Download Case Detection and Clinical Management during the Inter

Saint Elizabeth Regional Medical Center
DRAFT DRAFT
Pandemic Influenza Plan
Case Detection and Clinical Management of Influenza-like illness
A. During the Inter- Pandemic Alert Periods
(Phase 3: Human infection(s) with a new subtype but no human-to-human spread or at most rare instances of spread to a
close contact; Phase 4: Small cluster(s) with limited human-to-human spread is highly localized, suggesting; that the virus is
not well adapted to humans; Phase 5: Larger cluster(s) but human-to-human spread is still localized, suggesting that the virus
is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk).
1. Tissue, alcohol cleanser and cough kit are available in the Triage area and waiting room.
2. At triage point - Patients screened for Influenza-Like Illness (ILI)
a. Fever >100.4
b. Any of these three: Cough, Dyspnea, Sore throat
c. If positive for “a” and any of “b”, ask travel questions.
3. Give the patient a mask and escort to ED isolation rooms (8, 9, 10). * If more rooms are needed,
use a separate waiting room area.
4. Notify the Infection Control Coordinator and House Supervisor of possible infection
5. Determine need for hospitalization
6. If admission is needed, admit to Med/Onc, PCU, CCU or Peds (Providers possibly involved in
admission: IMS, Intensivists, ID, Patient’s personal physician)
7. If admission is NOT needed, utilize discharge planning via Social Services, Case Managers, or
Home Health. Teach patient home care infection control.
*supplies needed: gloves, masks, gowns, alcohol cleanser
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Saint Elizabeth Regional Medical Center
DRAFT DRAFT
Pandemic Influenza Plan
B. During the Pandemic Period
(Pandemic phase: increased and sustained transmission in the general population) .
1. Tissue, alcohol cleanser and cough kit are available in the Triage area and waiting room.
2. At triage point - Patients screened for Influenza-Like Illness (ILI)
a. Fever >100.4
b. Any of these three: Cough, Dyspnea, Sore throat
c. If positive for “a” and any of “b”, ask travel questions.
3. Give the patient a mask and escort to ED isolation rooms (8, 9, 10). * If more rooms are needed,
use a separate waiting room area.
4. Notify the Infection Control Coordinator and House Supervisor of possible infection
5. Determine need for hospitalization
6. If admission is needed, admit to Med/Onc, PCU, CCU or Peds (Providers possibly involved in
admission: IMS, Intensivists, ID, Patient’s personal physician)
7. If admission is NOT needed, utilize discharge planning via Social Services, Case Managers, or
Home Health. Teach patient home care per printed Home Care Pandemic Guidelines.
*supplies needed: gloves, masks, gowns, alcohol cleanser
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Saint Elizabeth Regional Medical Center
DRAFT DRAFT
Pandemic Influenza Plan
Assessment: (link to Meditech screen here)
In addition to the clinical assessments appropriate to the patient’s care, assess all patients with
symptoms of ILI illness for
1) Recent travel
2) Recent exposure to animals
3) Recent exposure to persons with infectious disease
Travel risks:
Persons have a travel risk if they have:
1. Recently (within 10 days prior to onset of illness) visited or lived in an area affected by highly
pathogenic avian influenza A outbreaks in domestic poultry or where a human case of novel
influenza has been confirmed, and either
2. Had direct contact with birds or poultry, Direct contact with poultry is defined as: 1) touching birds
(well-appearing, sick or dead), or 2) touching poultry feces or surfaces contaminated with feces,
or 3) consuming uncooked poultry products (including blood) in an affected area
Or
3. Had close contact with a person with confirmed or suspected of having a flu-like illness. Close
contact with a person from an infected area with confirmed or suspected a flu-like illness is
defined as being within 3 feet of that person during their illness.
Exposure to animals:
Inquire about
1. contact (within 3 feet) of any live poultry OR domesticated birds (e.g., visited a poultry farm, a
household raising poultry, or a bird market?
2. direct contact with any recently butchered poultry?
Occupational risks:
Persons at occupational risk for infection with a novel strain of influenza include persons whom:
1.
2.
3.
4.
5.
work on farms
work with live poultry markets
who process or handle poultry infected with known suspected avian influenza viruses,
work in laboratories that contain live animal or novel influenza viruses,
work as healthcare workers in direct contact with a suspected or confirmed novel influenza case.
Infection Prevention during Care – Patients arriving in ED
1. Standard and Droplet Precautions should be used when caring for patients with novel influenza
OR seasonal influenza.
2. Laboratory confirmation of influenza infection is recommended when possible before cohorting
patients.
3. Patients with mild disease should be provided with standardized instructions on home
management of fever and dehydration, pain relief, and recognition of deterioration in status.
Patients should also receive information on infection control measures to follow at home.
4. Patients care for at home – patients should be separated from other household members as
much as possible. All household members should carefully follow recommendations for hand
hygiene, and tissues used by the ill patient should be placed in a bag and disposed of with other
household waste. Infection within the household may be minimized if a primary caregiver is
designated; ideally, someone who does not have an underlying condition that places them at
increased risk of severe influenza disease. Although no studies have assessed the use of masks
at home to decrease the spread of infection, using a surgical or procedure mask by the patient or
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Saint Elizabeth Regional Medical Center
DRAFT DRAFT
Pandemic Influenza Plan
caregiver during interactions may be beneficial. Separation of eating utensils for use by a patient
with influenza is not necessary, as long as they are washed with warm water and soap.
Hospitalization
1. The decision about hospitalization of patients with known or suspected influenza should be based
on all clinical factors, including
a. the potential for infectiousness and the ability to practice adequate infection control.
b. If hospitalization is not clinically warranted, and treatment and infection control is feasible
in the home, the patient may be managed as an outpatient. The patient and his or her
household should be provided with information on infection control procedures to follow at
home. The patient and close contacts should be monitored for illness by local public
health department staff.
2. During a pandemic, the decision to hospitalize should be based on a clinical assessment of the
patient and the availability of hospital beds and personnel.
Standing Orders:
1. Depending on the clinical presentation and the patient’s underlying health status, initial diagnostic
testing might include: (order set link)
a. Pulse oximetry
b. Chest X-ray
2. Laboratory Tests (order set link)
a. Complete blood count (CBC) with differential
b. Blood cultures
c. Sputum (in adults), tracheal aspirate, pleural effusion aspirate (if pleural effusion is
present): Gram stain, culture and sensitivity
d. Multivalent immunofluorescent antibody testing or PCR of nasopharyngeal aspirates or
i. swabs for common viral respiratory pathogens, such as influenza A and B,
adenovirus,
ii. Children: PCR of parainfluenza viruses, and respiratory syncytial virus
iii. Adults with radiographic evidence of pneumonia: Legionella and pneumococcal
urinary antigen testing
e. adults and children <5 yrs with radiographic pneumonia: PCR for M. pneumoniae and
Chlamydia Pneumoniae
f. Comprehensive serum chemistry panel, if metabolic derangement or other end-organ
involvement, such as liver or renal failure, is suspected
g. All of the following respiratory specimens should be collected for novel influenza A virus
testing: nasopharyngeal swab; nasal swab, wash, or aspirate; throat swab; and tracheal
aspirate (for intubated patients), stored at 4°C in viral transport media; and acute and
convalescent serum samples.
3. Admission Orders (order set link)
a. Standard Precautions + Droplet Precautions.
b. IV solution:____________________________
c. Vital signs: ____________________________
d. O2: __________________________________
e. Activity: ________________________________
f. Diet: __________________________________
g. Medications:
 Antivirals
 Antibiotic
 Home Meds
 Antipyretic
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Saint Elizabeth Regional Medical Center
DRAFT DRAFT
Pandemic Influenza Plan
Treatment
1. Given the unknown sensitivity of tests for novel influenza viruses, interpretation of negative
results should be tailored to the individual patient in consultation with the local health department.
Novel influenza directed management might need to be continued, depending on the strength of
clinical and epidemiologic suspicion. Antiviral therapy and isolation precautions for novel
influenza may be discontinued on the basis of an alternative diagnosis. The following criteria may
be considered for this evaluation:

Absence of strong epidemiologic link to known cases of novel influenza

Alternative diagnosis confirmed using a test with a high positive-predictive value

Clinical manifestations explained by the alternative diagnosis
2. Antiviral therapy and isolation precautions for pandemic influenza should be discontinued on the
basis of an alternative diagnosis only when both the following criteria are met:

Alternative diagnosis confirmed using a test with a high positive-predictive value, and

Clinical manifestations entirely explained by the alternative diagnosis.
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