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Avian ‘fluInfection Control Recommendations
Prof Shaheen Mehtar
Unit for Infection Prevention & Control,
Tygerberg Academic Hospital
Spanish flu- 1918
21 million people died – official
40 million people died- unofficial
Avian flu H5N1- Far East
• No confirmed case of
human-to- human
transmission, however
possible case reported
from China
• Contact with infected
birds- secretions,
contaminated meat and
manure.
• Mutation and human-tohuman transmission
inevitable.
Routes of spread
Respiratory droplets.
• Influenza A:
Size 0.08- 0.12µ
small particle aerosols of <
10µ in diameter
Survival:
4 days at 4oC
10 days at 1oC
Contamination
Surfaces
uncooked meat and
poultry
IC recommendations
• Standard precautions
• Droplet precautions
• Isolation with negative pressure ventilation
for confirmed cases requiring
hospitalisation
• Waste management
• Environmental cleaning
Standard precautions
• Wear gloves and aprons during any exposure
risk procedure (blood and body fluids)
• After removing gloves, wash hands thoroughly
and dry if in contact with patient’s body fluids
including respiratory secretions
• May use alcohol rub where soap & water not
available
• Clean and disinfected equipment after use
• Discard sharps carefully,
• Discard waste as infectious waste if in hospital
Infection control recommendations
Masks essential
Community– Cloth over nose &
mouth
Healthcare workers
Community – surgical
mask
Paramedics- surgical
mask
Intensive care- N95
masks
IC recommendation
Gloves essential
• Community- any type of
glove
• WASH hands thoroughly
and dry.
• Alcohol rub
• Healthcare workers
– Gloves- as per protocol
– Hand disinfection
– Alcohol rub
Isolation precautions- in patient
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For confirmed cases
Keep in isolation for 7 days
(current recommendation)
Single room with negative
pressure vent (6-12 ac/hour)
Keep trolley with all equipment
outside the room
Garb before entering
Discard contaminated gloves,
aprons and mask inside the
room at end of procedure
Wash and dry hands
Discard waste as infectious
waste
IC provision
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Avoid panic: prepare list of team
and telephone numbers
Named team to attend to patient
Only enter room if essential
Keep all notes and records
outside the room
IC packs will be made up for
each team member
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Gloves
Mask
Apron
Eye protection
Laboratory test tubes
Ventilation equipment will be
processed according to protocol
IC protocol- clinical equipment
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Preferably use disposable items
– IV systems
– Endo-tracheal tubes
– Urinary catheters
If need to use re-usable items
– Use heat resistant items which
can be autoclaved
– If heat labile, ask IC Team for
advice on disinfectants
Restrict the sharing of clinical
parameter measuring items – BP
apparatus, thermometers etc
IC: Sharps management
• All sites must have sharps containers as close to
clinical beds as possible
• Always wear appropriate protective clothing
• Use closed systems for IV or needle-less system
• Complete task, discard into appropriate colour
coded waste containers- DONOT ALLOW
ANYONE ELSE TO CLEAR UP SHARPS
EXCEPT THE USER
• Remove gloves, wash hands and dry.
Waste management
• Organise before hand with the waste
management company
• All waste containers must be clearly labelled as
being part of the outbreak
• Remove sealed waste containers to the
periphery
• Regular collection of waste- clearly labelled
IC- environmental cleaning
• Using skilled clinical staff should keep
environmental contamination to a minimum
• HCW to be wear adequate protective clothing
• Clean with detergent and water
• Keep environment dry
• Wipe with disinfectant if advised by IC Team
• Separate mops for each area.
• Autoclave or hot water (90o C) and detergent for
mops. Store Dry
IC Team
• IC medical specialist and nurses
– Type of isolation procedure
– Cohort or single isolation accommodation
– Advise of type of protective clothing required
– Reinforce infection control practice
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Hand washing
Use of protective clothing
Clinical equipment management
Waste & sharps management
Vietnam: November 2005
Reports
• A new mutant killer flu is ready to invade. It's
nickname is the "bird flu."
Former HHS Secretary Thompson calls it
"a bomb that could impact the world." The
World Health Organization (WHO)
predicts this virus will kill 1/3rd of mankind.
• "This is the worst virus I have ever met in my
entire career."
-- Dr. Robert Webster, St. Jude's Children's
Hospital