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Sultanate of Oman Ministry of Health Department of Communicable Disease Surveillance and Control, Directorate General of Health Affairs, Ministry of Health HQ, Sultanate of Oman Address for Communication: Department of Communicable Disease Surveillance & Control Directorate General of Health Affairs, Ministry of Health HQ, PO Box 393, MUSCAT 113, Sultanate of Oman Fax: + (968) 24 601832 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Contents Contents .................................................................................................. 2 Reader Information ................................................................................. 3 Acronyms ................................................................................................ 3 1. Background ........................................................................................... 4 2 National Preparedness Plan 2.1 Introduction ..................................................................................... 5 2.2 Phases of Influenza Pandemic ......................................................... 5 2.3 Declaration of Pandemic .................................................................. 8 3. The Components of Preparedness 3.1 Enhanced Influenza Surveillance ..................................................... 8 3.2 Case detection ................................................................................. 9 3.3 Case investigation & Management ................................................... 9 3.4 Laboratory Surveillance.................................................................. 10 3.5 Infection control .............................................................................. 10 3.6 Non-Pharmaceutical interventions .................................................. 11 3.7 Pharmaceutical interventions ......................................................... 12 3.8 Information Dissemination .............................................................. 12 List of Annexure (1 to 6) ........................................................................... 13 List of Algorithms (1 to 6) ......................................................................... 24 Ministry of Health, Sultanate of Oman Page 2 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Reader information Policy Document Purpose Title Publication Date Revision Date Author Other Contributors Target Audience Description Cross References Contact Details This is the official policy document of the Ministry of Health, Sultanate of Oman For information and action National Pandemic Influenza(H1N1) Preparedness Plan 2005 revised May 2009 Department of Communicable Disease Surveillance & Control, Directorate General of Health Affairs, Ministry of Health HQ Experts from the “National Task Force on Influenza Pandemic Preparedness”. The plan has been reviewed by the legal Department of Ministry of Health All Director Generals, Directors, of the Regions, Governorates and Hospitals including the MOICs of the health centres, EHC’s, polyclinics, CDC’s, and other Ministry of Health institutions. Non-MoH health organizations viz. SQU Hospitals, AF hospital, ROP hospital, PDO clinics, Palace health services, ISS health services, all private hospitals and clinics and including those who are directly or indirectly involved in the pandemic management. This document outlines the framework of how the Ministry of Health, Sultanate of Oman would respond to an influenza pandemic. It is based on the recommendations of the World Health Organization for the national pandemic preparedness plan. Key Influenza Documents on the WHO and CDC websites H.E. Dr. Ali Jaffer M. Suleiman, Director General, Directorate General of Health Affairs, Ministry of Health, PO Box 393, Muscat 113, Sultanate of Oman. [email protected] Dr. Salah Al Awaidy, Director, Department of Communicable Disease Surveillance and Control, Directorate General of Health Affairs, Ministry of Health, PO Box 393, Muscat 113, Sultanate of Oman. [email protected] Acronyms AI DCDSC FAO HPAI GF TADs GLEWS ILI MoA&F MoH NADSS OIE PDO PPE RADISCON ROP SNS SQUH WHO (OMS) Avian Influenza Department of Communicable Disease Surveillance & Control Food and Agriculture Organization (UN) Highly pathogenic Avian Influenza Global Framework for the control of Transboundary Animal Diseases (FAO/OIE) Global Early Warning System (FAO/OIE/WHO) Influenza Like Illness Ministry of Agriculture and Fisheries Ministry of Health National Animal Disease Surveillance System Organization Mondiale de la Santé Animale (World Organization for Animal Health) Petroleum Development Organization Personal Protective Equipment Regional Animal Disease Surveillance and Control Network Royal Oman Police Strategic National Stockpile Sultan Qaboos University hospital World Health Organization (Organization Mondiale de la Santé) Ministry of Health, Sultanate of Oman Page 3 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 1 Background Influenza is one of the most common causes of febrile and respiratory illness. The risk of severe illness and/or death is higher among adults >65 years old; among persons of any age with underlying chronic diseases including lung or heart disease, metabolic diseases, and immune-suppression; and among children <2 years old. Vaccination represents the major strategy to reduce the impact of influenza and is recommended for high-risk persons. Influenza viruses circulating in the population are continuously evolving (antigenic drift and antigenic shift), which requires that vaccines be redesigned and produced annually to provide the best match to the influenza strains that are circulating. Pandemics occur when novel influenza A viruses most probably derived from animal or avian influenza viruses develop ability to spread effectively among people. By definition pandemics involve the circulation of strains for which almost all of the world’s population lack pre-existing immunity. Influenza pandemics resemble major natural disasters. It is impossible to anticipate when the next pandemic might occur or how severe its consequences might be. On an average, three pandemics per century have been documented since the 16th century, occurring at intervals of 10–50 years. The first pandemic of influenza of the 20th century, the “Spanish flu,” began in 1918 and, by the time it ended the following year, by conservative estimates, it had resulted in more than 20 million deaths worldwide. Later pandemics in 1957 and 1968 caused far fewer deaths but still posed a substantial burden on the health care system, and resulted in substantial economic costs and social disruption. Following the events which happened in Mexico and USA, where in many individuals are affected by Novel H1N1 influenza virus, the concerns for pandemic influenza is growing as more information are made available. This novel influenza virus H1N1 is a combination (re-assorted) of Human, Avian (bird) and swine influenza viruses. WHO has declared H1N1 influenza situation as an international public health emergency. On 29th of April 2009 the pandemic influenza alert has been upgraded to phase5 which means the global spread (pandemic) is likely as human-to-human transmission has been established. As of writing this plan, 11 countries have officially reported 257 cases of influenza A (H1N1) infection. The United States Government has reported 109 laboratory confirmed human cases, including one death. Mexico has reported 97 confirmed human cases of infection, including seven deaths. The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (19), Germany (3), Israel (2), Netherlands (1), New Zealand (3), Spain (13), Switzerland (1) and the United Kingdom (8). 2. The National Preparedness Plan 2.1 Introduction Ministry of Health, Sultanate of Oman Page 4 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Planning and preparedness are essential to optimally achieve the goals and objectives of a pandemic response. The Main Aim of this document is to provide a national framework for an integrated countrywide response to an influenza pandemic H1N1, with clear operational plans for the response at all levels. Main document, "National Pandemic Influenza Preparedness Plan" is already prepared by Ministry of Health which has provided guidance for the preparedness so far remains valid. Some modifications based on current available information about novel H1N1 virus are incorporated in this supplement plan. The objectives of this plan for an influenza pandemic H1N1 are to: Ensure optimal coordination, decision-making, and communication between national, state, and local levels Detect influenza strains through clinical and virology surveillance of human cases Deliver antiviral drug therapy and prophylaxis and avoid inappropriate use of these agents, which may result in antiviral resistance Provide optimal medical care and maintain essential community services Communicate effectively with the public, health care providers, community leaders and the media The national authorities will provide overall direction, guidance and coordination, while provincial (Regions/Governorates) health affairs departments and the private medical clinics will form the front line with respect to management of ill persons and administration of interventions such as vaccine and antiviral medications and possibly community-level interventions such as isolation and quarantine. Information and guidance provided in this plan will serve as a platform for the development of plans at the regional level. 2.2 Phases of an Influenza Pandemic In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans. The grouping and description of pandemic phases have been revised to make them easier to understand, more precise, and based upon observable phenomena. Phases 1–3 correlate with preparedness, including capacity development and response planning activities, while Phases 4–6 clearly signal the need for response and mitigation efforts. Furthermore, periods after the first pandemic wave are elaborated to facilitate post pandemic recovery activities. The current WHO phase of pandemic alert is 5. In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans. In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat. Ministry of Health, Sultanate of Oman Page 5 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic. Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion. Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way. During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave. Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature. Ministry of Health, Sultanate of Oman Page 6 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required. Phase changes It is important to stress that the phases were not developed as an epidemiological prediction, but to provide guidance to countries on the implementation of activities. While later phases may loosely correlate with increasing levels of pandemic risk, this risk in the first three phases is simply unknown. It is therefore possible to have situations which pose an increased pandemic risk, but do not result in a pandemic. Alternatively, although global influenza surveillance and monitoring systems are much improved, it is also possible that the first outbreaks of a pandemic will not be detected or recognized. For example, if symptoms are mild and not very specific, an influenza virus with pandemic potential may attain relatively widespread circulation before being detected; thus, the global phase may jump from Phase 3 to Phases 5 or 6. If the rapid containment operations are successful; Phase 4 may revert back to Phase 3. When making a change to the global phase, WHO will carefully consider whether the criteria for a new phase have been met. This decision will be based upon all credible information from global surveillance and from other organizations. 2.3 Declaration of Pandemic Ministry of Health, Sultanate of Oman Page 7 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 WHO Director General has declared H1N1 influenza situation as an international public health emergency. On 29th of April 2009 the pandemic influenza alert has been upgraded to phase5 which means the global spread (pandemic) is likely as human-to-human transmission has been established. 3. The Components of Preparedness One of the lessons learned from the SARS outbreaks of 2003 was the importance, in the event of an incident on the scale of an influenza pandemic, of strong international and national leadership and coordination, and a clear national ‘command and control’ structure. The appropriate people at all levels must have authority to make key decisions and act on them, and there must be a clear chain of accountability. The response to an influenza pandemic H1N1 should be on a nationwide basis, and therefore clear demarcation of roles is required between all the stake holders. 3.1 Enhanced Influenza Surveillance Specific objectives of this surveillance activity are to guide global prevention and control activities through the following actions: 1. Detect and confirm cases of H1N1 influenza A virus infection 2. Establish the extent of international spread of H1N1 influenza A virus infection 3. Assist in the early severity assessment of the disease Timely surveillance information will be the key to early identification of an influenza pandemic, and to the development of evidence based interventions at all stages. Oman contributes to internationally coordinated laboratory based influenza virus surveillance, which is co-ordinated by the World Health Organization (EMRO). Monitoring influenza disease activity is important to facilitate resource planning, communication, intervention, and investigation. A high level of vigilance for clusters of cases of respiratory disease provides an early warning mechanism. Influenza is a common condition and has symptoms similar to those of many other viral respiratory infections. Early detection of a new virus therefore requires clinicians as well as laboratory staff to be alert to the possibly unusual, for example respiratory illness in a patient, with a link to areas where a new virus has been already identified, or to a person with a travel history to affected areas/countries. In order to detect cases the existent surveillance mechanisms should be further strengthened at all levels. The sentinel SARI surveillance at Sohar, Ibra and Salalah Hospitals will continue so also the laboratory based influenza surveillance at Barka PC, Amerat HC, Al Khod HC and Salalah PC. The existing surveillance (ILI under the Group 'C') should be further strengthened as follows: Influenza like illnesses (ILI) and LRTI including pneumonia for all age groups should be monitored from all health institutions on a weekly basis. ICD-10 codes for these conditions are J01, J02-03, J04, J10-11, J1218, J20-21 and J40-42. These conditions should be reported for males and females, for inpatient and outpatient by age groups (MoH Monthly Statistical Booklets – for Health Institution and In-patient). Ministry of Health, Sultanate of Oman Page 8 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 These weekly surveillance reports should be sent by all health institutes including private to the office of the Director General or Director of Health Services of the Governorates and Regions. The compiled weekly reports of the Governorates and Regions should be sent to the Department of Communicable Disease Surveillance & Control on every Monday (international week) by e-mail/fax. 3.2 Case detection Case definitions for infections with H1N1 influenza A Virus Suspect Case (Refer Algorithm 1) Acute febrile respiratory illness (Fever > 380 C) with the spectrum of disease from influenza-like illness (ILI) to pneumonia inclusive of severe acute respiratory illness (SARI) with onset... - Within 7 days of close contact with a confirmed case of H1N1 influenza A virus OR - Within 7 days of travel to countries where one or more confirmed case of H1N1 influenza A virus were reported OR - Resides in a community where there were one or more confirmed cases of H1N1 influenza A virus Probable case Suspect case with an influenza test that is positive for influenza A, but is unsubtypable by reagents used to detect seasonal influenza virus infection OR Suspect case who died of an unexplained acute respiratory illness and who is considered to be epidemiologically linked to another probable or confirmed case. Confirmed case Suspect or Probable case with laboratory confirmed H1N1 influenza A virus infection by one or more of the following tests. • Real-time RT-PCR • Viral culture • Four-fold rise in H1N1 influenza A virus specific neutralizing antibodies. 3.3 Case Investigation & Management Health Institute anywhere in Oman that identifies unusual clusters of acute respiratory illness should immediately notify the Regional DGHS. Regional Epidemiologist should investigate using the WHO case summary form (Annexure 4 ) if the epidemiological compatibility is decided under the guidance of Department of Communicable Diseases Surveillance and Control. Definition of cluster A cluster is defined as two or more persons presenting with manifestations of unexplained, Acute respiratory illness with fever >38°C or who died of an unexplained respiratory illness and those are detected with onset of illness within a period of 14 days and in the same geographical area and/or are epidemiologically linked. Ministry of Health, Sultanate of Oman Page 9 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Triggers/signals for the investigation of possible cases of H1N1 influenza A virus are • Clusters of cases of unexplained ILI or acute lower respiratory disease • Severe, unexplained respiratory illness occurring in one or more health care worker(s) who provide care for patients with respiratory disease • Changes in the epidemiology of mortality associated with the occurrence of ILI or lower respiratory tract illness, an increase in deaths observed from respiratory illness or an increase in the occurrence of severe respiratory disease in previously healthy adults or adolescents • Persistent changes noted in the treatment response or outcome of severe lower respiratory illness. Close contact: having cared for, lived with, or had direct contact with respiratory secretions or body fluids of a probable or confirmed case of H1N1 influenza A virus. For contact surveillance refer Algorithm 2. Epidemiological risk factors that should raise suspicion of H1N1 influenza A virus include: • Close contact to a confirmed case of H1N1 influenza A virus infection while the case was ill • Recent travel to an area where there are confirmed cases of H1N1 influenza A virus All suspected cases from any institute of the region should be transferred, investigated, admitted and managed at designated isolation facility (usually regional hospital) ONLY. For case referrals refer Algorithm 3. For receiving referred case at designated isolation facility please follow Algorithm 4. For any H1N1 influenza A virus case please refer to Algorithm 5. 3.4 Laboratory Surveillance Laboratories are essential to confirm diagnosis, elucidation of characteristics of the virus, and to overall surveillance. The capability and capacity of the Central Public Health Laboratory will soon be upgraded to identify novel influenza strains. A proportion of isolates, including all unusual ones from the Oman, would be referred to the International Influenza Reference Laboratory, at WHO-EMR, Cairo for detailed identification. Details of the sample collection, storage and transport are included in the algorithm 6 of this document. 3.5. Infection control It is critical that health-care workers use appropriate infection control precautions when caring for patients with influenza-like symptoms, particularly in areas affected by outbreaks of A(H1N1) influenza, in order to minimize the possibility of transmission among themselves, to other health-care workers, patients and visitors. The WHO infection prevention and control guidance is attached in annexure 5. Ensure the availability of personal protective equipments (PPE) and laboratory supplies at the designated locations. All these should be accessible round the clock to the health care staff. 3.6. Non-pharmaceutical public health interventions The main aim of non-pharmaceutical intervention is to prevent the spread of infection. Each individual is expected to practice following general preventive measures for influenza: Avoid close contact with people who appear unwell and have fever and cough. Ministry of Health, Sultanate of Oman P a g e 10 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Wash your hands with soap and water thoroughly and often. Practice good health habits including adequate sleep, eating nutritious food, and keeping physically active. The persons who are not well should be cared for at home unless the person is seriously ill which require hospital admission keeping following guidelines in mind Separate the ill person from others, at least 1 meter in distance from others. Cover your mouth and nose when caring for the ill person. Either commercial or homemade materials are fine, as long as they are disposed of or cleaned properly after use. Wash your hands with soap and water thoroughly after each contact with the ill person. Improve the air flow where the ill person stays. Use doors and windows to take advantage of breezes. Keep the environment clean with readily available household cleaning agents. The person who is unwell having high fever, cough or sore throat is expected to follow following steps: Stay at home and keep away from work, school or crowds. Rest and take plenty of fluids. Cover your mouth and nose with disposable tissues when coughing and sneezing, and dispose of the used tissues properly. Wash your hands with soap and water often and thoroughly, especially after coughing or sneezing. Inform family and friends about your illness and try to avoid contact with people. If a person thinks that he requires medical attention then following is expected from him Contact by telephone your primary health care physician or healthcare provider near your home before travelling to a health facility, and report your symptoms. Explain why you think you have influenza A (H1N1) (for example, if you have recently travelled to a country where there is an outbreak in humans). Follow the advice given to you. If it is not possible to contact your healthcare provider in advance, communicate your suspicion of infection as soon as you arrive at the facility. Cover your nose and mouth during travel. 3.7 Pharmaceutical Interventions VACCINE Currently no vaccine is available for this novel H1N1 influenza virus. It is widely believed that it will require at least few months for vaccine to be developed and made available for general use. No evidence is available to support the use of conventional seasonal influenza vaccine to prevent novel H1N1 influenza virus responsible for causing pandemic. Ministry of Health, Sultanate of Oman P a g e 11 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 ANTIVIRAL AGENTS: Antiviral agents active against influenza are the only major medical countermeasure available. However, there are limitations to their use, their effectiveness in a pandemic situation has yet to be tested and antiviral resistance may be – or become – a problem. Oman has stockpiling the antiviral drugs required for an influenza pandemic. The Ministry of Health has procured 10,000 courses (10 tablets per course) for either prophylactic or therapeutic use available for the Strategic National Stockpile (SNS). As with other resources, given the possible scale of a current pandemic, the drugs will need to be given in the most effective way on operational, clinical and cost-effectiveness grounds taking into account the stocks available. Two drugs of the newer class of neuraminidase inhibitors (Zanamivir [Relenza] and Oseltamivir [Tamiflu]) are effective against Novel influenza H1N1 virus as per the WHO reports. 3.8 Information Dissemination The overall communications strategy covers the gathering, collation and dissemination of information for a variety of audiences, which can be divided broadly into: 3.8.1 Strategic communications Two way strategic communications will involve the MoH, and all other governmental agencies and organisations involved in the response, including the private health establishments and the international agencies. The Government briefings and public information will be controlled and monitored by Director, Communicable diseases surveillance and Control under the supervision of higher officials of the ministry of health. 3.8.2 Professional information and guidance Regular information bulletins to the health professionals will be issued by Director, Communicable diseases surveillance and Control as required, and as urgency indicates, via already established routes. 3.8.3 Communications with the public and the media Media communications will be co-ordinated initially by the MoH, PRO office. They will also coordinate cross government communication and depending on the scale will also co-ordinate the media and public communication for the other Government Departments involved. At present only national authorities are designated as official spokesperson of the government for this pandemic. Ministry of Health, Sultanate of Oman P a g e 12 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 4. List of Annexure Annexure 1 National Task Force (MoH) Annexure 2 Inter-Ministerial Committee on AI Annexure 3 National Rapid Response Team Annexure 4 Case Notification Form Annexure 5 Infection Control Guidelines (General) Annexure 6 List of Algorithms Annexure 1 NATIONAL TASK FORCE (MINISTRY OF HEALTH) National Spokespersons for Ministry of Health HE Dr. Ali Jaffer M. Suleiman, DGHA Dr. Salah Al Awaidy, Director, DCDSC Provincial Spokesperson (Governorates & Regions) Director/Director General of Health Services Name Designation Ministry of Health, Sultanate of Oman Office Fax Mobile P a g e 13 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Ministry of Health HQ HE Dr. Ali Jaffer M. Suleiman (Chairman) Director General of Health Affairs 24600808 24696099 99335681 Ph. Nusaiba Habib Mohd. Director General of Medical Supplies 24699973 24601593 99240990 Dr. Salah Al Awaidy (Focal Point) Director, Communicable Disease Surveillance & Control 24601921 24601832 99315063 Dr. Suleiman Al Busaidy Director, Central Public Health Laboratory 24705943 24793699 99426288 Ms. Sabah Al Bahlani Director, Health Education & Information 24562609 WHO Representative, Oman 24600989 24602637 99332792 WHO Country Office-Oman Dr. Jihan Tawilah MoH and Sultan Qaboos University Hospital Dr. Mohammed Al Balushi Director, Al Nahda Hospital 24835746 24831578 Dr. Mohammed Al Hosni Head of Child Health, Royal Hospital 24599552 24599173 Dr. Yaqub Al Mahrooqi Chest Specialist, Royal Hospital Dr. Abdullah Balkhair Infectious Diseases, SQUH 24413355 24413419 Ms. Farida Head of Nursing, Al Nahda Hospital 24837511 Ext. 1112 24837522 99474441 99427669 99293797 Department of Communicable Disease Surveillance and Control, MoH HQ (Field Staff) Dr. Shyam Bawikar Advisor Epidemiologist Dr. Idris Al Abaidani Surveillance Section Head Mr. Salem Al Mahrooqi National Surveillance Supervisor 99029195 Mr. Bader Al Rawahi National EPI Supervisor 99430689 99368327 24601921, 24607524 95208040 24601832 Annexure 2 INTER-MINISTERIAL COMMITTEE ON H1N1 INFLUENZA, SULTANATE OF OMAN Name Designation Office Fax Mobile Mr. Ali Amer Al Kiyumi Nature Conservation, Ministry of Regional Municipalities, Environment 24602285 24602283 99444808 Ministry of Health, Sultanate of Oman P a g e 14 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s and Water Resources DG of Health Affairs, Ministry of Regional Municipalities, Environment and Water Resources P l an : 20 09 24692564 24692547 99389883 Director General of Planning, Ministry of Interior 24707226 24790599 99420909 Director General of Commerce & Industry 24774100 24812030 99418909 Mr. Nasr Ali Al Wahaibi Director General of Animal Wealth 2469391 24694465 99382717 Dr. Salah Thabit Al Awaidy Director, Communicable Disease Surveillance and Control 24601921 24601832 99315063 Mr. Mubarak Khamis Al Araimi Asst. Director General of Information and Press Affairs 24697677 24521034 24602928 Mr. Mussallam Salem Al Jenebi Asst. Director General of Customs, Royal Oman Police 24521204 24521204 99319131 Dr. Sultan Eissa Al Ismaili Asst. Director General of Animal Wealth & Veterinary Services 24698512 24694465 99380316 Dr. Ali Abdullah Al Sahmi Head of Veterinary Services (Focal Point) 24696300 Ext. 1510 24694465 99371816 Mr. Said Darwesh Al Alawi Mr. Ali Said Al Hammadi Mr. Mudriq Kathiem Al Moosawi Annexure 3 RAPID RESPONSE TEAM In the event of suspected case notification of HPAI in Oman the rapid response team will initiate an epidemiological field case investigation to confirm the diagnosis and necessary interventions within 24-48 hours. The National Rapid Response Team for Avian Influenza Name Dr. Salah Al Awaidy TEAM LEADER Designation Director, Communicable Disease Surveillance & Control (DCDSC) Ministry of Health, Sultanate of Oman Office 24601921 Fax 24601832 Mobile 99315063 P a g e 15 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Dr. Suleiman Al Busaidy Director, CPHL 24705943 24793699 99426288 Dr. Shyam Bawikar Advisor Epidemiologist, DCDSC 24601921 24601832 99368327 Dr. Idris Al Abaidani Section I/c, Surveillance, DCDSC 24607524 Mr. Basim Zayed Coordinator, Infection control, DCDSC 99534234 Mr. Salem Al Mahrooqi Surveillance Supervisor, DCDSC 99029195 Dr. Ali Al Sahmi Focal Point for AI: 24696300 Ext. 1510 Ministry of Agriculture & Fisheries 95224261 24694465 99371816 Support Team Dr. Mohammed Al Hosni Head of Paediatrics, Royal Hospital Dr. Saif Al Abri Head of Medicine, Royal Hospital Dr. Yaqoob Al Mahrooqi Chest disease specialist, Royal Hospital 99427669 Ph. Anisa Rasool Medical stores in-charge, MoH 99476978 Mr. Mohammed Al Farsi Logistician &Transport, DGHA 99360541 99474441 Regional/Provincial Rapid Response Team Name and Designation Office Fax Mobile Director/Superintendent of Health Affairs TEAM LEADER Regional Epidemiologist OR Communicable Disease Focal Point Health inspector from the affected Wilayat Support Team Executive Director, Regional Hospital Regional Laboratory in-charge Infection control staff nurse, Regional Hospital HOD, Medicine, Regional Hospital HOD, Paediatrics, Regional Hospital Director of Administration, DGHS, Logistic support Veterinary Doctor - Ministry of Agriculture and Fisheries Ministry of Health, Sultanate of Oman P a g e 16 N atio n al Pa n d e mi c I n f lu en za Annexure 4 Ministry of Health, Sultanate of Oman P rep ar ed n e s s P l an : 20 09 Hospital sticker P a g e 17 N atio n al Pa n d e mi c I n f lu en za Ministry of Health, Sultanate of Oman P rep ar ed n e s s P l an : 20 09 P a g e 18 N atio n al Pa n d e mi c I n f lu en za Ministry of Health, Sultanate of Oman P rep ar ed n e s s P l an : 20 09 P a g e 19 N atio n al Pa n d e mi c I n f lu en za Ministry of Health, Sultanate of Oman P rep ar ed n e s s P l an : 20 09 P a g e 20 N atio n al Pa n d e mi c I n f lu en za Ministry of Health, Sultanate of Oman P rep ar ed n e s s P l an : 20 09 P a g e 21 N atio n al Pa n d e mi c I n f lu en za Ministry of Health, Sultanate of Oman P rep ar ed n e s s P l an : 20 09 P a g e 22 N atio n al Pa n d e mi c I n f lu en za Ministry of Health, Sultanate of Oman P rep ar ed n e s s P l an : 20 09 P a g e 23 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Annexure 5 Infection prevention and control in health care in providing care for confirmed or suspected A(H1N1) swine influenza patients Interim guidance provided by WHO on 29 April 2009 Background The current situation regarding the outbreaks of A(H1N1) swine influenza is evolving rapidly, and countries from different regions of the globe have been affected. Based on epidemiological data, human-to-human transmission has been demonstrated along with the ability of the virus to cause community-level outbreaks which together suggest the possibility of sustained human-to-human transmission. Health-care facilities now face the challenge of providing care for patients infected with A(H1N1) swine influenza. It is critical that health-care workers use appropriate infection control precautions when caring for patients with influenza-like symptoms, particularly in areas affected by outbreaks of A(H1N1) swine influenza, in order to minimize the possibility of transmission among themselves, to other health-care workers, patients and visitors. As at 29 April, human-to-human transmission of A(H1N1) swine influenza virus appears to be mainly through droplets. Therefore, the infection control precautions for patients with suspected or confirmed A(H1N1) swine influenza and those with influenza-like symptoms should prioritize the control of the spread of respiratory droplets. The precautions for influenza virus with sustained human-to-human transmission (e.g. pandemic-prone influenza) are described in detail in the document “Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care WHO Interim Guidelines” 1. This guidance may change as new information becomes available. Fundamentals of infection prevention strategies 1. Administrative controls are key components, including: implementation of Standard and Droplet Precautions; avoid crowding, promote distance between patients (≥ 1 m); patient triage for early detection, patient placement and reporting; organization of services; policies on rational use of available supplies; policies on patient procedures; strengthening of infection control infrastructure. 2. Environmental/engineering controls, such as basic health-care facility infrastructure 2 , adequate ventilation, proper patient placement, and adequate environmental cleaning can help reduce the spread of some respiratory pathogens during health care. 3. Rational use of available personal protective equipment (PPE) and appropriate hand hygiene. at http://www.who.int/csr/resources/publications/WHO_CD_EPR_2007_6/en/index.html more details, see Essential environmental health standards in health care. Geneva, World Health Organization, 2008. Available at http://whqlibdoc.who.int/publications/2008/9789241547239_eng.pdf 1 Available 2 For CRITICAL MEASURES: � Avoid crowding patients together, promote distance between patients � Protect mucosa of mouth and nose Ministry of Health, Sultanate of Oman P a g e 24 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 � Perform hand hygiene 2 Summary Precautions For staff providing care to patients with suspected or confirmed A(H1N1) swine influenza infection and for patients with influenza-like symptoms. Standard3 and Droplet Precautions4 should be strengthened when working in direct contact with suspected or confirmed A(H1N1) swine influenza infected patients. Key elements: � use a medical or surgical mask � emphasize hand hygiene and provide hand hygiene facilities and supplies. As per Standard Precautions2, if there is a risk of splashes onto face: � use face protection! Use either (1) a medical or surgical mask and eye-visor or goggles, or (2) a face shield and, � use a gown and clean gloves. � DO NOT FORGET HAND HYGIENE AFTER PPE REMOVAL! Aerosol generating procedures (e.g. aspiration of respiratory tract, intubation, resuscitation, bronchoscopy, autopsy) are associated with increased risk of infection transmission, and the infection control precautions should include using: � particulate respirator (e.g. EU FFP2, US NIOSH-certified N95); � eye protection (i.e. goggles); � a clean, non-sterile, long-sleeved gown; � gloves (some of these procedures require sterile gloves). KEY ELEMENTS FOR HEALTH CARE 1. Basic infection control recommendations for all health-care facilities Standard and Droplet Precautions when caring for a patient with an acute, febrile, respiratory illness. 2. Respiratory hygiene/cough etiquette Health-care workers, patients and family members should cover mouth and nose with a tissue when coughing and perform hand hygiene afterwards. 3. Infection control precautions for suspected and confirmed A(H1N1) swine influenza infection Place patient in adequately-ventilated room. If single rooms are not available, cohort patients in wards keeping at least 1 meter distance between beds. Standard, and Droplet Precautions for all persons entering the isolation room. 4. Triage, early recognition and reporting of A(H1N1) swine influenza infection. Consider A(H1N1) swine influenza infection in patients with acute, febrile, respiratory illness who have been in an affected region within the one week prior to symptom onset and who have had exposure to an A(H1N1) swine influenza infected patient or animal. 3 Standard Precautions: basic precautions designed to minimize direct unprotected exposure to potentially infected blood, body fluids or secretions (www.who.int/csr/resources/publications/standardprecautions/en/index.html) 4 Droplet Precautions: health-care workers to wear medical mask gowns and clean gloves when providing direct care. Placement of patients with same diagnosis in designated areas may facilitate the application of infection control precautions 3 5. Additional measures to reduce nosocomial A(H1N1) swine influenza virus transmission Ministry of Health, Sultanate of Oman P a g e 25 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Limit numbers of health-care workers/family members/visitors exposed to the A(H1N1) swine influenza patient. 6. Specimen collection/transport/handling within health-care facilities Use Standard, and Droplet Precautions for specimen collection. Use Standard Precautions for specimen transport to the laboratory. Health-care facility laboratories should follow good biosafety practices. 7. Family member/visitor recommendations Family members/visitors should be limited to those essential for patient support and should use the same infection control precautions as health-care workers. 8. Patient transport within health-care facilities Suspect or confirmed A(H1N1) swine influenza patients should wear a medical/surgical mask. 9. Pre-hospital care Infection control precautions are similar to those practiced during hospital care for all involved in the care of suspected A(H1N1) swine influenza patients. (e.g. transportation to hospital). 10. Occupational health Monitor health of health-care workers exposed to A(H1N1) swine influenza patients. Antiviral prophylaxis should follow local policy. Health-care workers with symptoms should stay at home. 11. Waste disposal Treat any waste that could be contaminated with A(H1N1) swine influenza virus as infectious clinical waste, e.g. used masks. 12. Dishes/eating utensils Wash using routine procedures with water and detergent. Use non-sterile rubber gloves. 13. Linen and laundry Wash with routine procedures, water and detergent; avoid shaking linen/laundry during handling before washing. Use non-sterile rubber gloves. 14. Environmental cleaning and disinfection Clean soiled and/or frequently touched surfaces regularly with a disinfectant. e.g. door handles. 15. Patient care equipment Dedicate separate equipment to A(H1N1) swine influenza patients. If not possible, clean and disinfect before reuse in another patient. 16. Duration of A(H1N1) swine influenza infection control precautions For the duration of symptoms. 17. Patient discharge If the A(H1N1) swine influenza patient is discharged while still infectious (i.e. discharged within the period of infection control precautions: see 16 above), instruct family members on appropriate infection control precautions in the home. 18. Prioritization of PPE when supplies are limited Medical/surgical mask for the care of all A(H1N1) swine influenza patients and hand hygiene are priorities. Ministry of Health, Sultanate of Oman P a g e 26 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 4 19. Health-care facility engineering controls If available, A(H1N1) swine influenza patients must be placed in adequately-ventilated single rooms. Aerosol-generating procedures should be performed in well ventilated spaces. 20. Mortuary care Mortuary staff and the burial team should apply Standard Precautions i.e. perform proper hand hygiene and use appropriate PPE (use of gown, gloves, facial protection if there is a risk of splashes from patient's body fluids/secretions onto staff member's body or face). 21. Health-care facility managerial activities Education, training, and risk communication. Adequate staffing and supplies. 22. Health care in the community Limit contact with the ill person as much as possible. If close contact is unavoidable, use the best available protection against respiratory droplets and perform hand hygiene. Annexure 6 List of Algorithms Ministry of Health, Sultanate of Oman P a g e 27 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s Algorithm # 1 Case Action guidance Algorithm # 2 Contact Surveillance Algorithm # 3 Case Transfer Protocol Algorithm # 4 Case Arrival at the Referral Hospital Algorithm # 5 Case Management Algorithm # 6 Laboratory Investigation Ministry of Health, Sultanate of Oman P l an : 20 09 P a g e 28 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 1. H1N1 Influenza A Case Action Protocol … Region/Governorate April 2009 Suspect human case of H1N1 Influenza A virus INITIAL CONTACT All Health Care Institutions (Private or Government) Primary/Secondary/Tertiary Care Suspect Case definition Acute febrile respiratory illness (Fever > 380 C) with the spectrum of disease from influenza-like illness (ILI) to pneumonia inclusive of severe acute respiratory illness (SARI) with onset... - Within 7 days of close contact with a confirmed case of H1N1 influenza A virus OR - Within 7 days of travel to countries where one or more confirmed case of H1N1 influenza A virus were reported OR - Resides in a community where there were one or more confirmed cases of H1N1 influenza A virus If ‘NO’ If ‘YES’ Inform DGHS & DCDSC immediately No further action Director/Superintendent of Health Affairs (GSM ….) Regional Epidemiologist/Focal Point (GSM …) Consult for Epidemiological compatibility Dr. Salah Al Awaidy (GSM 99315063) Dr. Idris Al Abaidani (GSM 95224261) Dr. Shyam Bawikar (GSM 99368327) Compatible Case Infection control procedures during initial contact (If needed consult Dr. Bassim Zayed GSM 99534234) Place surgical mask on the patient HCWs should also use surgical mask Place the patient away from other patients until referral Inform Executive Director of the …. Hospital Dr. ... (GSM ...) for admission and organize ambulance to transfer the case Follow ALGORITHM #3 for case transfer protocol Follow ALGORITHM #5 for Clinical Management Follow ALGORITHM #6 for Laboratory Investigations Consult: Dr. Suleiman Al Busaidy (GSM 99426288) Dr. Said Al Baqlani (GSM 99248132) Ministry of Health, Sultanate of Oman Consult: Adult cases Dr. ... (GSM ...) OR Dr. ... (GSM ...) Paediatric Cases Dr. ... (GSM ...) OR Dr. … (GSM…) P a g e 29 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Algorithm # 2. Contact Surveillance April 2009 CONTACTS of suspect case of H1N1 Influenza A virus Investigation Team Director of Health Affairs, Epidemiologist & Health Inspector from DGHS Team Coordinator: Wilayat Health Superintendent Follow-up of cases: Wilayat Health Inspector PPE should be worn during interview (mask, gloves, gown) To enlist all information of all close contacts (address, movement & contact telephone, etc) Ask & check for fever & severe respiratory symptoms daily for 7 days Asymptomatic Contacts House quarantine for 7 days from the day of close contact with the suspect case Daily visit/telephonic contact by the doctor from nearby health centre/hospital for development and progress of fever &/or respiratory symptoms Contact Advisory: Restrict movements of contact (self imposed) Should not report on duty (quarantine leave) If fever develops call Focal Point in the DGHS Dr. ... (GSM ...) OR Dr. ... (GSM ...) Provide information brochure Asymptomatic for 7 days No further action If the contact develops fever & respiratory symptoms Advise: Not to visit any clinic Government or private Minimize contact with family & restrict movements Call doctor of the nearby health centre/hospital for his/her follow-up Ministry of Health, Sultanate of Oman If fever or respiratory signs & symptoms present amongst contacts Follow-up Doctor should... Inform & Consult Focal Points In DGHS Dr. ... (GSM ) OR Dr. ... (GSM ) Inform DCDSC Dr. Salah (GSM 99315063), Dr. Shyam (GSM 99368327) Dr. Idris (GSM 95224261) Follow-up Doctor should... inform & consult to assess clinical compatibility Adult cases: Dr. ... (GSM ) OR Dr. ... (GSM ) Paediatric Cases: Dr. ... (GSM ) OR Dr. ... (GSM ) Follow-up Doctor should... Inform the Executive Director of the ….Hospital for Admission P a g e 30 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Algorithm # 3. Case Transfer to Referral Hospital April 2009 Suspect Case of H1N1 Influenza A virus detected in Primary Health Care institutions, in Private Clinics/Hospitals OR Royal Hospital/SQ University Hospital (Epidemiologically & Clinically Compatible) Health Care Worker Suspect case Doctor/health inspector should wear PPE - (N95 respirator mask, gown, gloves) immediately Do not carry out any procedures on the case and avoid unnecessary contact Airport duty staff should not accompany the case to the hospital Isolate case in a room He/she should wear a surgical mask Do not allow contact with others (relatives) Patient's documents/ belongings should be collected by the health inspector To inform & Consult Focal points in DCDSC (Algorithm # 1) AND the Directorate Dr. ... (GSM ...), Dr... (GSM ...) Contact Management Refer to Algorithm # 2 Instruction for transfer of case Organize ambulance with a staff nurse escort to transfer the case immediately The ambulance staff should use PPE Quarantine Hospital for HPAI in … Inform Executive Director, ... Hospital, … Dr. ... (GSM ...) for Admission to ... Hospital Ministry of Health, Sultanate of Oman P a g e 31 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Algorithm #4. Case Arrival at Referral Hospital April 2009 Under Supervision of the Executive Director of the Hospital Suspect case of H1N1 Influenza A virus Arrival at ... Hospital Ambulatory Non-ambulatory Case received & escorted by nurse to Triage Room on wheel chair Nurse should wear PPE Case received & escorted by two nurses to Triage Room on stretcher Nurse should wear PPE The Case is transferred to the quarantine/isolation ward immediately through the shortest possible route DISINFECTION PROCEDURES (Applicable to ambulance, stretcher, wheel chair, or any other medical/non-medical equipment used for the case during transfer) Equipment used should be cleaned & disinfected according to manufacturer’s instructions Clean all contaminated surfaces by using Sodium hypochlorite solution prepared according to manufacturer’s recommendations OR consult designated Infection Control Nurse in the referral hospital Ministry of Health, Sultanate of Oman P a g e 32 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Algorithm #5. H1N1 Influenza A virus Case Management April 2009 Suspect case of H1N1 Influenza A virus arrives at ...... Hospital Executive Director of the Hospital Dr. ... to inform... Consultants/Specialists Adult Cases: Dr. ... (GSM ) OR Dr. ... (GSM ) Internal Medicine/ Paediatrics Doctor on duty Paediatric Cases: Dr. ... (GSM ) OR Dr. ... (GSM ) Nursing duty Organization (refer duty roster) To call technician on duty CxR (full HPAI gear) Examine case in full HPAI gear Check vitals & Oxygen saturation Examine & confirm the child/ adult in isolation room (in full HPAI gear) Counsel family Manage on case-to-case basis Stable Condition Nursing Supervisor Pager: Sample collection by doctor/nurse Deterioration Inform Anesthesiologist on Call Laboratory Investigations Recommended* anti-viral Treatment Follow Algorithm #6 Epidemiologist To assess the need of quarantine of family members & other contacts * As per the national policy & guidelines Ministry of Health, Sultanate of Oman P a g e 33 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Algorithm #6. Laboratory Investigation of H1N1 Influenza A virus April 2009 On admission of a suspect case of H1N1 Influenza A virus in the hospital focal point should inform... Dr. Suleiman (GSM 99426288) OR Dr. Said (GSM 99248132) from CPHL, Muscat General investigations for Case Management Full PPE gear should be worn before taking respiratory samples from suspect case ... Hospital Laboratory Specific investigations for Diagnosis Central Public Health Laboratory Specimens to be collected immediately Doctor/Nurse on duty to collect blood samples by attending Doctor in ... Hospital, ... Nasopharyngeal swab Oropharyngeal swab Collect samples in VTM, refrigerate immediately (DO NOT FREEZE) Specimens to be collected during illness Haematology 5 ml Blood Clinical Chemistry 5 ml Blood by Chest specialist or Senior Physician Bronchoalveolar lavage Tracheal aspirate Collect samples in VTM, refrigerate immediately (DO NOT FREEZE) Preserve tissue samples from the deceased in VTM & formalin Routine Investigations on Arrival CBC, LFT, SB, UE, CK, LDH Electrolytes, Blood gases Sputum Gram stain & culture Blood culture Inform CPHL before sending samples Check-list (Must accompany samples sent to CPHL) Note For diagnostic tests collection bottles, swabs & VTM will be provided by CPHL & will be coordinated by... Dr. Suleiman (GSM 99426288) OR Dr. Said (GSM 99248132) Ministry of Health, Sultanate of Oman Name of the person taking sample (s) Date/time sample (s) taken Type of sample (s) Storage conditions (temp.) Date/time of shipment to CPHL Whether duplicate samples collected? Whether ‘triple’ packaging done? Whether communicated for sample arrival? Whether other samples collected for case management? If yes then provide results P a g e 34 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s Ministry of Health P l an : 20 09 Sultanate of Oman. PANDEMIC INFLUENZA H1N1 PREPAREDNESS REGIONAL ACTION PLAN MUSANDUM GOVERNORATE MAY 2009 DIRECTORATE OF HEALTH AFFAIRS & DHS MUSANDAM GOVERNORATE Ministry of Health, Sultanate of Oman P a g e 35 20 09 P l an : P rep ar ed n e s s I n f lu en za Pa n d e mi c N atio n al محضر اجتماع لجنه الترصد الوبائي بمحافظه مسندم بتاريخ 9002/5/3م تك عقد اجتماع لجنه الترصد الوبائي بمحافظه مسندم في صباح يوم األحد الموافق9002/5/3:م برئاسه الفاضل /ناصر بن سيف بن سالم السعدي – مدير دائرة الخدمات الصحيه وحضور أعضاء اللجنه الممثلين لكافه القطاعات والدوائر الحكوميه وبدء االجتماع بالترحيب بالحضور من قبل الفاضل/مدير الدائرة والتنويه عن أهميه هذا األجتماع وسبب انعقادة في هذه الفتره لمناقشه آخر المستجدات بخصوص أنفلونزا الخنازير. بعد ذلك قامت الفاضله/رئيسه مركز الخدمات الصحيه بواليه بخاء د.مريم بنت صالح بن صوالح الشحي بإلقاء محاضره عن مرض أنفلونزا الخنازير وتضمن هذا العرض تعريف بالمرض ومسبباته وأعراضه وكيفيه الوقاية منه والعالج المستخدم للحاالت المصابة وآخر نسب اإلصابه بجميع بلدان العالم. وبعد االنتهاء من العرض دارت مناقشه حول الموضوع حيث تم االستفسار من بعض األعضاء عن أعراض هذا المرض ومايمكن إتباعه من إجراءات للوقايه منه. وبعدها انهى االجتماع بشكر الفاضل /مدير الدائره لكافه الحضور على المشاركه الفعاله وحضر اإلجتماع اعضاء لجنه الترصد الوبائي وكان عددهم 55وهم: P a g e 36 Ministry of Health, Sultanate of Oman 20 09 P l an : P rep ar ed n e s s I n f lu en za Pa n d e mi c N atio n al كشف حضور اعضاء لجنه الترصد الوبائي االسم د .عدنان بن أحمد الصغر الشحي عبدهللا أحمد علي الشحي خالد بن عبدالرزاق البدري سيف بن حسن الشحي عبدهللا بن حسن بن علي الكمزاري مناره داوود الكمزاري حسين بن علي البلوشي ابراهيم أحمد محمد الشحي علي عبدهللا عبدهللا الشحي داوود بن محمد بن سليمان الشحي حليمه صالح سيف الكمزاري زيد محمد زيد الشحي علي سبيت المدحاني د/مريم صالح الشحي د/زينب محمد محمود P a g e 37 الوظيفه أخصائي صحيه بيطريه مركز الزراعه منسق كاتب رئيس قسم عضوه إداريه بالجمعيه ضابط مركز خصب مشرف خدمات صحيه اخصائي توعيه صحيه عضوه بالجمعيه مشرف خدمات صحيه خصب مشرف خدمات صحيه مدحاء رئيس مركز الخدمات الصحيه بخاء Ministry of Health, Sultanate of Oman N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 SWINE INFLUENZA-MEETING MINUTES On 3/5/09 a meeting was conducted at DHSM conference room under the chairman ship of Dr Mohd Mohd Amro Ghobashy,Supdt of Health affairs. Following Health care providers of the region attended the meeting -Medical officer incharge of all Hospitals&H/C except Leema H/C. -Infection Control incharge of all Hospitals&H/Cs except Leema H/C. -Dr Ashraf El Sayed,HOD (Paed),Khasab Hospital -Dr Zakaria Ibrahim,HOD (Med),Khasab Hospital -Dr Ashraf Jamal,Infection control doctor i/c,Khasb Hospital -Mr Abdullah Juma ,infection control nurse i/c,Musandum region -MCH Co-ordinator -Supdt of pharmacy&medical stores -Acting head of Nursing -Regional Vaccine store incharge -Dr D.P.Shah,doctor incharge ,Khasab private clinic Ministry of Health, Sultanate of Oman P a g e 38 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Supdt of Health affairs welcomed all for the meeting and following points discussed. -Swine influenza H1N1 is now of global concern.Since its outbreak is alarming,we as health care providers of Oman too to be prepared well enough,even though present situationin Oman is safe. -Global preparedness and situation updates were informed by Dr Ghobashy. -WHO recommendations and reports were shown on slides during meeting. -A Lecture is made to all staffs about swine influenza on 30/4/09 by Supdt of Health affairs in the regional lab symposium. -All Hospitals and private clinics must give awareness to all staffs and enough PPE to be made available -Regional Hospital is well equipped with an isolation ward and anti viral drugs -All Hospitals and Health centers can refer the cases to regional Hospital as per the protocol. -Dibba Hospital can receive from patients from Madha H/C and manage the case there itself since they have the facility. -Even Dibba Hospital can refer cases to Regional Hospital. -All Hospital must follow the swine influenza A(H1N1) case Action protocol of the Region/Governorate.A copy of the same to be available in each clinic. -Expressed thanks to Dr.Ahmed madhani,M.O incharge Madha H/C. Ministry of Health, Sultanate of Oman P a g e 39 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 -Dr Mariam asked to send E-mail for her the updated Algorithm -Weekly ILI report to be send to DHSM from all health institutions as it is an on going programme in Musandum region since last 3 yrs. -All health institutions must send the feed back of their preparedness on swine influenza management and the name of the staff responsible,based on Avian Influenza preparedness of Musandum Governorate. -Influenza A H1N1 update Mo.12 distributed to all members during the meeting. -Infection control protocol in case of acute Respiratory diseases to be distributed to all clinics. -There was a meeting with all Epidemic Preparedness Team on 3/5/09 at 11.30am and also Arabic lecture delivered about the same by Supdt.of Health Affairs. -No other points discussed. -Meeting concluded at 11.00 hrs. DHSM CONTD… Ministry of Health, Sultanate of Oman P a g e 40 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 WORKSHOPS CONDUCTED ON SWINE INFLUENZA HINI CATOGERIES 30/4/09 17/5/09 STAFF NURSE 31 36 SPECIALISTS 12 03 M.O 7 9 LABORATORY 7 13 PHARMACY 1 DIETITAN 1 DENTISTS 1 OTHERS 2(IT) Ministry of Health, Sultanate of Oman P a g e 41 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 KHASAB HOSPITAL Preparation for manangement of swine influenza A,Meeting was conducted at MOIC Office on 1/5/09 at 12.10 pm.The following members were present. 1.Dr Rakesh Sharma,Actg MOIC 2.Mr Ahmed Darwish.A.O 3.Dr Omaima A Wehab,MOIC Public Health 4.Dr Zakariya Boghdady,HOD (Med) 5.Dr Arshad Jamal,HOD(Surg) 6.Dr Ashraf El Gazar,HOD(Paed) 7.Mrs Amal Hassan,Nursing supervisor 8.Mrs Shaikh Al Kamali,MRO 9.Mr Bader Darwish,I/C Pharmacy&Medical store 10.Dr Wael Lotfi,pathologist The minutes of the meeting are as follows Dr Sharma Actg MOIC after welcoming participants gave a briefing on swine influenza situations as an International public health emergency and need for health care team to be ready. Ministry of Health, Sultanate of Oman P a g e 42 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 He delegated the responsibilities as follows 1.Dr Ashraf El Gazar HOD(Paed) will be responsible to check WHO website on (http.WWW.who.int) on computer twice a day in addition to being I/C Communicable disease&Paed cases. 2.Mr Haris Biomedical technician should ensure all ecquipments such as ventilators and defibrillator located in the treatment room of Isolation ward arew fully functional. 3.MOIC Public Health should make a team for surveillance in community and Mr Ali Khatab to initiate necessary steps if suspected/confirm cases come to notice. 4.Dr Wael Lotif is responsible for investigations of all cases of ILI and LRTI including pneumonia for all age groups.Weekly reports should be sent to the supdt of health affairs 5.Dr Arshad Jamal HOD(surg) and Mr Abdullah Juma will be responsible for Infection control in Hospital and Polyclinic including procurement of necessary materials. 6.Mrs Shaikha and Mr Khalid are responsible for inpatient/outpatient statistics and reporting of the same. 7.Dr Zakaria HOD (Medicine) is responsible for training all GPs and Staff Nurses regarding swine influenza and responsible for preparing detailed protocol for swine influenza management in addition to management of adult cases. 8.Mr Bader is responsible to ensure that all the medications and equipments stocks are updated. 9.Mrs Amal is responsible to keep ready the Swine influenza Isolation ward to receive any cases and prepare duty roster Ministry of Health, Sultanate of Oman P a g e 43 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 for Nursing staffs and Supervisor staff for smooth functioning of Isolation ward. B,As of now the Isolation ward including treatment room with all items including ventilator,defibrillator,oxygen cylinder,IV lines.disposibles and medications is filly ready in addition to two isolation rooms for patients which can be increased to three as and when need be. C,990 tablets of TAMIFLU 75 mg are available in medical store. D,Nursing Supervisor Mrs Amal has under taken detailed briefing of Nursing staff in above context.Copy of her report is attached here with. E,WHO website is being checked on daily basis by Dr Ashraf El Gazar and latest updated information as and when available will be circulated to all Health Care workers. F,Dr Zakaryia has been requested to prepare presentation and conduct briefing of all doctors at the earliest in consonance with guidelines and,protocols and materials from Supdt of Health affairs under his kind guidance. Ministry of Health, Sultanate of Oman P a g e 44 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 DIBBA HOSPITAL Preparation for management of swine influenza INTRODUCTION Dibba Hospital is a local health institute in Musandum region.The Hospital is provided with 40 beds and serves as primary and secondary health care.The catchment population is 6,222(Annual health report 2006) Disasters have been divided in internal disaster(refers to an incident that disrupts the every day,routine service of the medical facility itself)and External disaster(that has occurred outside the hospital and has not had a direct impact on the hospital servicecapabilities) Our external disaster plan consists of thre responsible phases.Phase 1 is an alert phase,during which staff remains at their regular dutiesand wait for further instructions from their supervisors(MOIC and Nursing incharge in co-ordination with hospital engineer). Phase 2 is a response phase and designated staff report to supervisors or the command post for instructions Phase 3 is expanded response phase during which additional persons are required.Therefor,off duty staffs are called in to the hospital.and existing staffs may be relocated within the hospital.The hospital engineer and his team will be responsible for repairing and laboratory equipments failure,potential chemical spills,and loss of radiography Ministry of Health, Sultanate of Oman P a g e 45 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 capability,suction,communication,lighting,medical gases and structural stability. Also adequatenumber of security personnelwillm report to areas of congestion to prevent thegeneral public from entering the facilityand to clear hallwaysto ensure that patient care,particularly in critical areas,is not hampered. Main Disaster team consists of MOIC;Dr Aisha Al Shehi Team incharge,contact numbers 99367157,28836600,26836281 Willayat Health Superintendent;Mr Ali Abdullah GSM 99422201 Physician and acting MOIC/Acting team incharge;Dr Wesam Hanna 26836793,Ext 312,GSM 99834319 Paediatrician;Dr Mahmood K,26836794.EXT 307,gsm 92726360 Anaesthetist;Dr Amani 26836446,ext 309 Surgeon;Dr Gamal 26836446,ext 311,GSM 99643749 Nurse I/C;Fatima Mohd GSM 92298226,26836699,26836109 Administrative Supdt;Atiqa Ali,GSM 92299883 Onec Company representative Mr Babu GSM 92174490 The above team is responsible to announace the emergency situations and co operate with the main committees at regional and centaral level as well as thwe other non medical committies available in the villayat.See attached algoritham,case action protocol,DGHS Ministry of Health, Sultanate of Oman P a g e 46 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 During external disaster and emergencies the following actions will be taken 1,Stopping all routine admissions and routine opd cases,discharge stable patients 2,Use the available isolation roomfor any suspected case till paitent transfer to regional hospital if needed according to regional protocol. 3,Keep male ward room no 3ready to be used as isolation room in case,if suspecting case increasing more than two. 4,All medical and paramedical staff should be 24 hours oncall 5,Ambulance to be kept 24 hours available for shiftingor transferring of patients 6,Suspected cases will be managed according to the swine influenza case action protocol,regional/Governorate April 2009 and according to WHO protocol,infection prevention and control in health care ,providing care for confirmed or suspected H1NI swine influenza patients. Dibba Hospital PPE equipments currently not adequate,accordingly a formal letter have been sent to Ph Moza,head of pharmacy and medical stores at musandum region to provide as with enough N95 mask and medications like TAMIFLU Laboratory acting incharge Muna will follow up with central/regional lab to provide special media for swab culture,inorder to be taken in Dibba Hospital and to sent immediately for central lab for confirmation. Infection control focal point of Dibba Hospital have been informed to follow up for WHO protocol implementation in Ministry of Health, Sultanate of Oman P a g e 47 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 providing care for confirmed or suspected swine influenza H1N1 patients. The following steps/lectures and meeting have been done in Dibba hospital since the start of phase 4 swine influenza world wide -On 29/4/09 meeting with all HODs,Willayat Health Supdt,AO,Nurse I/C,opdI/C,infection control focal point,Lab I/C,Pharmacy I/C,Public health I/C,to discuss and update Dibba Hospital swine influenza protocol and update main team and discuss infection control plan and responsibilities -On 5/5/09 CME conducted with all hospital staff about hand wash,saves lives(WHO celebration)to encourage hand hygiene and emphasis on using the recommened protocol an d guide line for hand wash On 6/5/09 CME conducted with all HODs,GPs,department I/CS,Infection control focal point and Nurses to discuss regional/local plan of swine influenza and infection control in health care in providing care for confirmed or suspected swine influenza H1N1. Regional algorithm and WHO protocol to be strictly followed in Dibba Hospital. Ministry of Health, Sultanate of Oman P a g e 48 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 BUKHA HOSPITAL PANDEMIC INFLUENZA PREPAREDNESS PLAN 2009 In view of the above and with the reference of letter no MH/DHSM/HHC/5/09/1048 on 6/5/09 below mentioned are the details from our institutions with respect to the above stated topics -ACTION PLAN -Formation of preparedness team; Dr Maryam salah Al Sawaleh (Head of Willayat Health services)GSM [email protected] MOIC(Dr Maryam Salah Al Sawaleh) Mr Mohd Ahmed Mohd,(AO)GSM 99006767 AnnammaV.O,GSM 92200751,[email protected] Infection control staff(SSN Badriya Al Dahoori)GSM 99435123 Lab I/C ,GSM 99464972 XRAY I/C,GSM 92385011 -Educating the public about Influenza A H1N1 .In this regard our doctors are providing advisory details to relevant OPD patients on their travel habits,etc,according to the current Influenza A H1N1 trends. Ministry of Health, Sultanate of Oman P a g e 49 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 -Continue updating the doctors and the other staffs with the most recent WHO reports about Influenza A H1N1 and the most recent recommendations. -Three doctors and two nurses attended the awareness lecture on swine influenza conducted by Dr Mohd Mohd Amro Gobashy on 30/4/09.Orientation given to other staffs in the hospital about the disease. -H1N1 Influenza case action protocol is distributed to all the clinics and in the wards and explained to the doctors and to the staffs. -prepration of the weekly ILI reports which are forwarded to DHSM as before done since 3yrs. -Infection control protocol in case of acute respiratory disease distributed to all clinics and wards. -Use a medical or surgical mask and emphasize on hand hygiene and provide hand hygiene facilities and supplies. -Ensure the availability of personal protective equipments and accessible round the clock to the health care staff,(surgical mask, gloves and mask). Ministry of Health, Sultanate of Oman P a g e 50 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 -In case of suspected cases 1-Inform Head of wilayat health service (Dr Mariam Al shehi)and M.O.IC., Nursing supervisior,and infection control nurse , and other members of the preparedness team. 2-suspected case to be first informed and consulted with Supdt of health affairs , HOD medicine in case of adult and HOD paeds in case of children. 3-If the case is fitting the criteria of suspected case then to refer by ambulance with staff nurse to khasab hospital. >suspected case transfer 1.Isolate the case in the treatment room in the IPD. 2.He/she should wear a surgical mask. 3.Do not allow contact with others (relatives). 4.patients documents/belongings should be collected by the health care provider. 5.Doctor/health care provider should wear PPE(surgical mask,gown, gloves). 6.carry out only most required procedures on the case and avoid unnecessary contact. 7.Organize ambulance with staff nurse to escort the case immediately 8.The ambulance staff must use PPE. Ministry of Health, Sultanate of Oman P a g e 51 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 *A lecture is given to all the staff about Influenza AH1N1 on 10/5/09 in Bukha hospital paediatric ward at 1p.m. *We are planning for continues education,orientation and training of health workers and school students about the disease and the possible ep0idemic. STAFFS RESPONSIBLE *Dr Mariyam saleh Al sawaleh (Head of wilayat health services, GSM-99319892 [email protected] *M.O.I.C (DR Mariam saleh Al sawaleh) *Mr Mohd Ahmed Mohd (A.O) GSM 99006767 *Annamma V.O.GSM 92200751,[email protected] *Infection control staff ( SSN Badriya Al Dahoori GSM,99435123) *x ray incharge GSM 92385011 *Lab incharge GSM, 9946972. Ministry of Health, Sultanate of Oman P a g e 52 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 LEEMA HEALTH CENTRE SWINE INFLUENZA A H1N1 PREPAREDNESS PREPAREDNESS TEAM 1.Dr AHLAM Mohd khalil (M.O.I.C) 2.Dr Mohanned Babiker( M.O) 3.Mr Ali suliman Ahmed (A.O) 4.Mr Ali Hassan Hilal (Nsg incharge) 5.Ms Saliamma kurian (S/N) 6. Ms Suma Stephen ( lan i/c ) PLAN OF ACTION *All staffs oriented and lectures given about Swine influenza and explained what to do in case of emergency. *Lecture given to school and discussion conducted among the students (attended 43) *Lecture given to CSGM and explain how to orient public and avoid unnecessary panic. *Leema staffs vaccinated against influenza. *Ready to meet any emergency. Ministry of Health, Sultanate of Oman P a g e 53 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 *when identify the case as suspect isolate the patient with mask and staffs to wear PPE.No isolataion facility in leema health centre. *Inform Supdt of health service and focal point of communicable disease of khasab hospital. * Inform public health i/c of khasab *Arrange the transfer of the patient to regional hospital. *Weekly ILI report to supdt of health affairs and the focal points. Ministry of Health, Sultanate of Oman P a g e 54 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 KUMZAR HEALTH CENTRE SWINE INFLUENZA A H1N1 PREPARDNESS Sultanate of Oman Ministry of Health Directorate of Health Services Musandam Governorate Kumzar H/C H1N1 Influenza A Case Action Protocol Suspect human case of H1N1 Influenza A INITIAL CONTACT (In the H/C seen by Doctor /Nurse Suspect Case Definition Acute febrile respiratory illness(fever>38C)with the spectrum of disease from Influenza- Like Illness(ILI)to pneumonia inclusive of severe acute respiratory illness(SARI)with onset----Within 7 days of close contact with confirmed case of H1N1 Influenza A virus OR -Within 7 days of travel to countries where one or more confirmed case of H1N1 Influenza A virus were reported OR -Resides in a community where there were one or more confirmed cases of H1N1 Influenza A virus. If No No further action If Yes -Inform Dr on call(if seen by nurse) -Inform: -Supdt of Health affairs/Dr Mohd (99381424) Ministry of Health, Sultanate of Oman Ghobashy P a g e 55 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 -Dr Zainab MCH Coordinator-99468845. During initial contact Compatible case -place surgical mask on the patient Inform Executive Director-Khasab Hospital -HCWs should also use surgical mask Dr Jolly philp(99220513)for admission& -place the patient away from other patients organize suitable method to transfer the until referral . patient (according to weather&case) -resuscitate the patient if needed Case Transfer to Khasab Hospital Suspect case H1N1 Influenza A virus detected in Kumzar H/C (by nurse or Doctor) (Epidemiologically &clinically compatible) -Dr/health inspector should wear PPEN95 respirator mask,gown,gloves) ImmediatelyDo not carry out any procedure on the case& avoid unnecessary contact Boat&Helicopter should not accompany the case to the hospital(also they should use PPE) Suspect case -Inform G P on call(if seen by nurse) -isolate case in a room. - Do not allow contact withothers(relatives) -patients documents/ belongings should be Collected by the health inspector Before referral inform consult Specialist on call ( Paediatric or medicine) Dr. Mohd Ghobashy ( 99381424) Dr. Zainab (99468845) Ministry of Health, Sultanate of Oman P a g e 56 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Instruction for transfer of cases -Organize method of transfer according To advice of the Specialist (by boat or by air) , with a staff nurse escort -Staff should use PPE Quarantine Hospital for HPA1 in ---Inform Executive Director, Khasab hospital Dr.Jolly Philip (GSM 99220513) for Admission to Khasab Hospital) - Ministry of Health, Sultanate of Oman P a g e 57 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 Suspect case MADHA HEALTH CENTRE PPDDD 1.A person with an acute respiratory illness who was a close contact to a confirmed cases of swine influenza virus infection while the case was ili or 2 Aperson with an acute respiratory illness with a recent history of contact with an animal with confirmed or suspected swin e influenza or 3.A person with acute respiratory illness who has traveled to an area where there are confirmed cases of swine influenza within 7days of suspect cases illness onset. No further action IF NO CONSULT FOR EPIDIMOLOGICAL COMBATIBILITY DR.MOHD GHOBASHY (99381424&26731655) DR AHMED AL MADHANI (99448498&26739090) CONSULT FOR CLINICAL COMPATIBILITY DR ZAKRIYA, HOD MED (26730138&26730155) DR ASHRAF, HOD PAED (26730138&26730155) Ministry of Health, Sultanate of Oman P a g e 58 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 CASE TRANSFER PROTOCOL QUARANTINE HOSPITAL IN MUSANDAM KHASAB HOSPITAL SUSPECTED CASE EPIDIMOLOGICALLY & CLINICALLY COMBATABLE HEALTH CARE WORKER 1.DOCTOR/HEALTH INSPECTOR MUST WEAR PPE(3M MASK,GOWN,GLOVES). 2.DO NOT DO ANY PROCEDURE ON THE CASE AND AVOID INNECESSARY CONTACT. INFORM DR MOHD GOBASHY (99381424) DR.ZAKRIYA &DR ASHRAF (26730138) Ministry of Health, Sultanate of Oman SUSPECT CASE 1.ISOLATE THE CASE IN A ROOM 2.HE/SHE SHOULD WEAR A SURGICAL MASK. 3.DO NOT ALLOW ANY CONTACT WITH OTHERS (RELATIVES) 4.PATIENTS DOCUMENTS /BELONGINGS SHOULD BE COLLECTED BY HEALTH INSPECTOR. CONTACTS P a g e 59 20 09 P l an : P rep ar ed n e s s I n f lu en za Pa n d e mi c N atio n al مركز صحي مدحاء الموظفين المسئوولين عن الحاالت الطارئه المشكوك بها حول أنفلونزا الخنازير أرقام االتصال الوظيفه األسم 22449429 طبيب مسؤول د.أحمد المدحاني 91232953 طبيب مسؤول بالنيابه د.إيمان 00225502001595 مشرف تمريض عبدهللا السعدي 00225504345129 المشرف اإلداري عبدهللا محمد المدحاني 00225503255222 مشرف الخدمات الصحيه علي محمد المدحاني 29440522 سائق أسعاف علي عبدهللا المدحاني الموظفين المسؤولين عن الحاالت الطارئه المشكوك بها حول أنفلونزا الخنازير أرقام االتصال الوظيفة االسم 22395494 مشرف الشؤون الصحيه د.غباشي 91230539 رئيس قسم الباطنيه خصب د.زكريا 91230539 رئيس قسم االطفال خصب د.أشرف 22312552 طبيب مسؤول مستشفى دبا د.عائشه الشحي 91931222 رئيس قسم األطفال دباء د.محمود 91931222 رئيس قسم الباطنيه دباء د.وسام P a g e 60 Ministry of Health, Sultanate of Oman N atio n al 1. 2. 3. 4. Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 CONTACT OF SUSPECT CASE CONTACT TO CONDUCT HOME VISIT . PPE SHOULD BE WORN DURING THE VISIT (MASK, GOWN , GLOVES ) TO ENLIST ALL INFORMATION OF ALL CLOSE CONTACTS.(ADDRESS, MOVEMENT, CONTACT TELEPHONE, ETC) ASK AND CHECK FOR FEVER AND RESPIRATORY SYMPTOMS ASYMPTOMATIC CONTACTS HOUSE QURATAINE FOR 10DAYS FROM THE DAY OF CLOSE CONTAACT WITH SUSPECTED CASE DAILY VISIT BY THE DOCTOR TO THE HOUSE FOR THE CHECK UP ( FEVER AND RESPIRATORY SYMPROMS) CONTACTS ADVICE 1.RESTRICT MOVEMENT OF CONTACTS 2 SHOULD NOT REPORT ON DUTY IF THE CONDAACTS DEVELOPS SYMPTOMS OF FEVER AND RESPRATORY SYMPTOMS CONTACT ADVISORY 1DO NOT VISIT ANY CLINIC/GOVTOR PVT 2.MINIMIZE CONTACT WITH FLY AND RESRICT MOVEMENT. 3. CALL DOCTOR IS THE ONE WHO IS DOING THE FOLLOW UP Ministry of Health, Sultanate of Oman IF FEVER OR RESPIRATORY SIGNS AND SYMPTOMS FOLLOW UP DOCTOR TO INFORM AND CONCULT DR MOHD GHOBASHY FOLLOW UP DOCTOR TO INFORM AND CONSULT FOLLOWUP DOCTOR SHOULD CALL THE MOIC TO ARRANGE P a g e 61 N atio n al Pa n d e mi c I n f lu en za P rep ar ed n e s s P l an : 20 09 SUSPECT CASE MADHA HEALTH CENTRE 1.APERSON WITH ACUTE RESP ILLNESS WHO WAS A CLOSE CONTACT TO A CONFIRMED CASE OF SWINE INFLUENZ H1N1 VIRUS INFECTION WHILE THE CASE WAS ILL OR 2.A PERSON WITH AN AC.RESP ILLNESS WITH ARECENT H/O CONTACT WITH AN ANIMAL WITH CONFIRMED OR SUSPECT SWINE INFLUENZAH1N1 VIRUS INFECTION OR 3.A PERSON WITH AN AC RESP ILLNESS WHO HAS TRAVEL TO AN AREA WHERE THEREARE CONFIRMED CASE .INFLUENZAH1N1WITHIN 7DAYS 1. THE STAFF MUST START USE PRECAUTION PROCESS (MASK, GOWN,GLOVESAND CLEAN USING70% ALCOHOL OR SOAP WITH WATER) 2.PATIENT MUST WEAR A MASK 3.SHIFT THE PATIENT TO THE DELIVERY WARD IMMEDIATELY. 4. STOP THE RELATIVES FROM COMING IN CONTACT WITH THE PATIENT. 5.RESTRICT THE STAFF WHO ARE DEALING WITH THE PATIENT TO THE PHYSICIAN AND THE NURSE ONLY WHO MUST STOP BEING IN CONTACT WITH OTH ER PATIENTS. 6.CALL THE MOIC AND NURSE INCHARGE.. 7. RECORD THE ATTENDANTS WITH THE PATIENTS, THE OTHER PATIENS WHO ARE IN THE CLINIC AND THE STAFF WHO ARE ON DUTY. Ministry of Health, Sultanate of Oman P a g e 62 N atio n al Pa n d e mi c I n f lu en za Ministry of Health, Sultanate of Oman P rep ar ed n e s s P l an : 20 09 P a g e 63