious risk of transmission of influenza virus in the healthcare setting. Therefore, it is critical that HCWs use appropriate infection prevention and control precautions when caring for patients with any influenza-like illness (ILI), in order to minimise the possibility of transmission between patients, visitors and other HCWs.
4. Infection Prevention and Control
The infection prevention and control measures appropriate for suspected or confirmed influenza (including seasonal and pandemic strains) in a healthcare setting, are the application of Standard Precautions and Additional Precautions for Droplet Transmission.
4.1 Standard and Additional Precautions
Standard Precautions are work practices required to achieve a basic level of infection prevention and control and therefore are the minimum acceptable level of practice in any HCF. Standard precautions include the use of personal protective equipment when there is potential for exposure or contact with blood / body fluids, including respiratory secretions. These practices are supported by implementation of Additional Precautions which are based on the mode of transmission of specific infectious agents. Some infectious agents may be transmitted by more than one route. The modes of transmission include: contact, droplet and airborne. Standard and Additional Precautions are described in detail in the WA Department of Health Operational Circular Standard and Additional Infection Control Precautions OP 2039/06.
4.2 Additional Precautions: Droplet Transmission
Respiratory droplets are generated when an infected person coughs, sneezes or talks, and during aerosol generating procedures such as suctioning, endotracheal intubation, sputum induction, chest physiotherapy and bronchoscopy.
Droplet transmission occurs when respiratory droplets carrying infectious pathogens are expelled short distances from the respiratory tract of the infectious individual to susceptible mucosal surfaces of the recipient, necessitating the use of facial protection. These droplets can also contaminate surfaces and be transmitted by direct and indirect contact routes, hence requiring the use of additional personal protective equipment, i.e. gown and gloves.
Evidence for droplet transmission comes from epidemiological studies of disease outbreaks, experimental studies and from information on aerosol dynamics. Studies have shown that the nasal mucosa, conjunctivae, and less frequently the mouth, are susceptible portals of entry for respiratory viruses. The maximum distance for droplet transmission is unresolved: however, based on current knowledge, close proximity is required (<1 metre around the infected person) for transmission to occur; droplets do not remain suspended in the air. However, this distance, should not be used as the sole criterion for determining when a mask should be donned and due to the unexpected nature of healthcare delivery it may be prudent to don a mask on entry to an ILI patient’s room2, 3.
5.1 All HCFs are to ensure their local infection prevention and control guidelines are congruent with the minimum standards as described in the attached Hospital Infection Prevention and Control Guidelines for Influenza-Like Illness (ILI) and that these precautions are implemented as the standard minimum practice for managing presentations of ILI.
5.2 All HCFs shall encourage HCWs to participate in annual influenza vaccination.
5.3 Individual HCWs have a responsibility to ensure they comply with these guidelines to minimise the risk of transmission amongst vulnerable patient populations.
1. CDC. Novel Influenza A (H1N1) virus infections among healthcare personnel. MMWR 2009;5:641-645.
2. Siegal Jane D, Rinehart E, Jackson M, et al for the Health Care Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. June 2007. Accessed 10 July 2009. http://www.cdc.gov/ncidod/dhqp/gl_isolation.html
3. Australian Government Department of Health and Ageing. Infection control guidelines for the prevention of transmission of infectious diseases in the healthcare setting. Canberra: Australian Government, 2004.
Dr Peter Flett
This circular last updated: Friday, 21 August 2009 at 3:55pm