Download National Pandemic Influenza Preparedness Plan

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
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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
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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)
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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
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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:

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
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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.
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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.
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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
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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).
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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.
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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.
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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
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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:
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
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

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
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.
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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.
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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
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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
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and Water Resources
DG of Health Affairs, Ministry
of Regional Municipalities,
Environment and Water
Resources
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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
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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
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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
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� 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
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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.
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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
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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
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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…)
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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
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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
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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
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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
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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
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Sultanate of Oman.
PANDEMIC INFLUENZA H1N1
PREPAREDNESS
REGIONAL ACTION PLAN
MUSANDUM
GOVERNORATE
MAY 2009
DIRECTORATE OF HEALTH AFFAIRS & DHS
MUSANDAM GOVERNORATE
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‫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:‬‬
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‫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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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I n f lu en za
P rep ar ed n e s s
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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
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-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
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-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
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*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
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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
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*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
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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
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-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
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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
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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
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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