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Guidance on Infection Control Precautions for Pandemic Influenza in Intensive Care
Principle:
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Infection control should follow standard droplet
precautions
Who This Applies To:

Health care workers treating patients potentially infected
with pandemic (H1N1) 2009
Visitors to patients potentially infected by pandemic
(H1N1) 2009.
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New admissions
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Placement
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All patients admitted with potential respiratory infection
requiring admission to HDU or ICU should be treated as
potential cases of pandemic (H1N1) 2009
During this period those patients presenting with
hospital acquired pneumonia for which there has not
been a clear aetiological explanation e.g. aspiration, will
also be treated as having pandemic (H1N1) 2009
infection.
Single room preferred if available
If not available, patients should be cohorted in a
separate area in the unit
There should be a minimum distance of 1m between
patients.
Sign

Laminated isolation sign specifying the PPE required
outside the bed space.
Masks

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Visitors should wear surgical masks only
Staff should wear a surgical mask within 1m of patients
unless there is an aerosol generating procedure
Staff should wear an N95 waterproof mask during
aerosol generating procedures and for 20 minutes
afterwards if remaining in the bed space
Such procedures include:
• nasopharyngeal aspirates or swabs
• administration of nebulised medications
• naso-gastric tube insertion
• CPAP/BiPAP
• High flow nasal cannulae (Optiflow)
• oropharyngeal suctioning
• intubation
• open tracheal suctioning
• bronchoscopy
• tracheostomy insertion
• extubation.
It is important that N95 masks should be fitted properly
Masks (surgical and N95 respirator masks) are single
use, so discard when no longer required, damp,
damaged or contaminated in any way.
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Hand gel

Hand hygiene is a critical part of droplet and contact
precautions

Alcohol based hand gel should be available both inside
and outside the bed space.


Gloves are to be worn by all entering the patient bed
space
Hand hygiene to be performed before and after wearing
gloves.
Gowns

A disposable waterproof gown or apron must be worn.
Eye protection

A face shield or goggles must be worn to protect the
eyes during aerosol generating procedures
For each bed space there must be sufficient items of
eye protection available for all staff whom may be
required to be present during aerosol-generating
procedures such as intubation
Face goggles must be wiped down with alcohol based
wipes in the bedspace.
Gloves
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Leaving bed space
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Ventilator
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Ceasing PPE
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Authors
Before leaving the patient bed space, all staff and
visitors should remove gown and gloves as described in
removing PPE
Disposable items should be placed in a rubbish bag
inside the bed space
Hands should again be immediately washed or alcohol
gel used.
Influenza viruses remain viable in warm, moist
environment
Use disposable circuit and closed suction system
Expiratory viral filter and/or expiratory gas scavenging
Breaking of circuit is potentially aerosol-generating.
Patients generally remain infectious for 7 days after the
onset of symptoms
There is some data to suggest that patients who remain
critically unwell have ongoing viral shedding beyond 7
days and may remain infectious
Consideration of stopping PPE should therefore occur
when completed a minimum of a 5 day course of
oseltamivir, AND
• absence of fever for 24 hours AND
• significant clinical improvement
OR
• two negative PCR swabs for pandemic (H1N1) 2009
AND
• significant clinical improvement.
Drs Carl Horsley - [email protected],
Colin McArthur - [email protected], for the New
Zealand National Intensive Care Advisory Group.