Download Grampian Health Advisory Group (HAG) This report

Grampian Health Advisory Group (HAG)
This report provides a summary of public health advice provided by the HAG to the Grampian Strategic Coordinating Group (SCG),
NHSG Strategic Group and NHSG Pandemic Influenza Management Team (PIMT); and will be updated on a regular basis.
HAG provides advice to the SCG, NHS Strategic Group and PIMT on the management of public health aspects of the outbreak and coordinates the risk assessment, risk management and risk communication
Actions
Recipients should
- check the “Actions” column and ensure that those they are responsible for are undertaken and reported back to HAG
([email protected])
- cascade the information in this document, as appropriate, within their area of responsibility
- always check HPS website for latest guidance
- List of additional information/planning guidance at end of document
Changes since Version 12 (Issued 10 September )
Infection control -Checklist of Infection Control Precautions to minimise transmission of Influenza A H1N1v in the General Dental
Practice setting
Schools -Preventing and controlling the spread of swine flu: Advice for schools and nurseries
Universities & colleges - Guidance on planning: influenza pandemic - revised
Offshore -Guidance for Management of Suspected Cases of Influenza A H1N1v on Offshore Installations (Draft)
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Public Health
From July 6 2009 the UK moved from containment to treatment.
For further Public Health
advice Tel: 01224 558520
during office hours and
0845-456-6000 out of hours
(ask for Public Health on
call).
See SGHD letter 2 July 2009. In summary
GP diagnosis of Influenza A (H1N1)v is on the basis of clinical assessment.
Routine swabbing and serology from all suspected cases will no longer be required
Hospitalised cases should be swabbed as part of normal investigations
All contact tracing has ceased and post exposure prophylaxis should only be given to
close contacts in exceptional circumstances – HPS guidance awaited.
Case Definitions
Confirmed case:
Any person with laboratory confirmation of influenza A(H1N1)v
Clinical diagnostic criteria (suspected case):
Clinicians are now encouraged to diagnose influenza A(H1N1)v cases on the basis of
symptoms. The clinical diagnostic criteria are:
Fever [pyrexia ≥ 38°C] or a history of fever
AND
Influenza-like illness (two or more of the following symptoms: cough, sore throat,
rhinorrhea, limb or joint pain, headache)*
OR
Severe and/or life-threatening illness suggestive of an infective process
*vomiting and diarrhoea has been a feature of some of the confirmed US cases
Antivirals
Patients clinically assessed as suffering from Influenza A (H1N1)v should be offered
anti-viral medication if clinically appropriate.
For information
When a GP authorises an anti-viral they should use a GP10 form, but endorsed below
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the drug description with the word “FLU” in capitals and underlined.
Local community pharmacies and dispensing practices will hold anti-viral supplies
ready to dispense on presentation of GP prescription.
A small amount of anti-viral stock will be distributed to all practices for use in GP bags.
This will be accompanied by advice regarding the most appropriate use of this small
amount of stock.
A summary of prescribing guidance for Oseltamivir (Tamiflu®) has been produced by
HPS http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/antiviralprescribing-2009-05-12.pdf
Oseltamivir suspension is only available for children under 1yr
Vaccination
The UK seasonal flu programme will go ahead as normal this year
A vaccine against Influenza A(H1N1) will be available in October 2009
For information
Plans are being developed to deliver the pandemic influenza vaccine
See Scottish Vaccine update for details
http://www.documents.hps.scot.nhs.uk/immunisation/scottish-vaccine-update/issue72009-08.pdf
In summary
Key planning assumptions
 The vaccines will be supplied by two manufacturers (GlaxoSmithKline and
Baxter).
 The programme will start at the same time across the UK.
 The programme will only start when the vaccines have been licensed by the
European Medicines Agency and licensed stock has been distributed across the
country.
 The earliest date for the programme to start in late October 2009.
 Each person will need two doses of H1N1v vaccine.
 The doses need to given at least three weeks apart.
 The different brands of vaccine are not interchangeable. Meaning that each
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person should receive two doses of either the GSK or the Baxter brand vaccine.
The HPV immunisation programme, routine childhood immunisation and
seasonal influenza immunisation programmes will proceed as planned.
H1N1v vaccine will be suitable for co-administration with HPV, seasonal
influenza and childhood immunisations.
Deliveries of vaccine will be made into NHS Board Vaccine Holding Centres on a
weekly basis, staged over several months.
Priority groups
The latest scientific advice on priority groups has been considered by the Joint
Committee on Vaccination and Immunisation (JVCI) and Scientific Advisory Group on
Emergencies (SAGE). The following groups will be given first priority once the vaccine
is licenced:
 Individuals aged six months and up to 65 years in the current seasonal flu
vaccine clinical at-risk groups.
 Pregnant women, subject to licensing considerations .
 Household contacts of immunocompromised individuals.
 People aged 65 and over in the current seasonal flu vaccine clinical at-risk
groups.
Frontline health and social care workers will be vaccinated alongside the first priority
groups as they are at increased risk of infection and of transmitting that infection to
susceptible patients.
It has now been agreed that GPs will support the programme
A training resource for vaccinators is available at
http://www.nes.scot.nhs.uk/hai/pandemic%5Fflu/ this will be updated regularly. The
content is abased on http://www.hps.scot.nhs.uk/training/education.aspx which is
already available to those undertaking routine vaccinations
Staff should review the
resource regularly for
updated information
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Infection
Control
General information on Influenza A(H1N1)
The general information contained within this document is for the use of clinical and
public health colleagues. It sets the scene for more specific guidance on transmissionbased precautions and infection control in defined clinical settings. Its aim is to facilitate
the implementation of measures to interrupt transmission on Influenza A(H1N1)v.
Action
For further infection
control advice for
healthcare premises please
contact:
08:30-17:00 Mon-Fri
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vgeneral-information-2009-08-17.pdf
Tel: 01224 552 118
Modes of Transmission of Influenza A H1N1v and Transmission Based
Precautions (TBPs)
Tel: 07500 033 688
This document describes the modes of transmission of Influenza A H1N1v and the
Transmission-Based Precautions (TBPs) required to prevent the spread of Influenza A
H1N1v.
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vtransmission.pdf
Checklist of Infection Control Precautions to Minimise Transmission of Influenza
A H1N1v in the Hospital Setting
Includes information on healthcare workers, personal protective equipment, patient
placement and transfers, respiratory hygiene, the environment, equipment, linen and
waste.
08:30-17:00 Weekends
Out with these hours contact
0845-456-6000 (ask for
Microbiologist on call).
For further infection
control advice in
community settings please
contact Public Health
Tel: 01224 558520 during
office hours and 0845-4566000 out of hours (ask for
Public Health on call).
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vic-precautions-hospitals.pdf
Checklist of Infection Control Precautions to Minimise Transmission of Influenza
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A H1N1v in the Primary Care Practice Setting
Includes information on healthcare workers, personal protective equipment, patient
advice and segregation, respiratory hygiene, hand hygiene, the environment,
equipment and waste.
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vchecklist-primary-care-2009-09-02.pdf
Checklist of Infection Control Precautions to minimise transmission of Influenza
A H1N1v in the General Dental Practice setting
Includes information on patient advice and segregation, healthcare workers, personal
protective equipment, respiratory hygiene, hand hygiene, the environment, equipment
and waste.
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vchecklist-dental-2009-09-10.pdf
Checklist of Infection Control Precautions to Minimise Transmission of Influenza
A H1N1v when Providing Care in the Patient’s/Client’s Home
Includes information on health/social workers, personal protective equipment, patient
advice and segregation, respiratory hygiene, hand hygiene, the environment,
equipment, linen and waste.
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vchecklist-social-care-2009-09-02.pdf
influenza A(H1N1)v is a category 2 pathogen and FFP3 masks are only required for
aerosol generating procedures with suspected or confirmed cases.
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British Thoracic Society and British Paediatric Respiratory Society statement on
the use of nebulisers in patients where influenza A/H1N1v infection is suspected
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/bts-bprs-statementnebuliser-use-2009-08.pdf
NHS Grampian Pharmacy supports the statement in principle and CHP Lead
pharmacists have had discussions with community hospitals and GPs regarding the
use of and stock of spacers and inhalers.
A Patient Group Directive (PGD) is being prepared to allow staff to administer inhalers
in this way where clinically appropriate and this has been sent to respiratory consultants
for approval. The PGD will go to the Medicines Guidelines and Policies Group on 24
September for approval and sign off.
Pandemic Flu: Guidance for infection control in hospitals and primary care
settings
This guidance provides specific recommendations, planning strategies, and tools for
local public health and healthcare officials who are the front line for managing and
containing an influenza pandemic.
http://www.documents.hps.scot.nhs.uk/respiratory/pandemic-influenza/ic-guidancehospitals.pdf
Health care workers (HCWs) caring for suspected (clinically diagnosed) or
confirmed cases of Influenza A(H1N1)v: Frequently Asked Questions
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/hcw-faqs-pandemicflu-v0.4-2009-09-08.pdf
FFP3 Respirators: Frequently Asked Questions
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FFP3 Respirators are designed to prevent infectious aerosols being inhaled, or landing
directly on the vulnerable mucous membranes of the upper respiratory tract. These
questions and answers explain the use of FFP3 respirators.
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/ffp3-faqs-2009-v0.42009-09-08.pdf
General advice on respiratory and hand hygiene.
All front line health professionals, including those working within social care and
schools, should take the opportunity to educate members of the public on good
respiratory and hand hygiene.
General guidance recommends that individuals should wash hands frequently with
soap and water; cover the nose and mouth with a tissue when coughing or sneezing
and dispose of tissues promptly; ensure that hands are washed after coughing or
sneezing. Supervising adults should make sure that children follow this advice.
NHS Education for Scotland (NES) infection control measures - training
programme
NES training programme
Education
Guidance for schools and early years or group childcare settings
Guidance for childminders
Guidance for further education colleges and higher education institutions
Guidance in residential settings for children and vulnerable young people
Justice
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Guidance for fire and rescue services
Guidance for funeral directors
Guidance for the Scottish Prison Service
Guidance for the Police Service
Environment
Guidance for cleaning staff and refuse collectors in non-health care settings
Tourism
Guidance for infection control for the Hospitality Industry
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Occupational
Health
Where an individual has concerns about their own health or that of a colleague then
advice can be sought from [email protected] in the usual manner. Individuals can
self refer or line managers can refer. Local risk assessments may require adjustment
during a pandemic and updated advice will be sought from Health Protection Scotland
and other experts.
For further information on
occupational health issues
please contact
[email protected]
Healthcare workers who are at high risk of complications of influenza (eg
immunocompromised workers and pregnant women) should be considered for alternate
work assignments, away from the direct care of patients, for the duration of the
pandemic or until they have been vaccinated, if it is clinically appropriate for them to be
vaccinated. At the very least they should not provide care to patients with confirmed
influenza A(H1N1), and neither should they enter parts of the facility segregated for the
treatment of patients with confirmed influenza A(H1N1).
For information
SG advice to employers' on swine flu has been circulated to all HR Directors. This
advice is available online on the NHS24 website.
Waste
There is no change to current waste disposal practices.
Guidance included in advice issued to service 30/04/09
Self Care
There is no change to current self care flu guidance.
Staff should continue to promote good hand hygiene practice, cough etiquette and
tissue disposal to patients and their visitors.
Social
Distancing
For information
Encourage good hygiene
All suspected flu cases are being asked to remain at home whilst symptomatic
Stay at home until antiviral medication completed and symptoms resolved.
For information
If necessary to go out stay away from crowded places and buildings where there are
large groups of people like schools, nurseries and hospitals.
Exclusions
Health and social care staff who are clinically diagnosed with Influenza A(H1N1)v
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should be excluded from work for 7 days, regardless of whether they have been
prescribed with antivirals or not. (Draft HPS guidance 27 July 2009)
For information
Staff who are asymptomatic do not need to be excluded from work.
Schools,
Further and
Higher
Education
Preventing and controlling the spread of swine flu: Advice for schools and
nurseries
For information
Advice for schools and nurseries on preventing and controlling the spread of swine flu.
This includes information on:
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the symptoms of swine flu
how it is spread
how to prevent the spread
action to be taken if children become unwell whilst at school or nursery
action to be taken if staff become unwell whilst at school or nursery
specific advice for special schools
specific advice for boarding schools
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vadvice-for-schools-2009-09-10.pdf
Please read in conjunction with general guidance in the Infection control section
Universities & colleges
Guidance on planning: influenza pandemic
http://www.scotland.gov.uk/Topics/Education/UniversitiesColleges/16640/pandemicflu
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Social Care
and Care
Homes
Checklist of Infection Control Precautions to Minimise Transmission of Influenza
A H1N1v when Providing Care in the Patient’s/Client’s Home
For information
Includes information on health/social workers, personal protective equipment, patient
advice and segregation, respiratory hygiene, hand hygiene, the environment,
equipment, linen and waste.
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vchecklist-social-care-2009-09-02.pdf
Please read in conjunction with general guidance in the Infection control section
Public
gatherings
No restrictions in place
For information
Travel and
Port Health
The current UK government travel advice can be viewed at http://www.fco.gov.uk/en/.
For information
Influenza A(H1N1)v – travel advice from HPS weekly 05 August 2009
Some authorities have introduced medical screening for influenza A(H1N1)v at
several airports for passengers arriving on international flights. Travellers who show
flu-like symptoms may be required to undergo further tests and some countries have
put quarantine measures in place for people travelling from affected countries. The
Foreign and Commonwealth Office (http://www.fco.gov.uk/en/travelling-and-livingoverseas/swine-flu) is posting information on individual country records where this is
taking place. British nationals who find themselves quarantined overseas should
contact their nearest British Embassy who will be able to offer consular assistance.
The Association of British Insurers (ABI) has issued a News Release
(http://www.abi.org.uk/Media/Releases/2009/07/) providing influenza A(H1N1)v
insurance information for travellers. Influenza A(H1N1)v is treated the same as any
other illness by travel insurers. Travel insurance will generally cover the cost of
medical treatment if people contract the infection while on holiday. It will also cover the
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cost of rearranged flights and accommodation for anyone covered by the policy.
People diagnosed with influenza A(H1N1)v before they are due to travel abroad, and
any immediate family members due to travel with them, will be covered for the cost of
holiday cancellation. ABTA - the Travel Association also provides useful information
for travellers (at http://www.abta.com/about/news/view/157).
The Muslim Council of Britain (MCB) has issued new guidance for those planning to
travel to Hajj/Umrah through the ongoing A(H1N1)v pandemic
(http://www.mcb.org.uk/uploads/MCBSwineFluAdvice1.pdf). It is advised that pregnant
women, the elderly, those with chronic illnesses and children postpone their
participation in Hajj and Umrah for this year.
Further advice is also available on the Travax and Fitfortravel websites
(http://www.travax.nhs.uk and http://www.fitfortravel.nhs.uk/home.aspx).
TPH2 - HPS Guidance on action at airports for the Treatment Phase during an
Influenza A (H1N1)v Pandemic with TPH6 as Annex
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/tph2-hps-guidanceon-action-at-airports-treatment-phase-v2-2009-08-06.pdf
TPH3 - HPS Guidance on action at sea ports for the Treatment Phase during an
Influenza A (H1N1v) Pandemic with TPH6 as Annex
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/tph3-hps-guidanceon-action-at-sea-ports-treatment-phase-v2-2009-08-06.pdf
TPH6 - HPS Guidance (Treatment Phase) - onward travel of passengers arriving
at air or sea ports
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/tph6-hps-guidance13 Advisory Group advice - Version 13 Issued 23 September 2009
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passengers-at-ports-diagnosed-as-possible-cases-v2-2009-08-06.pdf
Aircraft cleaning - HPS have issued interim guidance for aircraft cleaning when
swine influenza is suspected in a passenger or crew member
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/tph7-hps-guidanceon-cleaning-aircraft-2009-07-01.pdf
Interim local guidance agreed with Local Authorities
Red Cross protocol for transport in exceptional circumstances – agreed.
Offshore
Installations
Guidance for Management of Suspected Cases of Influenza A H1N1v on Offshore
Installations (Draft)
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For information
The first version of this guidance was produced at a time when it was feared the
Influenza A H1N1v virus might represent a virulent mutation of flu, causing a potentially
serious clinical condition, and when public and industry anxiety reflected this, causing
potential difficulties for the movement of personnel onshore and around the UK. It is
now shown that to date, the Influenza A H1N1v infection has been generally mild, with
fever, sore throat and clinical recovery in a few days.
In early July 2009, UK government policy on management of the Influenza A H1N1v
pandemic transitioned from 'containment' to 'treatment'. This means that, onshore,
Influenza A H1N1v is now diagnosed clinically rather than using laboratory diagnosis,
and patients who have a clinical diagnosis of Influenza A H1N1v receive antiviral
medication, either where specifically clinically indicated (for example, in the presence of
existing conditions) or where a strong preference for treatment is expressed by the
patient. Contacts are no longer being traced and antivirals are not being given to these
asymptomatic individuals as prophylaxis.
However, for the time being this guidance will continue to reflect the tactics necessary
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to implement a strategy of localised containment for offshore installations. To facilitate
this, the Scottish government has agreed to release a proportion of the national
stockpile of oseltamivir to offshore installations.
http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1voffshore-installations-draft-2009-09-18.pdf
HPS/Oil and Gas UK Statement on Transportation of H1N1 Flu patients by
helicopter in the UK North Sea. Available from Public Health
Further information:
http://www.hps.scot.nhs.uk/
http://www.scotland.gov.uk/Topics/Health/health/AvianInfluenza
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Scottish framework
Maternity Guidance
Health workforce guidance
Health Workforce Terms and Conditions Issues
Mental health services
Adult community care - Operational and strategic framework
Adult community care - Guidelines for community care staff
Provision of healthcare in a community setting
Acute care checklists
Death certification
Ethics framework
Scientific evidence base
Clinical guidelines
Good Medical Practice
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Vulnerable groups planning guidance
The Cabinet Office has produced the guidance document, 'Identifying People who are Vulnerable in a Crisis'. Although originally
developed for responders in England and Wales, the principles and methods for identifying vulnerable groups are equally applicable
across the UK so the document is also relevant for responders in Scotland.
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Planning for vulnerable groups
Schools, childcare and children's services
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Guidance for schools, childcare and children's services
Schools, Nurseries and children's services: Information for parents
Summary guidance for Scottish schools
Guidance to group childcare providers in Scotland
Further and Higher Education
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Guidance for colleges and universities
Business
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Workplace Guidance
Introductory advice for staff on planning for pandemic influenza
Distribution: for onward distribution as appropriate within each organisation
 SCG, HAG, PIMT, OMT and Operational leads
 NHS G Control Room for Public Health on call and Tactical CPHM folder
 GP practices, NES and SNBTS
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