Download Swine Influenza A/H1N1

Swine Influenza A/H1N1
Operational Guidance for Managers
This file will provide the Executive and on call managers with necessary information
and contact numbers to manage the present situation and, as appropriate, escalation.
1
Index
Section 1
Section 2
Section 3
3.1
Algorithms to follow for the Management of Patients suspected or diagnosed
with Swine Influenza A/H1N1

Swine Influenza Case definition

S5 Algorithm - the management of returning travellers and visiting countries
will follow S5 algorithm.
Page 5

P5 - Post exposure prophylaxis for close contacts of probable or confirmed
human case(s) of Swine Influenza A/H1N1
Page 7

ABM University NHS Trust algorithm for suspected cases of Swine Influenza
in A&E laboratory testing
Page 8
Page 4
Policy for the Management for patients with Swine Influenza (A/H1N1)

Swine Influenza A/H1N1Policy

A&E Princess of Wales Procedure for management of Swine Influenza
A/H1N1
Page 39

Local Accident Centre in Neath Port Talbot Hospital procedure for
management of Swine Influenza A/H1N1)
Page 40

A&E Morriston (inc Singleton Minor Injuries Unit page 44) Procedure for
management of Swine Influenza A/H1N1
Page 41
Page 9
Operational Management
Patients requiring admission
Patients requiring admission would be admitted to the areas identified in Table 1
Table 1
Morriston
Singleton
Neath Port
Talbot
Adult
Ward T
Ward 8
Ward C
Paeds
Oakwood
Ward 15
Pregnant
mums
Neonates
Ward T
Ward 8*
N/A
Neonatal Unit
Ward 15
Singleton
Hospital
Ward8/
Maternity
N/A
Princess of
Wales
Hospital
CDU/Ward2
Paediatrics
CDU/Ward2*
Maternity Unit
* Any pregnancy related complications then the patient needs to be discussed with
the obstetric/maternity Department.
2
3.2
PPE (refer to page 49)
Adequate supplies of PPE are available at the four access points of the Trust:
Morriston Hospital - A&E Department;
Singleton Hospital - Minor Injuries Unit;
Neath Port Talbot Hospital – Local Accident Centre;
Princess of Wales Hospital - A&E Department.
The receiving wards will also have a limited stock of face masks which can be
supplemented from the stocks available in the above areas.
3.3
Swab Kits
Limited number of swab kits are available in NPHSW Swansea laboratory and can
be accessed through the on call Microbiologist for the Trust.
3.4
Access to anti virals
Access to all anti virals will be via the on call pharmacists on all sites who can be
contacted via the site switchboard.
3.5
Transport for specimen testing
Additional arrangements have been put in place over the weekend for specimen
testing and if required can be contacted through the switchboard.
3.6
Ambulance Service
Ambulance have been notified of the arrangements in section 3.4.
Section 4
4.1
Communications
On call cover arrangements





Page 50
LHB (Swansea/Bridgend & NPT)
Trust Bridgend and NPT
Trust Swansea
Consultant Microbiologist on call
Infection Control Team on call
4.2
Key Contacts
Page 54
4.3
Advice regarding Staff Returning from Travel to Countries with
cases of Confirmed Swine Influenza A/H1N1
Page 56
4.4
Frequently Asked Questions
Page 58
4.5
Swine Influenza A/H1N1 Information Leaflet – separate attachment
3
4
5
6
7
8
This is a working document and will be subject to further amendment
POLICY ON THE MANAGEMENT OF PATIENTS WITH
POTENTIAL/ACTUAL SWINE INFLUENZA [A/H1N1]
Effective from:
Review Date:
Expiry date:
Author:
Approved by:
V7
April 2009
April 2010
September 2010
Swine Influenza Task & Finish Group
1. INTRODUCTION
The purpose of this policy is to advise the Trust staff in the operational management
of patients who self present, or are referred to the Trust who may potentially be
infected with swine influenza [A/H1N1].
In practical terms the key issues for the NHS Wales and the Trust is to ensure that
returning travellers and visitors from countries affected by swine influenza or
presenting with febrile respiratory illness are managed appropriately.
Action is required to ensure that possible cases that present to the A&E Department
are recognised and treated, appropriate infection control arrangements are in place
and rapid laboratory tests are undertaken to confirm or exclude the diagnosis. If
cases are confirmed it will be necessary to ensure that appropriate infection control
measures are maintained and that antiviral chemoprophylaxis (Tamiflu) is provided
for the patient and for contacts of confirmed cases if indicated. This is available
through the pharmacy department and the out of hours pharmacy store.
In most instances patients with suspected or confirmed swine influenza [A/H1N1]
should not be admitted or referred to the hospitals, unless clinically essential.
Patients with such symptoms should be managed within Primary Care and isolated
within their own homes.
This policy comes into force when a patient does get referred to the Trust or self
presents at the Trust.
2. BACKGROUND
What is Swine Influenza?
Swine influenza is a respiratory disease of pigs caused by type A influenza viruses.
Outbreaks of swine influenza happen regularly in pigs. People do not normally get
swine influenza, but human infections can and do happen.
Recently, cases of human infection with swine influenza [A/H1N1]] viruses have
been reported in Southern California and near San Antonio, Texas. In addition,
isolation of the same virus from cases in an outbreak in Mexico has indicted more
widespread human-to-human transmission (Source of information www.hpa.org.uk).
3. PATIENT MANAGEMENT
In the event of a patient / patients being referred to the Trust via the GP with
suspected or confirmed swine influenza [A/H1N1] the doctor receiving the request
should ascertain with the GP that admission is clinically essential and that
management in Primary Care is not possible. All such patients must be referred via
the A&E Department and be advised to present at the dedicated entrance.
All emergency departments must identify a dedicated entrance and a dedicated
equipped decontamination room. There should be posters guiding patients away
10
from the public entrance to a controlled entrance. There should be a separate
mechanism for staff to be notified of the arrival. This will alert the reception staff,
who will then inform the nurse in charge. The nurse in charge should proceed to the
decontamination room, and enter the patient via the external doors for triage to take
place, having first donned
In instances where a patient / visitor has entered the main public entrance to the
department, the receptionist should direct the patient to the designated area and
inform the nurse in charge who will proceed to the area (having already donned
PPE).
Decontamination Room
The decontamination room should be in a state of readiness to accept and isolate
patients at any time.
All patients should enter the decontamination room via the external doors (keys are
available from the controlled drug cupboard in decontamination room (Site specific
details needed).
A trolley must be available specifically for isolated patients with the necessary
equipment needed to maintain isolation precautions and other infection control
procedures. This trolley is kept in the decontamination room but should be
removed and placed outside the ambulance entrance door prior to any potentially
infected patients entering the room.
Trolley Equipment:








Green plastic aprons.
Gloves (S,M,L)
Goggles
Surgical Face Mask.
FFP2 Mask
FFP3 Mask
X-Ray cassette Covers
Swabs
Full oxygen and suction equipment is available in the room and any further
equipment should be taken in as required all equipment must be decontaminated
using a combined detergent/disinfectant wipe (e.g Tuffie 5), prior to it’s removal
from the room).
4. TRIAGE, SCREENING AND ASSESSMENT
In order for potentially contagious patients to remain isolated until proven otherwise
the decontamination room should be utilised for triage and assessment purposes.
A full history should be taken from the patient in order to decide if they fit the criteria
for isolation or if they can be treated in the main areas of the department (See
Appendix 1). This must be undertaken in full discussion with duty consultant
microbiologist and consultant in communicable disease control (NPHS out of hours
team – Appendix 2).
Swabs maybe required to be undertaken as guided by discussions within the
consultant microbiologist and CCDC as outlined in Appendix 2.
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Once criteria is established the following need to contacted and instruction awaited:







Lead Consultant/On call A&E Consultant
Senior Nurse Manager or A&E & Emergency Planning (in and out of hours)
Infection control
Bed/site manager
Pharmacy
Outbreak Co-ordinator- Hazel Abbot
Emergency Planning Executive Lead- Karl Murry
Treatment
Where treatment is indicated, this should also take place in the decontamination
room. Depending on clinical need, the patient should be nursed on a stretcher or
treatment couch.
X-ray
If an x-ray is required where feasible this should be undertaken as a portable
procedure within the patient isolation room.
Pharmacy
A limited stock of anti-viral medication (Tamiflu) is available form the emergency
cupboard in Pharmacy. Contact Pharmacy/on-call pharmacist when required.
5. INFECTIVITY, SPREAD & SEVERITY OF ILLNESS
Influenza is a respiratory illness characterized by fever, cough, headache, sore
throat, aching muscles and joints and is spread mainly by droplets or respiratory
aerosols produced when an infected person talks, coughs or sneezes. It may also
be spread by hand to face contact after touching a contaminated person or surface.
The virus can persist outside the body for 24-48 hours on hard services, 8-12 hours
on cloth/tissue and 5 minutes on hands. A summary of influenza and complications
and mode of transfer is provided in Appendix 3
The infectious period starts, typically, one day before the symptoms start and
people are highly infectious thereafter for about four to five days from the onset of
symptoms, and for longer in children and immuno-compromised people. The
incubation period is one to three days; about 10% of people are infectious before
they have symptoms. On average, one person will infect 1.4 others, but this may
be a greater number in closed communities.
Recovery usually occurs within seven days but complications such as bronchitis,
pneumonia, pneumonia, myocardidtis and pericarditis, myositis, encephalitis and
Syndrome can cause serious illness or death. Bacterial pneumonia is the most
common pulmonary complication. In 1918, many victims died rapidly of viral
pneumonitis.
Most complications usually occur in vulnerable groups such as the elderly or the
chronically ill, but pandemic viruses can have serious complications in any age
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group. Illness is more severe than the usual seasonal influenza and may occur in
all population groups.
Experimental studies of influenza virus survival suggest that the virus can survive
for limited periods of time in the environment, be transferred from contaminated
surfaces onto hands, and is easily inactivated by commercially available alcohol
hand disinfectant. Thus, contact spread is likely to be important unless controlled by
careful and frequent hand washing and environmental cleaning.
Pandemic influenza initially occurs in waves lasting 6-8 weeks in any one location.
The planning for health care need is based on an attack rate of 25% over a 6-8
week period. During this wave approximately 60% of cases will occur during 1-2
week period.
Evidence suggests that when the pandemic affects the local area there will be a
period of 1-2 weeks when a large number of people will be suffering from acute
influenza (modelling shows that while at a national level the peak activity may last
for up to 6 weeks, at a local level it is likely to be much shorter). Demand on
services locally during this peak phase will be very high. Most patients will return to
normal health after 5-7 days but some will progress to develop complications: either
exacerbation of pre-existing cardiac and/or respiratory symptoms, etc., or bacterial
infections. Up to 10% of those who develop ‘flu may become acutely ill and will
need to see a doctor. When the pandemic hits, Primary care resources must be
concentrated on these acutely ill individuals, it will be important that working
together with NHS colleagues and Social Services, that as many as possible should
be cared for in their own home.
 Management of Children with Pandemic Influenza
Children have the highest attack rate for influenza and are the major disseminators
of the virus1. Children aged 6-12 months have the highest attack rates in seasonal
influenza due to the waning of maternal antibodies 2,3. Although uncomplicated
influenza in children may be similar to the disease in adults there are significant age
related differences in toddlers and infants.
Symptoms of Influenza in Young Children
There is uncertainty as to how any new influenza virus causing a pandemic will
affect children – but we know that:







Young children usually develop higher temperatures than adolescents and
adults and often have febrile convulsions4,5
In neonates and infants unexplained fever may be the only indication of
influenza4,5
Influenza is a common cause of croup, pneumonia, pharyngitis and bronchitis in
young children
40% - 50% of those aged 3 years and under will present with gastrointestinal
symptoms2,6
In young children otitis media and non-purulent conjunctivitis is common
20% of infants will present with neurological symptoms – some of which will be
suggestive of meningitis
In children aged 5 years and over the most frequent symptoms are fever, cough,
headache, chills, myalgia and sneezing
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Systemic
 Fever > 38oC
(may fit)
Respiratory
 Cough
Non Respiratory
 Not playing


Nasal congestion

Low energy/lethargic

Difficulty breathing

Poor feeding

Fast Breathing*

Vomiting and diarrhoea

Hoarse

Irritability/crying
excessively

Earache

Photobia

Meningism
Apnoea
 Fast breathing:




< 2 months
2-12 months
12-5 years
> 5 years
= RR > 60/min
= RR > 50/min
= RR > 40/min
= RR > 30/min
Symptom checklist for children aged 4 years and under
Danger Signs in Children aged 2months to 4 years:








Difficulty breathing – not caused by nasal congestion
Cyanosis – or sudden pallor
unable to breast feed or drink
continuous vomiting
lethargic / seems confused
convulsions
has a full/sunken fontanelle
photobia, stiff neck
Danger Signs in Children aged < 2months:

Stopped feeding well (less than ½ normal feeds)
Providing Antiviral Therapy to Children
2. The hospital pharmacies should provide antiviral therapy to children for whom it
is recommended following assessment at the paediatric assessment centre
3. Those five years and over who do not require hospital assessment should have
the antiviral therapy distributed to their home as per the local distribution plan.
Current pharmaceutical guidance recommends that those under 23kg in weight
must have it prescribed by a doctor. Children on the 5th percentile would not
achieve this weight until they are 11 years of age. (A decision has yet to be
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reached on how children 5 years and over who weigh less than 23 kg will have
their antiviral medication prescribed and delivered).
Primary Triage Centre
5 to 17 years
inclusive
4 Years and under
Acute
Respiratory
Illness
(ARI)
ARI
dangers signs
present
Refer to
Outpatient
Paediatric
Assessment
Centre
ARI
No co-morbidity
or dangers signs
Advise parent or
guardian on home
management and
provide antiviral
therapy
Follow Up
home visit or
telephone
Paediatric Triage
Management of Pregnant Women with Pandemic Influenza
Women with influenza in their 2nd and 3rd trimesters of pregnancy are at increased risk of
hospitalization for cardio-respiratory disorders. Probably due to the increase in heart rate,
stroke volume, and oxygen consumption observed in these months, as well as to
decreases in lung capacity and changes in immunological function. A recent review of
pneumonia in pregnancy has shown that maternal disease, including asthma and anaemia
increase the risk of contracting pneumonia. Antiviral and respiratory therapies can reduce
morbidity and mortality from viral pneumonia. ITU management of respiratory compromise
can reduce mortality rate.
Providing health care to pregnant women during a flu pandemic aim to:

ensure pregnant women understand signs and symptoms of flu and measures to
take to minimise exposure to the virus

limit exposure of women to the pandemic virus in high risk occupations

ensure systems are in place for early detection of illness and timely administration
of antivirals

ensure adequate observation and follow up in the community for early detection

ensure obstetric services have plans in place for
- Admission to “flu” areas of obstetric units where segregation from other
obstetric inpatients can be assured
15
-
Critical care support
Operating elyth i
Paediatric support
The community midwife plays a central role and pregnant women should contact their
midwife should symptoms of flu develop. Home assessment will be undertaken if any of
these women develop symptoms compatible with influenza and antiviral therapy will be
commenced if recommended by GP/Obstetrician. While symptoms persist daily home
visits will be undertaken by the midwife and the general practitioner will be contacted in the
first instance if the patient deteriorates. Hospital admission will be by agreement with the
obstetric unit and to an agreed protocol.
PATIENT
HEALTH RESPONSE
Pregnant Woman
2nd & 3rd Trimester
Daily Monitoring from
midwife by telephone
Symptoms of flu
develop
Clinical diagnosis
of influenza made
Patient
deteriorates and
informs midwife
Patient hospital
admission
required
Home visit by
midwife
•
•
•
•
Home care if no other complications.
Antivirals commenced.
GP informed
Daily follow up while symptoms persist
GP home visit and hospital
admission arranged if
required
Patient admitted
to hospital under
agreed protocol
Care Pathway for Pregnant Women with Pandemic Influenza
6. PERSONAL PROTECTIVE EQUIPMENT (PPE)
PPE should be worn to protect staff from contamination with body fluids and thus
reduce the risk of transmission of pandemic influenza between patients and staff
and from one patient to another (see table below). Care in the correct donning and
removal of PPE is essential to avoid inadvertent contamination please refer to
Appendix 3. All contaminated clothing must be removed before leaving a patient
care area. Disposable or surgical masks being removed last.
All PPE should comply with the relevant BSEN standards.
16
b. Surgical masks
A surgical mask should be worn for close patient contact (e.g. within 3 feet). This
will provide a physical barrier and minimize contamination of facial mucosa by large
particle droplets, one of the principal ways influenza is transmitted.
All contaminated PPE must be removed before leaving a patient care area. Surgical
masks or FFP3 respirators should be removed last, followed by thorough hand
hygiene.
Surgical masks should:
 Cover both the nose and the mouth and not be allowed to dangle around the
neck after usage
 Not be touched once put on
 Be changed when they become moist
 Be worn once and discarded in an appropriate receptacle as clinical waste
 Hand hygiene must be performed after disposal is complete
c. Respirators
A disposable respirator providing the highest possible protection factor available
(i.e. an EN149:2001 FFP3 disposable respirator) should be worn when performing
procedures which have the potential to generate aerosols (see below). If an
EN149:2001 FFP3 disposable respirator is not immediately available, the next
highest category of respirator available should be worn (e.g. FFP2).
Fit testing: As per HSE requirements, every user should be fit tested and trained in
the use of the respirator. Fit is critically important and a fit check should be carried
each time a respirator is worn, as follows:
 Select a fit tested respirator
 Place over nose, mouth and chin
 Fit flexible nose piece over nose bridge
 Secure on head with elastic
 Adjust to fit
 Perform a fit check –

Inhale – respirator should collapse

Exhale – check for leakage around face
The respirator must seal tightly to the face, or air will enter from the sides. A good fit
can only be achieved if the area where the respirator seals against the skin is cleanshaven. Beards, long moustaches, and stubble may cause leaks around the
respirator.
Changing and disposal: If breathing becomes difficult, the respirator becomes
damaged or distorted, or contaminated by body fluids, or if a proper face fit cannot
be maintained, the wearer should go to a safe area and change the respirator
immediately.
FFP3 respirators should be replaced after each use. If, during the process of
providing care, respirators become contaminated with a patient’s respiratory
secretions they should be disposed of immediately. Respirators should be disposed
of as clinical waste according to local infection control policy.
17
Aerosol-generating procedures: include intubation, nasopharyngeal aspiration,
tracheostomy care, chest physiotherapy, bronchoscopy, nebulizer therapy. The
performance of aerosol-generating procedures should be minimized as is feasible
without compromising patient care.
To avoid unnecessary exposures, only those staff needed to perform the procedure
should be present. In addition to respirators, eye protection must be worn to prevent
eye contact with infectious material during such procedures.
d. Gloves
Gloves are not required for the routine care of patients with pandemic influenza per
se.
Standard Infection Control Principles
procedures, contact with sterile sites,
during all activities that carry a risk of
(including respiratory secretions) and
contaminated instruments.
require that gloves be worn for invasive
non-intact skin, and mucous membranes,
exposure to blood, body fluids, secretions
excretions, and when handling sharp or
Gloves should be removed immediately after use, disposed of as clinical waste, and
hand hygiene performed. No attempt should be made to wash gloves for
subsequent reuse.
If glove supplies become limited during a pandemic, priorities for glove use may
need to be established. In this circumstance, gloves should always be elyth ized
for contact with blood and body fluids, invasive procedures, and contact with sterile
sites.
e. Aprons
Disposable plastic aprons should be worn whenever there is a risk of personal
clothes, or uniform coming into contact with a patient’s blood, body fluids,
secretions (including respiratory secretions), and excretions; or during activities that
involve close contact with the patient (e.g. examining the patient).
Plastic aprons should be worn as single use items for one procedure, or episode of
patient care, and then discarded and disposed as clinical waste. In cohorted areas,
aprons need to be changed between patients.
f. Gowns
Gowns are not required for the routine care of patients with influenza. However
gowns should be worn if extensive soiling of personal clothing or uniform with
respiratory secretions is anticipated, or there is risk of extensive splashing of blood,
body fluids, secretions, and excretions onto the skin of the HCW. Procedures such
as intubation, and activities that involve holding the patient close (e.g. in paediatric
settings), are examples of when a gown may be needed.
Fluid-repellent gowns are preferable, but if non fluid-repellent gowns are used a
plastic apron should be worn beneath.
Gowns should:
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

Fully cover the area to be protected
Be worn only once and then placed in a waste or laundry receptacle as
appropriate, and hand hygiene performed immediately after removal
g. Eye protection
The use of eye protection should be considered when there is a risk of
contamination of the eyes by splashes and droplets e.g. blood, body fluids,
secretions, and excretions generated through patient care. This should be an
individual risk-assessment at the time of providing care. Eye protection should
always be worn during aerosol-generating procedures.
Eye protection can be achieved by the use of any one of the following:



Surgical mask with integrated visor
Full face visors
Polycarbonate safety spectacles, or equivalent.
Of note, non-disposable eye protective equipment (e.g. polycarbonate safety
spectacles issued as personal equipment to staff on a long-term basis) pose a
potential cross-infection risk. It is important that any such items are decontaminated
after soiling, using agents recommended by the manufacturer, and when leaving an
influenza patient segregated area prior to performing final hand hygiene.
.
19
7. PATIENTS TO BE ADMITTED
If due to the clinical condition patients need to be admitted to the hospital please
follow Tabel1.
Table 1
Morriston
Singleton
Neath Port
Talbot
Adult
Ward T
Ward 8
Ward C
Paeds
Oakwood
Ward 15
Pregnant
mums
Neonates
Ward T
Ward 8*
N/A
Neonatal Unit
Ward 15
Singleton
Hospital
Ward8/
Maternity
N/A
Princess of
Wales
Hospital
CDU/Ward2
Paediatrics
CDU/Ward2*
Maternity Unit
* Any pregnancy related complications then the patient needs to be discussed with the
obstetric/maternity Department.
8. COMMUNITY ISSUES
If GP’s determine that specimens are required from a patient in the community this
should be organised following discussion between the Gp and the Consultant in
Communicable Disease Control Out of Hours via NPHS On Call Rota.
9. TRUST WORKFORCE
Occupational Health
The Occupational Health Department will lead on the implementation of systems to
monitor for illness and absence, implement vaccination and antiviral therapy
programmes for the healthcare workforce (if specified by the WAG/NPHS), and
liaise with the Infection Control Team to give general advice on the management of
staff with pandemic influenza.
Who should work?
Staff will be at risk of acquiring Swine influenza through both community and
healthcare-related exposures, and should be made aware of the symptoms of
pandemic influenza. Before commencing duty all staff must report any symptoms of
pandemic influenza to their line manager who will then advise accordingly. Similarly,
if a member of staff develops such symptoms whilst on duty he/she must report to
their line manager immediately.
As a general principle, all staff who have symptoms of Swine influenza should be
excluded from work to avoid infecting patients, colleagues, and others. However, in
exceptional circumstances where staff shortages are extreme, line managers may
allow symptomatic staff to work. Staff who feel well enough to work, and are
20
beginning to experience symptoms of Swine influenza, or are recovering and have
residual symptoms, may do so provided they work in parts of the facility segregated
for the care of influenza patients, and avoid contact with non-influenza patients and
staff who remain well. This means for example that staff must stay in the
segregated patient area of the facility throughout their shift (including rest periods).
All staff who have recovered from pandemic influenza should report to their line
manager before resuming clinical duties because their illness needs to be recorded,
and it may also affect future deployment. These staff can care for people with
influenza. Line managers, in turn, should ensure that sickness/absence is recorded,
and this information is sent to the Occupational Health Department.
Staff deployment
Staff assigned to care for patients with Swine influenza or who work in areas of a
facility segregated for patients with Swine influenza should not be assigned to care
for non-influenza patients or work in non-influenza areas. Exceptions to this include:



Situations where there is a limited number of staff; e.g. medical staff, Allied
Health Professionals (AHP), although segregation of staff should be maintained
as much as practically possible
Situations when the care and management of the patient would be compromised
Staff who have fully recovered from Swine influenza.
In some community settings this may not be feasible. Nevertheless, consideration
should be given to developing approaches comparable to hospital settings; for
example, one District Nurse can be designated to see all the patients with
symptoms of influenza on the morning list.
In hospitals, staff from a non-influenza area can be redeployed to an area
segregated for the care of influenza patients. However, once deployed a worker
cannot return to their original non-influenza area for the duration of the pandemic.
Staff who have recovered from pandemic influenza or have received a full course of
vaccination against the strain and therefore considered unlikely to develop or
transmit influenza should be elyth ized for the care of patients with Swine
influenza. In exceptional circumstances, these workers can be moved within a
period of duty, but this is not desirable. These workers may also be placed in units
where the introduction of influenza would have serious consequences for patients
(e.g. transplant units, special care baby units, renal units). These workers should
not be moved within a period of duty.
Bank and agency staff
Bank and agency staff employed by ABM University Trust are usually utilized to
complement staffing levels on a day-to-day basis across the Trust. For example,
over five consecutive working days they may work in five different clinical
environments. During this period this form of work allocation must be avoided. Bank
and agency staff should follow the same deployment advice as permanent staff.
Workers at risk for complications from pandemic influenza
Healthcare workers who are at high risk for complications of Swine influenza (e.g.
pregnant women, immunocompromised workers) should be considered for alternate
21
work assignment, away from direct patient care for the duration of the outbreak /
pandemic, or until vaccinated. At the very least they should not provide care to
patients known to have influenza, nor enter parts of the hospital segregated for the
treatment of patients with influenza.
General Principles
During a pandemic healthcare workers can be exposed to persons with influenza
both through their normal daily lives (outside of work) and in healthcare settings.
Limiting transmission of pandemic influenza in the healthcare setting requires
application of tried and tested principles including:
 Timely recognition for cases of influenza. In the current pre-pandemic period,
having a high index of suspicion for possible rare cases of influenza caused by a
novel strain of virus such as avian A/H5N1 is particularly critical
 Consistent and correct implementation of appropriate infection control
precautions to limit nosocomial transmission. Standard Infection Control
Principles and Droplet Precautions are applicable in most circumstances. In
certain situations these control measures may need to be augmented with
higher levels of respiratory protection
 Administrative controls, such as the segregation or cohorting of patients with
pandemic influenza from those who have other medical conditions
 Use of auxiliary measures such as restricting ill workers and visitors from the
facility and posting of pertinent signage in clear and unambiguous language
 Education of staff, patients, and visitors about the transmission and prevention
of influenza that is understandable and applicable
 Treatment of patients and staff with antivirals which can reduce infectiousness
and the duration of illness
 Vaccination of patients and staff, when developed
Under COSHH Regulations all employers, including the NHS, are required to
undertake local risk assessments to inform decisions on choice of control
measures. The COSHH guidance can be viewed as a generic assessment
designed to ensure that infection control measures across the NHS are
implemented in a consistent manner. It reflects published evidence on influenza
transmission and control, and the exceptional circumstances of a pandemic, where
there may be:



Potential for a large number of patients
Greater number of HCWs potentially exposed to the pandemic virus; and where
the
Availability of control measures may vary.
The local COSHH risk assessment will identify any local circumstances, which
should also be taken into account.
Hand hygiene
Hand hygiene is the single most important practice to reduce transmission of
infectious agents in healthcare settings, and is an essential element of Standard
Infection Control Principles. During outbreaks of pandemic influenza strict adherence
to hand hygiene recommendations should be enforced.
22
The term ‘hand hygiene’ includes hand washing with soap and water and thorough
drying, and the use of alcohol-based products (i.e. gels or foams) containing an
emollient that do not require the use of water. If hands are visibly soiled or
contaminated (for example, contaminated with respiratory secretions), they should
be washed with soap and water and dried. When decontaminating hands using an
alcohol rub, hands should be free of dirt and organic material. The handrub solution
must come into contact with all surfaces of the hand.
Hands should be decontaminated before and after all patient contact with an infected
patient or their bed area, removal of protective clothing, and cleaning of equipment.
Following hand washing, hands should be dried thoroughly using paper towels that
are then discarded in the nearest waste receptacle. Waste bins with foot-operated
lids should be used whenever possible.
In addition to the placement of alcohol rub at the point of use (e.g. patient’s
beds/exam rooms and lockers), consideration should also be given to
extend/reinforce the distribution of personal carried alcohol rub to certain groups of
transient/migratory staff (e.g. medical staff in hospitals, and community staff
performing home visits).
All staff, patients and visitors entering and leaving areas where care is delivered
should perform hand hygiene with either soap and water followed by drying, or
alcohol hand rub.
Management of the coughing and sneezing patient
Patients, as well as staff, and visitors, should be encouraged to minimise potential
influenza transmission through good hygienic measures as follows:
 Cover nose and mouth with disposable single-use tissues when sneezing,
coughing, wiping and blowing noses
 Dispose of used tissues in nearest waste bin
 Wash hands after coughing, sneezing, using tissues, or contact with respiratory
secretions and contaminated objects
 Keep hands away from the mucous membranes of the eyes and nose
 Certain patients (e.g. the elderly, children) may need assistance with
containment of respiratory secretions; those who are immobile will need a
receptacle (e.g. a plastic bag) readily at hand for immediate disposal of tissues
and a supply of hand wipes and tissues.
Patient masking: Where possible, in common waiting areas or during transport (e.g.
from the community to an acute hospital, or from one area of the hospital to
another), coughing/sneezing patients should wear surgical masks to assist in the
containment of respiratory secretions and to reduce environmental contamination.
10. ENVIRONMENTAL ASPECTS
Clinical and non-clinical waste
No special handling procedures beyond those for Standard Infection Control
Principles are recommended for clinical and non-clinical waste that may be
contaminated with influenza virus. Waste generated within the clinical setting should
be managed safely and effectively, with attention paid to disposal of items that have
23
been contaminated with secretions/sputum (e.g. paper tissues) in addition to other
routine and domestic waste management.
Liquid waste such as urine and faeces can be safely disposed of into the sewerage
system.
All waste collection bags should be tied and sealed before removal from the patient
area. Gloves should be worn when handling ALL waste and hand hygiene
performed after removal of gloves.
Linen and laundry
Linen used during the patient’s care should be managed safely as per Standard
Infection Control principles.
Linen should be categorised as ‘Used’ or ‘Infected’. Both ‘Used’ and ‘Infected’ linen
must be handled, transported and processed in a manner that prevents skin and
mucous membrane exposures to staff, contamination of their clothing and the
environment, and infection of other patients.




Linen should be placed in appropriate receptacles immediately after use and
bagged at the point of use
Linen bags must be tied and sealed before removal from the influenza
patient care area
Gloves and aprons should be worn for handling all contaminated linen
Hand hygiene should be performed after removing gloves that have been in
contact with soiled linen and laundry
Hospitals: Bed curtains should be changed following patient discharge.
Community care: Paper sheeting is a good alternative for use on patient
examination couches, and should be changed after each patient.
Laundry workers: Guidance on laundry worker protection is described in HSG(95)18
– Hospital Laundry arrangements for used and infected linen. Staff should be fully
trained in all laundry operations, including hand hygiene and the correct use of
protective clothing.
Staff uniforms
The appropriate use of PPE will protect uniforms from contamination in most
circumstances. During an outbreak / pandemic, staff should not travel to and from
work, or between hospital residences and place of duty in uniform.
Hospital laundry services should be used to launder uniforms if they are available. If
there are no laundry facilities available then uniforms should be laundered in a
domestic washing machine in water as hot as the fabric will tolerate, then ironed or
tumbled-dried.
Uniforms should be transported home in a sealed plastic bag, washed separately
from other linen, in a load not more than half the machine capacity, in order to
ensure adequate rinsing and dilution.
24
Consideration may be given to the use of theatre type blues for staff who do not
usually wear a uniform.
Crockery and utensils
No special precautions, beyond those for Standard Infection Control Principles, are
recommended for dishes and eating utensils used by a patient with influenza.
Wash dishes and eating utensils in a dishwasher with a hot rinse. Do not hand
wash these items. There is no need to use disposable plates and cutlery.
Environmental cleaning and disinfection
Patient cohorted areas and clinical rooms should be cleaned daily at a minimum.
Cleaning schedules may vary by setting:
Hospitals: as a minimum, daily and after patient discharge
Clinical rooms: as a minimum, daily (preferably at the end or the beginning of the
day) and in-between influenza and non-influenza sessions if the same clinical room
is used
Frequently touched surfaces (e.g., medical equipment, door knobs): at least twice
daily and when known to be contaminated with secretions, excretions or body fluids.
Freshly prepared neutral detergent and hot water should be used.
Damp rather than dry dusting should be performed to avoid generating dust
particles. During wet cleaning a routine should be adopted that does not redistribute
micro-organisms. This may be accomplished by cleaning less heavily contaminated
areas first and by changing cleaning solutions and cloths frequently. The use of
vacuum cleaners should be avoided.
Dedicated or single-use/disposable equipment should be used. Non-disposable
equipment, including mop heads, should be laundered after use.
Any spillage or contamination of the environment with secretions, excretions or
body fluids should be treated in line with the local spillage policy.
Domestic staff should be allocated to specific areas, and not moved between
influenza and non-influenza areas. They must be trained in the correct methods of
wearing PPE and the precautions to be taken when cleaning cohorted areas.
Domestic staff should wear gloves and aprons; in addition a surgical mask should
be worn when cleaning in the immediate patient environment in cohorted areas.
Patient care equipment
Effective cleaning of patient care equipment is an essential prerequisite to both
disinfection and sterilisation. Standard practices for handling and reprocessing used
and soiled patient-care equipment, including re-usable medical devices, should be
followed for both influenza and non-influenza areas of hospital and primary care
settings:
25




Prevent exposure of the skin and mucous membranes and contamination of
clothing and the environment. Gloves should be worn when handling and
transporting used patient-care equipment
Clean heavily soiled equipment with neutral detergent and hot water before
removing from the patient’s room or consulting room
Reusable equipment (e.g. stethoscopes, patient couch in treatment and
consulting rooms) must be scrupulously decontaminated between each patient;
equipment that is visibly soiled should be cleaned promptly. If applicable, follow
local and manufacturers recommendations for cleaning and disinfection, or
sterilization of reusable patient-care equipment
Wipe external surfaces of portable equipment for performing x-rays and other
procedures in the patient’s room with neutral detergent and hot water upon
removal from the patient’s room or consulting room.
Whenever possible, non-critical patient equipment should be dedicated for use by
pandemic influenza patients only.
Use of equipment that re-circulates air (e.g. fans) should be avoided.
Furnishings
Remove all non-essential furniture, especially soft furnishings from reception and
waiting areas in hospitals and community settings, and treatment rooms (including
A&E, and day rooms/lounges). The remaining furniture should be easy to clean and
should not conceal or retain dirt and moisture. Toys, books, newspapers, and
magazines should be removed from the waiting area.
11. PANDEMIC FLU
Pandemic influenza occurs when a new influenza, a virus subtype emerges which is
markedly different from recently circulating subtypes and strains, and is able to:



Infect humans (rather than, or in addition to, animals and birds)
Spread efficiently from person to person (because a high proportion of the
population is susceptible as most people will have little or no immunity to the
new virus because they will not have been infected or vaccinated with or ot a
similar virus before)
Cause significant clinical illness is a high proportion of those infected.
The likely timing and burden of illness in the UK is summarised below. The scale,
severity of illness, and consequences of pandemic influenza exceed those of the
most severe winter influenza epidemics.
1. Mortality in the UK is likely to exceed 50,000 deaths. This compares with an
estimated 12,000 deaths each year in the UK from inter-pandemic (seasonal)
influenza, mainly in elderly people.
2. Excess mortality is likely to occur in the elderly, younger adults and children.
3. Modelling suggests that it may take 2-4 weeks for the virus to reach the UK
after a case has occurred in Asia.
4. Once cases occur in the UK influenza activity will be widespread within a few
weeks.
5. There may be more than one epidemic wave (with an interval of several
months), and a second wave may be more severe than the first.
6. Cumulative clinical and serological attack rates across all waves together may
26
be in the order of 25% and 50% respectively.
Surveillance of influenza has improved markedly since the last pandemic of 1968.
Modelling studies using transmission characteristics based on the 1968 pandemic
and air traffic data from 2002 indicate that the approximate delay between a first
case in Hong Kong and a first case in the UK would be less than a month. In terms
of the spread within the UK, it will probably take only 2-3 weeks from the initial
introduction until activity is widespread and a further 3 weeks (6 weeks from initial
UK cases) until activity peaks.
It is expected that the first wave of the pandemic will last 15 weeks and follow the
predicted case per thousand, as illustrated in the graph below. The graph indicates
a short lead in time with a rapid climb the maximum within 6 weeks of onset.
Subsequent waves of pandemic influenza will occur in waves weeks or months
apart. The planning assumption is that 25% of the population will be affected
although this operational plan also considers the NHS response required should
50% of the population become affected (Cabinet Office Refreshed Guidance Feb. 2006).
Pandemic Impact
Hospital admissions for acute respiratory and related conditions are likely to
increase by at least 25%. At the peak of the pandemic this could be 19,000 new
patients each week nationally requiring hospitalization. A short, sharp epidemic
would put greater strains on services than one that is more sustained at a lower
level. In general, emphasis should be given to out-of-hospital care, saving hospital
beds for only the most severe cases.
Absence from work
Normal sickness rates are around two percent, but previous pandemics indicate
that 10% or more of the population may lose working days. Based on the estimated
clinical attack rates, 25% of workers will take time off during the pandemic (possibly
five to eight working days). Workers’ needs to care for others, and difficulties (or
fear of) traveling to work mean that absenteeism may be higher. Modeling
suggests that absenteeism due to the pandemic peaks at 3.5% of the workforce by
week 14. This would double the normal absenteeism in a private sector company
and equate to a two-thirds increase in the public sector.
Health care workers are likely to have a higher sickness absence rate than other
population groups because they have a higher risk of exposure. In Liverpool in
1957, 12-19% of nurses were absent during the first four weeks of the pandemic. In
one hospital nearly a third were absent at the peak. NHS sickness rates are usually
around four to six percent.
Potential Impact on Services
Workforce:
 Staff sickness or even death and workforce depletion
 Disruption to supplies and utilities, including foodstuffs
 Existing patients acquiring influenza
 Business continuity
 Communications with staff, patients and clients
 Complexity of added infection control measures
 Managing demand for vaccine/antivirals
 Need to draft in ‘volunteers’ (indemnity/CRB checks etc)
27

Domestic pressures on staff if schools close or members of the family
are ill
Acute Care:
 Higher A&E attendance
 Pressure on HDU/ITU beds
 Infection control processes
 Bed- blocking because of reduced community capacity
Intermediate care:
 Pressure on admissions
 Difficulty admitting patients to secondary care
 Higher transmission among residential institutions
Primary care:
 Illness and death at home
 Difficulties in arranging hospital admissions/increase in early discharges
 Staff sickness – especially in single handed practices
Social care:
 Sickness in clients/carers
 High transmission in residential homes/daycare
 Children whose parents are too ill to care for them
Others:
 Pressure on mortuary facilities, delays in registration, burials and
cremations
 Long-term effects on the national and world economies and societal
structures
 Logistical problems due to interruption of supplies, utilities and transport
in communities, including foodstuffs
12. INTERNATIONAL & NATIONAL PHASES
The World Health Organisation [WHO] has defined phases in the evolution of an
influenza pandemic which allow a step-wise escalating approach to preparedness
planning and response leading up to declaration of the onset of a pandemic. Once a
pandemic has been declared, UK action will depend on whether cases have been
identified in the UK, and how extensively it has spread. For UK purposes, additional
UK alert levels are included within the WHO pandemic phase.
The WHO phases, which were revised in April 2005, describe the progression of an
influenza pandemic from the first emergence of a novel influenza virus, to a wide
international spread. This is a global classification based on the overall international
situation and is now used internationally for planning purposes:
INTER-PANDEMIC PERIOD
No new influenza virus subtypes have been detected in humans.
An influenza virus subtype that has caused human infection may
PHASE 1
be presenting animals. If present in animals, the risk to human
infection or disease is considered low.
No new influenza virus subtypes have been detected in humans.
PHASE 2 However, a circulating animal influenza virus subtype poses a
substantial risk to human disease.
PANDEMIC ALERT PERIOD
Human infection(s) with a new subtype, but no new human-toPHASE 3 human spread, or at most rare instances of spread to a close
contact.
28
Small cluster(s) with limited human-to-human transmission but
PHASE 4 spread is highly localised, suggesting that the virus is not well
adapted to humans.
Large cluster(s) but human-to-human spread still localised,
suggesting that the virus is becoming increasingly better adapted
PHASE 5
to humans, but may not yet be fully transmissible (substantial
pandemic risk).
PANDEMIC PERIOD
Pandemic phase – increased and sustained transmission in the
general population.
Past experience suggests that a second, and possibly further,
PHASE 6
waves of illness caused by the new virus are likely 3-9 months after
the first wave has subsided. The second wave may be, or more,
intense than the first.
POST PANDEMIC PERIOD – return to inter-pandemic period
Transition between phases may be rapid and the distinction blurred. The crucial
interval is between WHO Phases 5 and 6, which will determine to a large extent
whether a vaccine can be developed in time for the first wave of illness in the UK.
The WHO plan recognises additional national subdivisions for Phase 2 onwards,
according to whether a country is affected itself, had extensive travel/trade links
with an affected country, or is not affected.
13. THE ROLE OF THE HEALTH PROTECTION TEAM
Infectivity, spread and severity of illness
Influenza is spread mainly by droplets or respiratory aerosols produced when an
infected person talks, coughs or sneezes. It may also be spread by hand to face
contact after touching a contaminated person or surface. The virus can persist
outside the body for 24-48 hours on hard surfaces, 8-12 hours on cloth/tissue and 5
minutes on hands.
People are highly infectious for about four to five days from the onset of
symptoms, and for longer in children and immuno-compromised people. The
incubation period is one to three days; about 10% of people are infectious
before they have symptoms. On average, one person will infect 1.4 others, but
this may be a greater number in closed communities.
Recovery usually occurs within seven days but complications such as bronchitis,
pneumonia, pneumonitis, myocardidtis and pericarditis, myositis, encephalitis and
Guillain-Barré Syndrome can cause serious illness or death. Bacterial pneumonia is
the most common pulmonary complication; in 1918 many victims died rapidly of
viral pneumonitis.
Most complications usually occur in vulnerable groups such as the elderly or the
chronically ill, but pandemic viruses can have serious complications in any age
group. Illness is more severe than the usual seasonal influenza and may occur in all
population groups.
14. COMMUNICATIONS AND MEDIA ENQUIRIES
All communication from the media must be directed to Susan Bailey
29
15. QUESTIONS AND ANSWERS
Is swine influenza contagious?
It has been determined that this virus is contagious and is spreading form humanto-human. However, at this time it is not known how easily the virus spreads
between people.
What are the symptoms of swine influenza?
The symptoms of seine influenza in people are similar to the symptoms of regular
human seasonal influenza infection and include fever, fatigue, lack of appetite,
coughing and sore throat. Some people with swine flu have also reported vomiting
and diarrhoea.
What measures can I take to prevent infection?
General infection control practices and good respiratory hand hygiene can help to
reduce transmission of all viruses, including the human swine influenza.
This includes:




Covering your nose and mouth when coughing or sneezing, using a tissue
when possible.
Disposing of dirty tissue promptly and carefully.
Maintaining good basic hygiene, for example washing hands frequently with
soap and water to reduce the spread of the virus from your hands to face or to
other people.
Cleaning hard surfaces (e.g. door handles) frequently using normal cleaning
products.
Making sure your children follow this advice.
(Public information available from www.hpa.org.uk)
16. CONTACT DETAILS OF HEALTH PROTECTION TEAM
Cardiff:
02920 402478
Gwent:
01495 332219
Carmarthen: 01267225042
Swansea:
01792 607358
North Wales: 01352 803255
17
References:
1. Simonsen L The global impact of influenza on morbidity and mortality. Vaccine
17 Suppl 1:S3-10.1999
2. Ryan-Poirier KA. Influenza virus infection in children. Adv Pediatr Infect Dis
1995 10:125-156
3. Giezen WP, Taber LH, Frank AL, Gruber WC, and Piedra PA. Influenza virus
infection in the first year of life. Pediatr Infect Dis 1997; 11:1065 – 1068
4. Murphy BR and RG Webster. Orthomyxoviruses. , p 1397-1445. In: Fields
Virology., 3rd edition, volume 1.
5. Giezen WP, Payne AA, Nelson Snyder D and Downs TD. Mortality and
influenza. J Infect Dis 1982; 146:313-321
6. Paisley JW, Bruhn FW, Lauer BA and McIntosh K. Type 2 influenza in children
Am J Dis Child 1978; 132:34-36
30
Appendix 1
31
Appendix 1
32
Appendix 2
Appendix 3
Summary of Influenza
Stable Case:
Patient with influenza like illness but without abnormalities meeting criteria for
secondary assessment.
Co-morbidity:
 >65 years
 pregnancy (second and third trimester)
 Chronic lung disease (asthma, bronchitis, bronchiectasis, emphysema,
cystic fibrosis)
 Congestive cardiac failure
 Renal failure
 Immunosuppression (AIDs, transplant recipient)
 Haematological
abnormalities
(anaemia,
haemoglobinopathies,
oncological disorders)
 Diabetes Mellitus
 Hepatic disease, cirrhosis
 Patients on long-term acetylsalicylic acid therapy (for rheumatoid arthritis/
acute rheumatic fever/other)
Criteria for secondary care assessment:
 Temp - < 35oC or > 39oC
 Pulse - new irregular beat or > 100/min
 BP - < 100 mmHg systolic. Dizziness on standing
 Respiratory Rate - > 24/minute (tachypnoea)
 Chest pain/symptoms – any abnormality on auscultation/chest pain
 Mental State – new confusion
 O2 saturation - < 90% room air
 Vomiting if very young or very old (> 3 episodes in 24 hours)
Home Care:
 Paracetamol/Ibuprofen
 Fluids (hot fluids)
 Bed rest
 Decongestants
Patients advised to seek help if:
 Increasing shortness of breath
 New pleuritic chest pain
 New purulent sputum
 Persistent vomiting
34
Complications of Influenza
Respiratory:
 Lower respiratory tract complications are found in 10% of 5-50 year olds;
75% after 70 years of age
 Upper respiratory: Otitis Media, sinusitis, conjunctivitis
 Croup
 Bronchiolitis
 Bronchitis
 Pneumonia – 1° viral 2° bacterial Combined
 Complications of pre-existing disease
Cardiovascular:
 Pericarditis
 Myocarditis
 Complication of pre-existing disease
Muscular:
 Rhabdomyositis
 Rhabdomyolisis with myoglobinaemia and renal failure
Neurologic:
 Encephalitis
 Reyes Syndrome
 Guillan Barre Syndrome
 Transverse Myelitis
Systemic:
 Toxic shock
 Sudden death
Droplet transmission
Droplet transmission involves contact of the conjunctivae or the mucous membranes of the
nose or mouth of a susceptible person with large-particle droplets (larger than 5 μm in size)
containing microorganisms generated from a person who has a clinical disease or who is a
carrier of the microorganism. Droplets are generated from the source person primarily during
coughing, sneezing, or talking and during the performance of certain procedures such as
suctioning and bronchoscopy. Transmission via large-particle droplets requires close contact
between source and recipient persons, because droplets do not remain suspended in the air
and generally travel only short distances, usually 3 feet or less, through the air.
Airborne or fine droplet transmission
Airborne transmission occurs by dissemination of either airborne droplet nuclei (small particle
residue [5 μm or smaller in size] of evaporated droplets that may remain suspended in the air
for long periods of time) or dust particles containing the infectious agent. Microorganisms
carried in this manner can be dispersed widely by air currents and be inhaled and may
become inhaled by or deposited on a susceptible host within the same room or over a longer
distance from the source patient, depending on environmental factors.
Direct contact transmission
Direct contact transmission involves skin-to-skin contact and physical transfer of
microorganisms to a susceptible host from an infected or colonized person, such as occurs
when personnel turn patients, bathe patients, or perform other patient-care activities that
require physical contact. Direct-contact transmission also can occur between two patients
(e.g., by hand contact), with one serving as the source of infectious microorganisms and the
other as a susceptible host.
Indirect contact transmission
Indirect-contact transmission involves a susceptible host with a contaminated intermediate
object, usually inanimate, in the patient’s environment.
[Adapted from: Garner, J.S. and The Hospital Infection Control Practices Advisory Committee.
Guideline for isolation precautions in hospitals. AmJ Infect Control 1996;24:24-52.]
Available at www.cdc.gov/ncidod/hip/ISOLAT/ISOLAT.HTM
35
PATIENT CARE PATHWAY (Adult)
Appendix 4
Telephone
Triage
Influenza
Symptoms?
Exhibits Flu Like Illness
Influenza
Symptoms?
Primary Care
No
Refer to
Primary Care
No
Yes
Yes
No
Meets criteria
For antiviral
treatment
Able to be
Treated at home?
Rapid Response Team
No
Treat as
Appropriate in
Non Flu Area
If practicable
Visit by GP
Home Assessment Team
Or Rapid Response Team
As appropriate
Yes
Rapid Post-visit
Deterioration?
Yes
Yes
Does the patient
need secondary
care assessment?
No
No
Treat at Home
Patient representative to collect antiviral.
Home delivery in exceptional circumstances
Yes
No
Sub Acute
Care Facility
Sub Acute
Placing available?
Yes
On clinical assessment
Does patient satisfy
Criteria for Secondary
Care?
No
Yes
Yes
Yes
Pneumonia with
No co-morbidity?
No
Observation Results:
Evaluation not definite
Not able to cope
Pneumonia & Co-morbidity
Acute confusion
Respiratory Failure
Acute Cardiac deterioration
Metabolic derangement
No
No
Yes
No
Bed
Available?
Yes
Admit To Hospital
Terminology
Definition
Non Flu Area
Telephone Triage
Home Assessment Team
An area set aside for the examination and treatment of patients without flu like symptoms
Assessment of patient symptoms as given over the telephone to an experienced operator working from a pre-defined proforma
A team of clinicians with the ability to undertake home assessment of patients who fall outside the patient group directive for the prescription of antiviral
36
Rapid Response Team
Sub Acute Care Facility
Secondary Care Assessment
Patient Group Direction (PGD)
medication. This team may be made up of either primary or secondary care clinicians according to circumstance.
A team of clinicians or ambulance paramedics who would be able to undertake a more involved assessment of patients who deteriorate rapidly in the hours
subsequent to telephone triage or home assessment.
A care facility able to support those that cannot support themselves or rely upon the support of family in the home. The use of sub acute care facilities may
also allow a more early hospital discharge to enable increased bed capacity for the acutely ill.
Assessment in the hospital environment
A PGD is a written instruction for the supply and / or administration of a named medicine in an identified clinical situation.
37
RC/DD/EIP/A&E- 2009-04
38
Emergency Department - Princess of Wales
Draft guidance on patients with potential swine flu.
1. Sign on main entrance directing patient to ambulance entrance to ring bell.
2. If patient has already entered department, reception staff will give patient a
surgical mask immediately to put on. Patient will be booked in reception
staff to ask patient to remain were they are and inform nurse in charge.
3. Staff to put on protective face mask, apron and gloves.
4. Proceed to receive patient (at ambulance entrance or reception) – ask
patient to put on surgical mask.
5. Proceed with patient to decontamination room.
6. Ask doctor to see patient in the decontamination room ( if unwell take
patient to the secure room for barrier nursing )
7. Complete initial assessment as per screening checklist. (See green folder )
8. Manage patient as per screening algorithm.
9. Discuss with microbiology and CCDC and inform infection control.
10.If swabs indicated take 1 dry throat swab and 1 dry nose swab PLUS 1 throat
swab and 1 nose swab put into a single container of virus transport
medium.Culture medium available for swabs from microbiology lab. ( if
taking swabs ensure goggles are worn) Swabs will be in packs form
microbiology or contact on call microbiologist through switchboard.
11.Antiviral if indicated available from pharmacy ( out of hours from the on call
pharmacist)
12.Patients should be managed in the community unless condition mandates
admission to hospital.
13.Further information if required available from duty virologist at 02920 74
2178 during working hours or the On Call consultant Virologist via 02920
747 747 out of hours
14. Inform OONP who will inform necessary managers as per policy.
15. If patient has been nursed in the secure room ensure terminal cleaning has
been performed.
16. Keep patient information in folder and those who have had contact with
patient and give to Clinical nurse manager.
Becky Gammon 1/5/09
RC/DD/EIP/A&E- 2009-04
39
LAC – Neath Port Talbot
Guidance on patients with potential swine flu.
17.Sign on main entrance directing patient to ambulance entrance to ring bell.
18.If patient has already entered department, reception staff will give patient a
surgical mask immediately to put on. Patient will be booked in reception
staff to ask patient to remain were they are and inform nurse in charge.
19.Staff to put on protective face mask, apron and gloves.
20.Proceed to receive patient (at ambulance entrance or reception) – ask
patient to put on surgical mask.
21.Proceed with patient to decontamination room.
22.Ask doctor/Nurse to see patient in the decontamination room ( if unwell
take patient to a cubicle for barrier nursing)
23.Complete initial assessment as per screening checklist. (See folder)
24.Manage patient as per screening algorithm.
25.Discuss with microbiology and CCDC and inform infection control.
26.If swabs indicated take 1 dry throat swab and 1 dry nose swab PLUS 1 throat
swab and 1 nose swab put into a single container of virus transport
medium.Culture medium available for swabs from microbiology lab. ( if
taking swabs ensure goggles are worn) - Swabs will be in packs form
microbiology or contact on call microbiologist through switchboard.
27.Antiviral if indicated available from pharmacy ( out of hours from the on call
pharmacist)
28.Patients should be managed in the community unless condition mandates
admission to hospital.
29.Further information if required available from duty virologist at 02920 74
2178 during working hours or the On Call consultant Virologist via 02920
747 747 out of hours
30. Inform hospital manager who will inform necessary managers as per policy.
31. If patient has been nursed in cubicle ensure terminal cleaning has been
performed.
32. Keep patient information in folder and those who have had contact with
patient and give to Clinical nurse manager.
R gammon 1/5/09
RC/DD/EIP/A&E- 2009-04
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Accident & Emergency Unit,
Morriston Hospital,
Swansea, SA6 6NL.
Minor Injuries Unit,
Singleton Hospital,
Swansea, SA2 8QA.
West Division
ACCIDENT & EMERGENCY SERVICE
Clinical Governance
Patient & Public Involvement
Policy on the Management of Patients with
Potential/Actual Swine Influenza [A/H1N1] Version 2
Date effective from
Review date
Expiry date
Author
Approved by
April 2009
April 2010
September 2010
Rebecca Clarke – Senior Sister A&E
Ann Paynter – Senior Sister A&E
Delyth Davies – Lead Infection Control Nurse
(Signature)
Senior Nurse A&E & Emergency Planning
Introduction
This policy is to advise the Accident & Emergency Service staff in the
management of patients who attend the A&E department potentially infected
with swine influenza [A/H1N1].
In practical terms the key issue for the NHS in Wales is to ensure that
returning travelers and visitors from countries affected by swine influenza
presenting with febrile respiratory illness are managed appropriately.
Action is required to ensure that possible cases that present to the A&E
department are recognized and treated, appropriate infection control
arrangements are in place and rapid laboratory tests are undertaken to confirm
or exclude the diagnosis. If cases are confirmed it will be necessary to ensure
RC/DD/EIP/A&E- 2009-04
41
that appropriate infection control measures are maintained and that antiviral
chemoprophylaxis is provided for contacts of confirmed cases if indicated.
Isolation Procedure
During an outbreak of swine influenza, posters will be displayed at the main
walking entrance to A&E instructing patients and visitors not to enter the A&E
department via this way but instead to approach the ambulance entrance and
press the ‘Isolated Patients Only’ call bell. This will alert the reception staff, who
will then inform the nurse in charge. The nurse in charge should proceed to
the decontamination room, and enter the patient via the external doors for
triage to take place having first donned universal precautions.
In instances where a patient/visitor has entered the department without
ringing the bell, the receptionist should give the patient a face mask and ask
them to remain where they are. The receptionist should then inform the nurse
in charge who will proceed to the decontamination room and enter the patient
via the walking side entrance of the decontamination room in order to minimize
contact with other patients.
Setting Up & Equipment
The decontamination room should be in a state of readiness to accept and
isolate patients at any time.
All patients should enter the decontamination room via the external doors (keys
are available from the controlled drug cupboard in decontamination room).
A trolley is available specifically for isolated patients with the necessary
equipment needed to maintain barrier nursing and infection control
procedures. This trolley is kept in the decontamination room but should be
removed and placed outside the ambulance entrance door prior to any
potentially infected patients entering the room.
Trolley Equipment:
Green plastic aprons
Blue ‘thumb loop’ plastic gowns
Gloves (S,M,L)
Surgical mask
Goggles
Surgical face masks
FFP2 mask
FFP3 mask (use only if fit testing completed)
X-ray cassette covers
Wound culture swabs
RC/DD/EIP/A&E- 2009-04
42
Universal specimen containers
Other equipment
Viral transport media swabs (kept in major incident
store cupboard fridge)
Triage, Screening & Assessment
In order for potentially contagious patients to remain isolated until proven
otherwise the decontamination room should be utilized for triage and
assessment purposes. A full history should be taken from the patient in order
to decide if they fit the criteria for isolation or if they can be treated in the main
areas of the department (see appendix 1).
Once criteria are established you should inform the following and await further
instruction:






Lead Consultant/On-call A&E Consultant
Senior Nurse Manager for A&E & Emergency Planning
Infection Control
Bed/site manager
Pharmacy
Consultant Microbiologist
(in and out of hours)
Treatment
Where treatment is indicated, this should also take place in the
decontamination room. Depending on clinical need, the patient should be
nursed on a stretcher or treatment couch. Full oxygen and suction equipment
is available in the room and any further equipment should be taken in as
required (but then follow decontamination procedure advice given prior to
removal from that room of equipment).
One throat swab and one nose swab should be placed in viral transport media
and one dry standard throat swab taken and sent to Cardiff National Public
Health Service Laboratory for testing. A blue microbiology form indicating
‘influenza PCR testing’ should accompany them. If viral transport media is not
available, a standard wound culture swab should be used with tips cut off and
placed in universal containers (contact infection control team for more
information.
X-ray – if a portable x-ray is required, the AMX4 machine located outside Cyril Evans H.D.U should be
utilized. Inform A&E radiographer as required.
RC/DD/EIP/A&E- 2009-04
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Pharmacy – A stock of anti-viral medication packs (Tamiflu) are available from the emergency cupboard
in pharmacy. Contact pharmacy/on-call pharmacist when required. Further stock is available from
Bridgend.
Infection Control Team – Available via switchboard in and out of hours.
Minor Injuries Unit Singleton Hospital
At Singleton M.I.U a notice will be displayed at the entrance instructing
patients to ring the bell, not to enter and wait for assistance. The nurse will
don PPE and the patient will be taken into the relative’s room for triage.
In instances where a patient/visitor has entered the department without
ringing the bell, the receptionist should give the patient a surgical face mask
and ask them to remain where they are. The receptionist should then inform
the M.I.U nurse who will direct the patient to the relative’s room in order to
minimize contact with other patients.
The G.P, bed manager/NNP and infection control team should be informed as
soon as possible.
Other Information
What is swine influenza?
Swine Influenza is a respiratory disease of pigs caused by type A influenza
viruses. Outbreaks of swine influenza happen regularly in pigs. People do not
normally get swine influenza, but human infections can and do happen. Most
commonly, human cases of swine influenza happen in people who are around
pigs but it’s possible for swine influenza viruses to spread from person to
person also.
Recently, cases of human infection with swine influenza (A/H1N1) viruses have
been reported in Southern California and near San Antonio, Texas. In addition,
isolation of the same virus from cases in an outbreak in Mexico has indicated
more widespread human-to-human transmission.
Is swine influenza virus contagious?
It has been determined that this virus is contagious and is spreading from
human to human. However, at this time, it not known how easily the virus
spreads between people.
What are the symptoms of swine influenza?
The symptoms of swine influenza in people are similar to the symptoms of
regular human seasonal influenza infection and include fever, fatigue, lack of
appetite, coughing and sore throat. Some people with swine flu have also
reported vomiting and diarrhoea.
RC/DD/EIP/A&E- 2009-04
44
What measures can I take to prevent infection?
General infection control practices and good respiratory hand hygiene can help
to reduce transmission of all viruses, including the human swine influenza.
This includes:
- Covering your nose and mouth when coughing or sneezing, using a tissue
when possible.
- Disposing of dirty tissues promptly and carefully.
- Maintaining good basic hygiene, for example washing hands frequently with
soap and water to reduce the spread of the virus from your hands to face or
to other people.
- Cleaning hard surfaces (e.g. door handles) frequently using a normal
cleaning product.
- Making sure your children follow this advice.
RC/DD/EIP/A&E- 2009-04
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PANDEMIC FLU SCREENING CHECKLIST
DATE:
PATIENT DETAILS
ASSESSOR:
NAME:
DoB:
ADDRESS:
PRINT __________________________________
SIGN
__________________________________
HOME PHONE:
MOBILE PHONE:
OBSERVATIONS
PULSE:
SATS:
BP:
RR:
TEMP:
TRAVEL - WHERE
COUNTRY / COUNTRIES
AREA / RESORT
POTENTIAL EXPOSURES:
CROWDS (eg sports / tourists)
PUBLIC TRANSPORT (bus / tube)
SHOPPING (malls / markets)
SPECIFIC INFECTIOUS CONTACTS
TRAVEL – WHEN
DATE LEFT UK:
DATE AND TIME RETURNED TO UK:
AIRPORT / FLIGHT NUMBER:
METHOD OF AIRPORT TRANSFER:
DURATION OF AIRPORT TRANSFER:
METHOD OF TRANSPORT HOME:
DURATION OF JOURNEY HOME:
SYMPTOMS
YES / NO
DATE OF ONSET
RAISED TEMP / FEVER
COUGH
HEADACHE
RHINORRHEA
VOMITING
DIARRHOEA
OTHER
RC/DD/EIP/A&E- 2009-04
47
CONTACTS SINCE RETURN TO UK:
PMH:
(NB RENAL IMPAIRMENT)
DH:
IMMUNISATIONS UP TO DATE: YES /
FLU VACCINE:
YES /
NO
NO
SOCIAL CIRCUMSTANCES:
ADVICE GIVEN:
YES
NO
ISOLATE
MASKS GIVEN
GP FOLLOW UP
OTHER
ANY ADDITIONAL INFORMATION:
RC/DD/EIP/A&E- 2009-04
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RC/DD/EIP/A&E- 2009-04
49
Section 4
On Call Cover
LHB (Swansea, Bridgend & NPT) on call
25th May – 31st May
Andrew Goodall 07971537039
Bridgend &NPTAcute on Call
2nd May 2009 – end August 2009
DATE
TITLE
NAME
2 May – 8 May
8 May – 15 May
15 May – 22 May
22 May – 29 may
29 May – 5 June
5 June – 12 June
12 June – 19 June
19 June – 26 June
26 June – 3rd July
3rd July – 10th July
10th July – 17th July
17th July – 24th July
24th July – 31st July
31st July – 7th August
7th August – 14th August
14th August – 21st August
21st August – 28th August
Hof N Region
M/S
A.CC
Med
H of N
WCH
Med
HR
POWH
POWH
POWH
HR
NPTH
Radiology
HR
HR
Finance
T Weston
Steffan Gwynne
Gill Skinner
Dean Packman
Veronique Hughes
Bernie Steer
Andrew Carruthers
Donna Griffiths
Gaenor Shaw
Jo Williams
Sian Franks
Phil Spivey
Karl Murray
Ian McLelland
Phil S to nominate
Julia Dummer
Angela Fisher
Bridgend/NPT Executive on Call Rota
1st May to 21st December
(On call period is 9am to 9am)
NAME:
Stephen Wade – until
5pm on 7th
Huw Llewellyn – 5pm
onward
Geraint Evans
Darren Griffiths
Eiri Jones
David Clementson
Debbie Morgan
Christine Lewis
Ian Phillips
Vicki Franklin
FROM: 9am on…
1
May
2009
7
7th
May
2009
8th
May
2009
8th
15th
22nd
29th
5th
12th
19th
26th
May
May
May
May
June
June
June
June
2009
2009
2009
2009
2009
2009
2009
2009
15th
22nd
29th
5th
12th
19th
26th
3rd
May
May
May
June
June
June
June
July
2009
2009
2009
2009
2009
2009
2009
2009
st
th
TO: 9am on…..
May
2009
RC/DD/EIP/A&E- 2009-04
50
Swansea First on Call – May 2009
4 – Midnight Cover
Thursday 7th May
Friday 8th May
Saturday 9th May
Sunday 10th May
Monday 11th May
Tuesday 12th May
Wednesday 13th May
Thursday 14th May
Friday 15th May
Saturday 16th May
Sunday 17th May
Monday 18th May
Tuesday 19th May
Wednesday 20th May
Thursday 21st May
Friday 22nd May
Saturday 23rd May
Sunday 24th May
Monday 25th May
Tuesday 26th May
Wednesday 27th May
Thursday 28th May
Friday 29th May
Saturday 30th May
Sunday 31st May
Tracy Jenkins
Ceri Matthews
Alison Kingdom
Lee Davies
Karen Jones
Nell Brown
Helen Griffiths
Linda Bevan
Sian Passey
Emyr Phillips
Heulwen Howells
Nigel Weale
Linda Howell
Linda Reid
Linda Davies
Melanie Simmons
Hazel Abbott
Paul Davies
Jenny Sanders
Davina Lowndes
Les Hammond
Andrea John
Tersa Humphreys
Christine Griffiths
Fiona Hughes
SWANSEA - SECOND ON CALL TEAM
Week
Paul
Baker
Mike
Bond
Sally
Buckland
Jones
John
Calvert
Calum
Campbell
Liz
Rix
Rob
Royce
Jan
Thomas
Malcolm
Thomas
Huw
Williams
Janet
Williams
√
4.5.09
√
11.5.09
√
18.5.09
25.5.09
√
√
1.6.09
8.6.09
15.6.09
22.6.09
√
√
√
√
29.6.08
* Please note the second On Call Manager is also the designated officer for Civil Contingencies
RC/DD/EIP/A&E- 2009-04
51
CONSULTANT MICROBIOLOGIST ON-CALL ROTA
MICROBIOLOGY LABORATORY
Any enquiries for clinical advice on microbiological matters and requests for
antibiotic treatment advice should be referred to the consultant on-call.
Please try home telephone number first. If there is no reply, please contact the consultant via
the relevant mobile phone. For Dr. Keith Thomas and Dr. Louise Wooster, please contact via
the Princess of Wales Hospital Switchboard Telephone No: 01656 752752
Saturday morning in Swansea laboratory
Period beginning
5th May
2009
Dr. Nidhika Berry
11th May
Dr. Khalid El-Bouri
th
2009
9th May
2009
Dr. Nidhika Berry
16th May
2009
Dr. Khalid El-Bouri
rd
18 May
2009
Dr. Ann Lewis
23 May
2009
Dr. Ann Lewis
26th May
2009
Dr. Nidhika Berry
30th May
2009
Dr. Nidhika Berry
1st June
2009
Dr. Keith Thomas
6th June
2009
8th June
2009
Dr. Khalid El-Bouri
13th June
2009
15th June
2009
Dr. Louise Wooster
20th June
2009
Dr. Khalid El-Bouri
Dr. A. M. Lewis
Dr. K. El-Bouri
Dr. N. Berry
Dr. A. Davies
Dr. K. Thomas
(01792) 203657
Mobile phone:
07974 672577
(01792) 414554
Mobile phone:
07773 768535
(01443) 230277
Mobile phone:
07812 637455
(01792) 456944
Mobile phone:
07961 364933
01656 646395
Mobile phone:
07969 918057
Contact via Princess of Wales Switchboard 01656 752752
Dr. L. Wooster
Unavailable
Mobile phone:
07974 666954
Contact via Princess of Wales Switchboard 01656 752752
NOTE: PLEASE REMIND STAFF NOT TO LEAVE MESSAGES ON HOME
ANSWERPHONE
Please notify consultant on-call about the following:
 All positive CSF specimens.
 All positive sterile fluids e.g. joint aspirates.
 On Sunday morning/Bank Holiday mornings, whether any blood cultures
have become positive.
 More than expected numbers of microbiology specimens from the same
clinical area (this may suggest an outbreak of infection).
* Please refer any requests for clinical advice or antibiotic treatment to the
consultant on-call via the switchboard.
RC/DD/EIP/A&E- 2009-04
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RC/DD/EIP/A&E- 2009-04
53
Key Contact List
Name
Site
Work No
Mobile
Calum Campbell
THQ
01639
683326
07791592962
Acting Chief
Executive
Karl Murray
NPTH
01639
Home : 01639 899376
Site Manager, NPTH
& Executive Lead for
Eergency
Preparedness
Vicki Franklin
Mobile : 07968329572.
THQ
01639
683308
07825429420 - personal
Nurse Director
Bruce Ferguson
THQ
01639
683304
07771 644701
Medical Director
Nicola Williams
THQ
01639
683335
07966478099
THQ
01639
683330
07800 662215
THQ
01639 683332
07876707274
Morriston
A&E
01792
703417
Bleep 3570
bleep 3770
01792
703422
ext 3422
01792703422/19
07785 541770
01792
703690
07794072420
POWH
01656
752652 or
752088
07974 312247
POWH
01656
752741
07590433142
Associate Nurse
Director -Governance
& Safeguarding
Sue Bailey
Associate Director of
Corpriate Affairs Communciations
Hazel Abbott
Associate Director of
Corpriate Affairs –
Risk Management
Emyr Phillips
Senior Nurse
Manager, A&E &
Emergency Planning
Delyth Davies
Morriston
A&E
designated
bleep holder
Nurse in
Charge Morriston
Morriston
Home – 01269 850166
Head of Incefction &
Prevention Control
Veronique Hughes
Head of Nursing
Medical Directorate
Jayne Evans
RC/DD/EIP/A&E- 2009-04
54
Fiona Reynolds
Head of Nursing,
Intermediate Care&
Re-ablement
Mike Tidley
Consultant in
Occupational
Medicine
Jeff O’Malley
Occupational
Health
Janet Williams
Site Manager,
Morriston Hospital
Linda Davies
Lead Nurse,
Morriston Hospital
Malcolm Thomas
Site Manager,
Singleton Hospital
Alison Kingdom
Lead Nurse,
Singelton Hospital
Gaenor Shaw
Site Manager,
Princess of Wales
Hsopital
Sian Franks
Deputy General
Manager, POW
Becky Gammon
Block D
NPTH
01639
683162
07974930748
Home 01792 850256
POWH
01656 752158
Morriston
Hospital
01792
703610
Morriston
Hospital
01792
703999
home number 01792
297439
mobile number 07968313186
Morriston
Hospital
Ext 7049
01554751045
Mobile 07855509222
Singleton
Hospital
01792
285263
07967146596
Singleton
Hospital
01792
285263
07773389695
Princess of
Wales
Hospital
01656
752445
07597565038
Princess of
Wales
Hospital
01656
752634
07779704997
Princess of
Wales
01656
752397
07966597105
Lead Nurse, A&E,
POW
Assistant Co-ordinator
South Wales Local Resilience Secretariat
Rm 215, Merthyr Tydfil CBC, Civic Centre, Castle Street, Merthyr Tydfil
CF47 8AN
Tel: 01685 725149
[email protected]
Fax: 01685 387740
<blocked::mailto:[email protected]>
Mob: 07725 965053
[email protected]
SECURE EMAIL
[email protected]
RC/DD/EIP/A&E- 2009-04
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Advice regarding Staff Returning from Travel to Countries with
Confirmed Cases of Swine Influenza A/H1N1
1.
Staff symptomatic within 7 days of return from an affected area:
Staff should contact their GP. The GP will undertake an assessment of
risk in accordance with Health Protection Agency (HPA) guidelines. If
considered necessary, the GP will prescribe anti-viral treatment and
the member of staff should be excluded from work following advice
from the Health Protection Team.
If the GP assessment excludes Swine Influenza, the GP is likely to
advise that the member of staff may return to work.
2.
Staff who are asymptomatic following return from an affected
area:
Asymptomatic staff may continue working.
3.
Staff who have returned from an affected country, but who have
returned to work before developing symptoms:
These symptomatic staff should refrain from work until they have
sought advice from their GP and the local Health Protection Team.
4.
Staff who are close contacts of a probable or confirmed case
during the period when the latter was symptomatic AND last
exposure occurred no more than 7 days ago:
If symptomatic, contact GP and follow advice in section 1.
If asymptomatic, the advice of the HPA is that exclusion from work is
not required, even for healthcare workers.
In all instances above, staff are responsible for notifying their Manager
AND the Occupational Health Department of their symptoms and of any
relevant advice received from their GP/Health Protection Team.
Reference:
HPA : P5 WHO PANDEMIC ALERT PHASE 5: Actions and post exposure
prophylaxis for close contacts of probable or confirmed human case(s) of swine
influenza A/H1N1 (updated 02.05.2009)
RC/DD/EIP/A&E- 2009-04
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RC/DD/EIP/A&E- 2009-04
57
FREQUENTLY ASKED QUESTIONS
GENERAL
What are we calling this infectious disease outbreak?
We are referring to this outbreak as “Swine Flu.”
What are the current WHO and UK Alert Levels?
We are currently at WHO Alert Level 5 and the current UK Alert Level is 0. UK Alert Levels only come
into action once we reach WHO Alert Level 6, eg. once a pandemic has been declared. A pandemic
has NOT yet been declared.
If WHO move to Alert Level 6, would the UK move to Alert Level 2 or 3 immediately?
There are 4 UK alert levels (1= no cases in the UK, 2= virus isolated in the UK, 3= outbreaks in the UK,
and 4 = widespread in the UK). Since there are confirmed cases in the UK, a UK alert level of at least
2 is expected if the WHO phase is raised to 6.
Do we know when WHO may increase their Alert Level to Level 6?
Scientists at WHO are currently reviewing the available evidence on the nature of the H1N1 influenza
virus. We are in regular contact with the WHO and, as far as we are aware, the WHO has no plans at
present to raise the pandemic alert level to Phase 6.
HEALTH ISSUES
PLANNING ASSUMPTIONS
What are the planning assumptions we should use for this Swine Flu outbreak?
We are collecting information at the present time and we will study the first 100 cases in detail so that
we can provide an estimate of what we can expect from the current swine flu outbreak.
Will all the interventions identified for WHO Phase 5 be implemented?
The interventions outlined in the UK Government COBR response guide for Pandemic Influenza for
WHO phases 4 to 6 are designed to assist decision making within COBR. These actions, priorities and
decisions are not exhaustive or prescriptive. They are intended to provide an overview on how the
Government will approach developing its response to a pandemic, which will depend on the nature of
the virus.
INFORMATION GATHERING AND DISSEMINATION
Is the reporting of cases being limited to confirmed cases rather than including the number of
probable cases?
The HPA are releasing daily figures on their website (www.hpa.org.uk – announcement usually at 3pm)
setting out the number of confirmed cases to date. The website also lists the number of cases currently
under laboratory investigation. Cases currently under laboratory investigation change on a daily basis
as some of those under assessment are discounted and new ones are introduced.
SURVEILLANCE (INCLUDING PORT HEALTH AND TRAVEL ADVICE)
What information and advice has been issued to the public at points of entry to the UK?
Posters and leaflets are being made available at points of entry (airports) (text compiled by HPA,
distribution via UK Border Agency). These include messages of what to do if you begin to show
influenza like symptoms. Media messages are also seeking to ensure that any returning travellers who
are symptomatic go home, stay home and contact their GP or NHS direct over the telephone. The
RC/DD/EIP/A&E- 2009-04
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posters and leaflets are
www.ukba.homeoffice.gov.uk
available
online
at
the
UK
Borders
Agency
website
at
Has the above information (port health posters and leaflets) been sent to private airfields /
charter aircraft?
Posters and leaflets have been sent to all UKBA-staffed ports and airports.
What arrangements are in place at airports to protect public health and maintain public confidence?
The purpose of health activities at international terminals is to protect the UK population from the
adverse impact of imported disease, and to comply with the International Health Regulations (IHRs). In
public health terms, there are two issues; first, to ensure that cases are diagnosed rapidly and treated,
and second, to trace close contacts and prescribe anti-virals.
The existing arrangements for responding to Swine Flu at airports are based on a risk assessment
aimed at protecting public health and should be maintained. Carriers for all direct flights from Mexico
have been asked to keep the passenger manifest and seating plan for two weeks after landing. If this is
not effective, and contact tracing is indicated, the HPA will consider publishing the flight number and
asking passengers to contact the HPA.
To maintain public confidence in the current situation:



all direct flights from Mexico are met by an HPA employee
all passengers are given the information leaflet
HPA staff are available to deal with any queries that arise.
Are we limiting travel control only to countries where there are swine flu mortalities and does
this leave us at risk of visitors from countries where there are symptomatic people?
FCO is currently only recommending against all but essential travel to Mexico because of the flu
outbreak. This is being done in consultation with the HPA and is due mainly to the uncertainty over the
spread of the disease (the epidemiology). To extend this advice to other countries at present would be
contrary to WHO advice.
PPE AND HYGIENE ADVICE
Where can healthcare professionals find more information on Swine Flu? What advice (in the
form of algorithms) have they received?
The Health Protection Agency website contains a range of advice for healthcare professionals that may
also be on interest to resilience practitioners. The Swine Flu page can be found at:
http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1240732817665?p=124073
2817665
Will guidance be available for the independent social care sector comparable to that given to
other health care workers?
General guidance is already available for health care workers and much of this is applicable to social
care. In addition, in November 2007, the Department of Health published a strategic and operational
framework called Responding to Pandemic Flu in Adult Social Care. This will be supported by a Social
Care Tools and Implementation Pack which is designed to assist planning and response to a pandemic
in the social care sector. Four modules of this pack are already available on the Department for Health
website. A further five are being finalised and will be put on Department of Health website next week.
We are aware that the door-drop leaflet advises people to maintain their personal hygiene.
Please can you confirm what discussions have been held with the relevant retailers to ensure
that hygiene products are kept well stocked within supermarkets and shops.
BERR has been in touch with most of the leading national retailers of products mentioned in the doordrop leaflet as well as with the principal retailer trade bodies. In a further consultation by the BRC with
RC/DD/EIP/A&E- 2009-04
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major retailers on 5 May, retailers reported a significant increase in demand in hygiene products,
particularly antibacterial wipes and gels. In some cases, this increase in demand was as high as
3000%. Nevertheless, retailers were confident that they could meet the demand for these products.
It is possible there will be intermittent, very short-term, gaps on shelves from time to time, but retailers
are closely monitoring this to ensure that shelves are swiftly replenished with supplies both from stock
rooms and by new deliveries to stores.
What information can you provide on national activity to obtain PPE for emergency responders?
As detailed in previous guidance, the science does not support the use of facemasks by nonsymptomatic people outside of the health setting. The Dept of Health are purchasing facemasks for
health and social care workers in line with agreed policy in this area.
SHA report that DH have stated they will not have enough face masks for social care staff but for
frontline NHS staff only. Can you confirm this?
Arrangements are being made by the Department of Health to procure surgical facemasks for health
and social care workers for use if required (based on a risk assessment if the situation escalates). One
third of the stock of facemasks being procured will be provided for social care workers across both adult
and children’s sectors. The remaining two thirds will be allocated to healthcare workers. Facemasks will
be delivered to PCTs, and Local Authorities will need to arrange collection and distribution from there
on.
Facemasks should only be used by social care workers who have close (within 1 metre) contact with a
symptomatic individual. There is no benefit in staff who are not in this situation wearing a mask. Local
authorities will need to identify staff who may have close contact with symptomatic individuals and
prioritise their supplies of facemasks.
Guidance for Local Authorities on Facemasks for Social Care Workers has been issued by DH on 5
May (sent via RRTs to LAs). DH have confirmed that the facemasks should start to be delivered to the
PCTs from 11 May. Until then, the only stocks available will be those PCTs are currently holding or
those LAs have decided to purchase.
What advice can you provide for employers on the use of PPE by their staff?
DH/HPA/CCS recently published a risk assessment document for employers (see below) which can be
used to assess the potential risk that individuals will face in the event of a pandemic and provides
information on appropriate infection control mechanisms, including facemasks. Only on very rare
occasions would a facemask be deemed an appropriate precaution. No further advice will be issued by
Government on PPE.
http://www.cabinetoffice.gov.uk/media/187638/flu_businesses_risk_guidance.pdf
Useful information on facemasks can also be found on the HPA website at
http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1195733839643?p=1191942170
467
and on the HSE website at
http://www.hse.gov.uk/news/2009/swineflu.htm
What action should the Police take if they suspect that someone in custody may have Swine
Flu?
If the police suspect that someone in custody may have swine influenza, then they should ensure that
the person is assessed by a medical practitioner as soon as possible. However, they need to bear in
mind that unless the suspect was in Mexico or the US in the seven days before they became unwell, or
is a contact of a probable or confirmed case, then the likelihood of this being swine influenza is still very
low. The immediate steps would be to isolate the suspect and ask the suspect to wear a mask if
they are likely to be in close contact with anyone. If close contact with the prisoner is necessary, then
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the police officers should wear a facemask, disposable plastic apron and gloves while with the suspect
and wash their hands afterwards. The suspect should be encouraged to adopt good
respiratory hygiene.
Do we have advice for people working in polling stations for the forthcoming local and European
elections re. arrangements for general hygiene?
There are currently no restrictions in place regarding mass gatherings, however basic hygiene and
cleanliness of designated polling stations should be maintained. Information can be found on
the Business Link website (www.businesslink.gov.uk/swineflu) which offers advice to businesses
specifically relating to the outbreak of Swine Flu. This includes a risk assessment in the occupational
setting.
The Health Protection Agency and the Department of Health have worked closely with the healthcare
sector and certain non-healthcare services, such as the police and fire and rescue services, to develop
pandemic influenza infection control guidance for specific occupational settings (available at
http://www.cabinetoffice.gov.uk/ukresilience/pandemicflu/guidance/sector_specific.aspx). However, it is
not possible to outline detailed pandemic influenza infection control guidance for every occupation or to
cover every conceivable scenario where a person might be exposed to the risk of infection from flu.
With this in mind, this simple and generic guidance has been developed to raise awareness of the
measures that may be employed to reduce the spread of the flu virus at work. It aims to:

allow businesses to evaluate potential situations where there may be possible exposure
to the flu virus
 describe the steps that can be taken to moderate any potential exposure to the flu virus in the
workplace
 set out the measures that might be used to reduce the spread of the flu virus in the
workplace
 provide a matrix that can be used to consider the best ways of reducing the spread of flu in a
work environment
 put into context the relative value of personal protective equipment, including the wearing of
face masks, when compared with other environmental and organisational approaches.
http://www.cabinetoffice.gov.uk/media/187638/flu_businesses_risk_guidance.pdf
The Department of Health website also contains a range of materials (primarily aimed at health and
social care professionals) to help communicate the public health information contained in the national
media campaign. In particular, the Catch It, Bin It, Kill It posters may be useful for display in public
buildings.
http://www.dh.gov.uk/en/Publichealth/Flu/Swineflu/DH_098802
MEDICAL COUNTERMEASURES
How will antivirals be distributed?
The Department of Health are currently reviewing this issue as a matter of urgency. They are engaged
with local health providers who have been asked to develop their own plans in this area. We would
encourage LRFs to engage with PCTs and the NHS in their area on this issue.
How does the current distribution of antivirals fit into the overall policy framework?
As detailed in the National Framework for responding to an influenza pandemic the UK may use AVs for
post-exposure prophylaxis in the early stages in order to contain spread, allow planners more time to
prepare and also enable clinical analysis of the first few hundred cases to inform planning assumptions.
Post-exposure prophylaxis to immediate contacts at the same time as treating a symptomatic patient is
given on the grounds that some of the contacts may already be incubating the infection. The response
we are currently seeing is in line with this. Pre-exposure prophylaxis is not being implemented.
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Apart from attempts to contain initial spread, general prophylaxis (pre-exposure) is not currently
regarded as an effective or practical response strategy.
If antivirals are prescription only, how is it legal for organisations to distribute stocks to staff?
What statutory instruments have been tabled by the Department of Health in relation to
prescriptions and anti-virals, and what will they achieve?
Policy and legal officials are looking at this issue and will provide guidance in due course.
What messages are being given to the public regarding what anti-virals do?
The DH leaflet that will be going to all UK households, and is currently available online at
http://www.direct.gov.uk/en/Swineflu/DG_177831?CID=SFlu&TYPE=sponsoredsearch&CRE=2, details
how taking antivirals can help symptomatic people: Antiviral drugs are not a cure, but they help you to
recover if taken within 48 hours of symptoms developing, by: Relieving some of the symptoms.
Reducing the length of time you are ill by around one day and reducing the potential for serious
complications, such as pneumonia.
What information has been provided about the risks of purchasing tamiflu online (worries about
counterfeit drugs)?
A statement has been released by the Royal Pharmaceutical Society of Great Britain. This can be found
at http://www.rpsgb.org.uk/pdfs/pr090429.pdf
What extra antibiotics have been purchased?
Antibiotics will play an important part in our response to a pandemic. DH have worked with clinicians to
develop clinical management guidelines which identify the types of antibiotics needed to treat the
complications arising for pandemic influenza. The clinical management guidelines have been published
on the DH website and in a number of academic journals. Further purchases of antibiotics are currently
being accelerated.
Why do you need antibiotics in a pandemic?
While antivirals may reduce the number of complications, there are still likely to be significant numbers
of complications occurring in a pandemic. Some of the most common include bacterial infections in the
respiratory tract and lungs. Antibiotics are needed to treat such complications.
Antibiotics will be used to treat people in the community, if they develop complications. In secondary
care, antibiotics will be used to treat the sickest patients and may reduce the length of hospitalisation.
Is there consideration being given to extending sickness self-certification arrangements during
the outbreak?
Yes. If the circumstances warrant it, ministers can extend the current 7 day period to reduce the burden
on GPs.
EXCESS DEATHS
When will national guidance on excess deaths be issued?
The Home Office and Ministry of Justice have been tasked with taking this forward as a matter of
urgency. A working group has been established to take this forward. We hope to be in a position to
provide regional and local partners with the outstanding guidance documents and further clarification as
soon as possible.
When will the final version of the national guidance document Pandemic influenza - draft
guidance on the operation of the coroner system in England and Wales be published?
Pandemic Influenza - Guidance on the Operation of the Coroner System in England and Wales for
Coroners is available to coroners on the Coroners’ Society’s members only website (5 May).
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This document is not being made available on public websites nor is it available to the media at present
to prevent misunderstandings with regard to the current swine flu situation. CCS circulating this
document to Regional Resilience Teams (for onwards transmission to Local Authorities and other
relevant partners) on 6 May.
Where can I find the most up to date guidance on Death Certification? I remember being
consulted on a draft guidance document Pandemic influenza - Guidance on the management of
death certification and cremation certification by the Dept of Health in May 2008 – is this the
latest document? Will there be specific guidance for doctors and police officials?
The most up to date guidance on Death Certification can be found at the address below. This replaces
the document which was issued for comment on the 19 May 2008. There are no plans to issue specific
death certification guidance for doctors and police officials as the main guidance covers these issues. If,
however, there are any specific concerns in relation to this, please raise these concerns via your RRT /
through the CCSControl mailbox.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086
832
Can you provide clarity on the length of time a body can be stored under chilled conditions (not
embalmed)?
As lead department for mass fatalities, the HO have set up a working group to consider all issues
relating to this subject, including body storage. CCS are keen that the issue of storage is fully
considered and that lines/guidance are not provided until they have been fully considered by all of the
key players.
NON-HEALTH ISSUES
SCHOOLS
What guidance has been issued to schools?
DCSF have issued specific guidance and a series of Q&As for schools on Teachernet.
This can be accessed via the following links:
Main emergency planning page: http://www.teachernet.gov.uk/emergencies/planning/flupandemic/
Updates page: http://www.teachernet.gov.uk/educationoverview/flupandemic/
Q and A page: http://www.teachernet.gov.uk/educationoverview/flupandemic/flupandemicqanda/
What guidance is going to schools regarding closure if cases are identified among students or
staff?
It is too early to consider whether school closures will be appropriate measure as we move forward. As
the situation develops, a risk assessment will be carried out by HPA/DH/DSCF who will then advise
(through CCS and the RRTs cc DAs) local responders of the decision. The processes are outlined in
guidance previously issued.
How will advice on closure of independent residential schools be communicated?
In the event of a decision being made to advise schools to close (as described above), the
communications mechanisms are for DCSF (via CCS) to let RRTs know, and then for RRTs to ensure
messages are passed to LAs and then onwards to all schools (including private / independent schools,
etc) in their area. DCSF would follow up the cascaded message with a direct message to schools.
For residential schools, slightly different measures may be required, for instance moving some children
to guardians, or accommodating those who have nowhere to go while reducing social mixing. DCSF
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guidance to schools (issued by then DfES in 2006) provides more information - schools should consider
paragraphs 2.31 - 2.36 of that guidance.
What plans are being put in place in case school examinations are affected by the Swine Flu
outbreak?
Ofqual has worked with awarding bodies, regulators in Wales and Northern Ireland, UCAS, higher
education institutions and government to ensure that contingency plans are in place in the event of
disruption to the test and examination system. Schools will be made aware of the appropriate
contingency plans if they need to take any action with regard to examinations.
DCSF have published specific guidance on examinations in a series of Q&As on Teachernet. The link is
as follows:
http://www.teachernet.gov.uk/educationoverview/flupandemic/flupandemicqanda/
What action should schools take when a pupil is known to be (by the school and parents) a
contact of a probable or possible infected person (ie. one of flu symptoms under investigation)?
Issues of containment of infection are not sectoral. HPA will decide appropriate containment / voluntary
quarantine measures for each case. HPA are currently carrying out contact tracing of possible and
probable cases and contacts (such as the pupil above) would be directly contacted by HPA and
provided with advice if there was any action required.
What advice/guidance is available for schools on what to do with pupils returning from Mexico
although showing no flu symptoms?
HPA advise that children in this situation should go to school. The same applies to staff members who
have been to Mexico.
What advice/guidance is available for schools on what to do with pupils arriving at school
showing flu-like symptoms?
Children with any flu-like symptoms should not be taken to their school or childcare setting, and their
parents should be told to take them home if they arrive with symptoms. If a child is taken ill in the day,
their parents should be called immediately, and asked to collect the child, and the child should be kept
separate from other children - to reduce the risk of infection - until they are collected. In a boarding
school, we would expect the child to be in a sick room or similar - arrangements will depend on local
circumstances.
PRISONS AND THE CRIMINAL JUSTICE SYSTEM
What guidance will be issued to prisons? Will it cover restrictions on visitors and include the
securing of young people?
The Ministry of Justice are finalising guidance for the criminal justice system. This will be issued as
soon as it is signed off by Ministers. The guidance includes advice on prisons and the Youth Justice
Service.
Prison Service have reiterated to Managers the need to ensure contingency plans are in place in line
with existing guidance on pandemic influenza. Decisions on regime levels and activities, including the
running of visits, will be taken in the light of local circumstances and existing policy.
Can you provide advice on when guidance for the judicial system will be made available?
The Ministry of Justice (MoJ) are currently finalising this guidance and it will be published in the near
future (see above).
FAITH GROUPS
Advice sought from Faith Groups on the subject of Passing of Chalice at Communion
Faith Community guidance is available at
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http://www.communities.gov.uk/documents/communities/pdf/1219379
Page 20 provides specific advice on the subject of Passing of Chalice at Communion.
“In a pandemic, sharing of common vessels for food and drink should cease. For
example, the sharing of cups for Christian Communion or Eucharist, and the
tradition of Langar in the Sikh religion for the free vegetarian-only food served in
a Gudwara.”
What information has been produced by Faith Groups for their members?
The Hindu Forum of Britain has prepared guidance which was sent out to all its member organisations
on 5 May. The guidelines are aimed at those practicing or gathering for Hindu rituals and services in
temples and community centres and offers simple advice on reducing the levels of infection.
http://www.hfb.org.uk/Default.aspx?sID=45&cID=358&ctID=43&lID=0
INFRASTRUCTURE
What national engagement is taking place with Critical National Infrastructure
owners/operators?
Many operators of Critical National Infrastructure are members of the wider resilience community as
Category 2 responders under the Civil Contingencies Act 2004, and are therefore engaged at various
levels of response within the UK. Those organisations with links with Local and Regional Resilience
Forums will be working in partnership with other organisations in response to the outbreak of Swine
Flu. In addition, Government Departments are keeping contacts in the Critical National infrastructure
community apprised of the situation with bespoke briefings and the Top Lines Brief prepared by the
National News Coordination Centre.
MASS GATHERINGS
How will any decisions be taken on mass gatherings, and how will these decisions be
communicated and to whom?
The Government are not recommending the cancellation of mass gatherings at this stage. To reach a
decision on specific emergency measures that might be required if a pandemic were declared, in the
absence of more information on the nature of the virus and an evidence-based assessment of the likely
consequences for the UK, would be premature at this stage.
The Government stands ready to take whatever measures are necessary to respond to the virus. As
part of the detailed planning that has been undertaken during the past five years, Government
departments have identified potential changes to existing legislative provisions that might be necessary
during a pandemic, including measures relating to mass gatherings and other social-distancing aspects.
Some of these may be addressed through existing secondary legislation, others might require new
primary legislation, or use of Part 2 of the Civil Contingencies Act. Any decisions will be cascaded
though the RRTs (cc DAs).
What definition is being used for “mass gatherings”?
Mass gatherings are defined as events attracting significant numbers of people to an event. They can
take place nationally, regionally or locally and may involve use of public transport. They include sporting
events, concerts, church services, etc. but do not cover school attendance or public transport. We are
not currently advising against mass gatherings. This is being kept under review and will update RRTs if
our position changes.
ANIMAL HEALTH
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Have Defra issued (or do they intend to issue) guidance to farmers and the public to respond to
issues around public perception of eating pork or pork products?
This is a public health matter and the Department of Health and HPA are in the lead. Defra is providing
them with support. Advice to the public re. eating pork / pork products has been included in the Top
Lines Brief. The following lines have been sent to key pig and avian stakeholders given their mutual
interest in A type flu viruses which can infect animals and humans. Please feel free to draw on this in
communications to your stakeholders.
The CVO has stated:
There is continual surveillance of pigs in this country and there is currently no evidence of this
variant of the disease. Swine Influenza cannot be transmitted by eating pork products. Eating
properly handled and cooked pork and pork products is perfectly safe.
Existing EU rules which prevent imports of all live pigs and pigmeat from Mexico into the EU
will continue to be upheld.
Defra have also prepared some Q&A material which you may want to draw upon - see below – plus you
can find information about swine influenza on the animal disease pages of Defra’s website.
Q&A material
Why is this called swine influenza?
The virus associated with the human cases in Mexico and USA have characteristics from a number of
influenza viruses found in pigs, birds and humans. There are no reports of the virus which is currently
causing disease in humans being found in pigs (although the situation in Mexico is uncertain).
There are no reports of an increase in influenza in pigs occurring in the US/Mexico or elsewhere in the
world. Therefore, although parts of this virus may have originated in pigs, it now appears to be
transmitting from human to human direct. There is no evidence that pigs are currently involved in this
human disease although further work is needed.
What are the rules about imports of pigs and pigment into the EU?
EU rules do not permit the importation of live pigs from either the US or Mexico. EU rules do not permit
the import of pig meat from Mexico, but pigmeat products can be imported from the US. However, even
if pigs are involved with this virus, the risk to humans from pigmeat is considered by the US CDC to be
negligible. EU rules do not allow the personal import of meat or meat products from either the US or
Mexico.
Can people catch swine flu from eating pork?
No. Swine influenza viruses are not transmitted by food. You cannot get swine influenza from eating
pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking
pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.
We have heard reports of the H1N1 virus being transferred from human to pigs in Canada and
wonder whether there is the potential for the disease to mutate? Also, will the UK consider
culling pigs as a means of controlling the H1N1 virus as in Egypt?
This strain of swine flu has not been found in pigs in the UK and DEFRA will maintain their surveillance
procedures. However the transmission from humans to pigs is not unexpected and DEFRA guidance to
pig keepers reflects this. Swine Flu does not pose a food safety risk to consumers and has not been
shown to be transmissible to people through eating pork and pork products.
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EU rules currently allow the import of live pigs from Canada to the EU. Trade in live pigs to the UK from
Canada is limited and only one consignment has been sent this year (in February). DEFRA will review
the current rules at EU level. Given the high health status of the consignments likely to come from
Canada, their infrequency, and the fact that disease has been found in only one herd to date (which had
an epidemiological link to Mexico), the risk from live pig imports from there is very low.
DEFRA advice to pig keepers is that they should stay out of contact with pigs if they have influenza
signs. This is consistent with the Health Protection Agency advice to returning travellers, which asks
people to stay out of contact with other people if they have influenza signs.
CONSTITUTIONAL ISSUES
Can you provide advice on the implications of Flu Pandemic for constitutional matters, including
local and European Elections?
Preparations for holding the elections on 4 June should proceed as planned, however, the position is, of
course, being kept under review.
When will we know whether the elections will be held or delayed?
The Ministry of Justice, working with other Departments, is reviewing how Swine Flu may impact on the
elections. They are also in touch with the Electoral Commission, Regional Returning Officers, and the
AEA. For the present, they are not advising that any specific steps be taken. However, they are
monitoring the situation carefully and will issue further updates through the Regional Returning Officers
network for distribution to electoral administrators.
Local authorities should be considering contingencies within their area, and Regional Returning Officers
should be discussing plans with Local Returning Officers in their region. It may be useful to share this
planning for the benefit of others and the Regional Returning Officers co-ordination group circulation list
may prove to be a suitable tool for that.
The European Parliamentary election is set for 4-7 June in European Union Member States. Any
decisions on the timing of those elections need to be taken in consultation with other Member States.
At present, there are no plans to change the timing of the elections.
If people have specific queries in relation to the elections and planning for them, please send those
through to MoJ at the elections mailbox at [email protected] (given that many of the queries
may be similar, or the answers of interest to others, MoJ will seek to respond to those all together).
Do we have advice for people working in polling stations for the forthcoming local and European
elections re. arrangements for general hygiene?
(For answer, see the PPE AND HYGIENE ADVICE section above)
PUBLIC COMMUNICATIONS
How will national web communications for the public be co-ordinated?
A protocol has been agreed that makes: Directgov (www.direct.gov.uk/swineflu) the primary government
website for essential cross-government swine flu messages; NHS Choices (www.nhs.uk) the primary
public-facing health information and advice service; the Department of Health website (www.dh.gov.uk)
the home of content relating to health and care professionals; and Business Link
(www.businesslink.gov.uk/swineflu) the home of business-related information
Directgov are leading the coordination of Swine Flu cross-government messages and information
(including video and online updates (RSS feeds)) from all relevant Departments. The Department of
Health is the policy lead for all health-related information and will clear all health-related information
placed on websites.
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What public communications activity will we see in the next few days?
The Department of Health's flu TV ad aired from 30 April. The leaflet (to be door-dropped from Tuesday
5 May) was available online from 10pm on 29 April on the Directgov, NHS Choices, and Department of
Health websites.
What is the Swine Flu Information line?
The Swine Flu Information line has been set up to provide information on the swine flu virus. This is a
recorded service and the telephone number is 0800 1 513 513. The information provided on the Line is
the same as that contained in the door-drop leaflet and on the websites listed above.
What information is contained in the door-drop leaflet?
The leaflet includes information about what swine flu is and how it could spread, what UK governments
have done to prepare for a wider outbreak of flu, how you can protect yourself against flu, and what to
do if you have flu symptoms.
Will the door-drop leaflet be made available in other languages / accessible for people with
disabilities?
The alternate formats (16 languages in simple PDF version, large print, and audio) were posted on the
Directgov website on Tuesday 5 May (http://www.direct.gov.uk/en/Swineflu/News/DG_177995). Hard
copy audio CDs, Braille sheet, and large print formats will be available to order from Thursday 7 May
and will take up to a week to deliver depending on demand. Hard copies of ten translations will be
available to order from Friday 8th May (including Welsh/English bilingual, Polish, Bengali, Chinese,
Urdu, Arabic, Punjabi, Gujarati, Somali, French) and will take up to a week to deliver, depending on
demand.
The leaflet has been translated into Welsh and can be found at
http://wales.gov.uk/topics/health/protection/communicabledisease/swine/?skip=1&lang=cy.
The Stakeholder team at DH have spoken to RNIB and Help the Aged about this campaign and are
talking to more groups as the accessible and translated information comes on stream.
The Swine Flu Information Line is a recorded service using the information in the leaflet. Therefore, its
use should not be an issue for people with speech impairments.
What work is taking place nationally to brief the media?
As part of the Government strategy to ensure that media at all levels are as informed as possible about
the ongoing Swine Flu situation, the National Media Emergency Forum met on May 7. This meeting
included a briefing from the Chief Medical Officer, informing the group about the current Swine Flu
situation and associated medical advice.
Ministers (including Devolved Administration Ministers) and the Chief Medical Officer, as well as the
HPA, are doing a wide range of interviews, plus DH and HPA as well as the DAs are issuing regular
updates on line.
What communication is being undertaken nationally with the Trade Unions?
Although there are no formal communications aimed specifically at Trade Unions, DWP has a close
working relationship with them and are keeping them up to date with the key issues through the HR
representatives on the Business Disruption Forum. This forum was set up to support the business
continuity management process in relation to the Departmental response to Swine Flu.
What advice is available for employers?
Annex A contains details of current guidance that is available for employers. This information is
included on the Business Link website at:
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http://www.businesslink.gov.uk/bdotg/action/detail?type=ONEOFFPAGE&itemId=1082470688&r.li=108
2470975&atom_id=0.PR270942&r.lc=en&r.pp=11&r.pt=global&furlname=swineflu&furlparam=swineflu&
ref=&domain=www.businesslink.gov.uk
Request for the Health and Safety Executive Website to be updated to refer to Swine Flu rather
than Bird Flu.
The Health and Safety Executive website was updated on 30 April. The bird flu advice remains, but
specific swine flu advice has been added.
The relevant page can be found at:
http://www.hse.gov.uk/news/2009/swineflu.htm
What advice is available for elected members?
A toolkit for MPs and other elected representatives has been created. We are currently awaiting
confirmation that this can be published on UK Parliament intranet, by DAs on their parliamentary sites,
and on Info4Local.
OTHER ISSUES
LRF / GO WORKLOADS
What relaxation of deadlines have been given for LRF work (eg. flood planning) to ensure LRF
capacity and capability can be diverted to dealing with the Swine Flu outbreak?
RRTs have provided CCS with details of the regional and local work which they would like to see put on
hold / delayed. CCS is in discussions with the relevant Government departments on this. Initial
feedback has been provided to RRTs (1 May) and a further update will be issued on Tuesday 5 May.
FOI REQUESTS
Could we have some advice from the Legal Cell on dealing with FOI questions? Most
organisations would like to give out as much information as they can if asked, but also want to
keep in step with the rest of the country.
Organisations are responsible for seeking their own advice on FOI requests as each case needs to be
taken on its own merits. We acknowledge that it is important to maintain a degree of consistency with
regards how FOI requests are treated. The Legal Cell is looking at options for how best to deliver this
and will produce guidance in due course.
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