Download Polisi Pandemik Influenza Unit Kawalan Infeksi, Hospital Teluk Intan

PANDEMIC INFLUENZA POLICY
1.0 PURPOSE
The purpose of this policy is to facilitate an organized, coordinated and effective hospital
preparedness and response in the event of an influenza pandemic. The plan provides a
framework for preparedness and response by the hospital.
2.0 GENERAL OBJECTIVES:
To outline a guideline to provide a preparedness and response plan for influenza pandemic
hence to ensure rapid, timely and coordinated intersectorial and interagency actions in
reducing the morbidity, and mortality, as well as minimizing the resultant social and
economic impact of the pandemic.
3.0 SPECIFIC OBJECTIVES:
3.1 To develop hospital specific training programs on Influenza for professional and
general public
3.2 To strengthen influenza surveillance mechanisms in the hospital in order to provide an
early warning system and on-going monitoring during a pandemic.
3.3 To provide optimal medical care and support maintenance of essential services.
3.4 To provide recommendation for the appropriate use of antiviral drug and prophylaxis.
3.5 To implement measures to reduce the spread of the disease guided by the
epidemiology of the pandemics.
3.6 To facilitate the timely access to and supply of influenza vaccines and antiviral drugs
during an outbreak.
3.7 To make specific recommendations and those in the essential services.
3.8 To communicate effectively with the public, health care provider, health professionals,
stakeholders, community leaders and the media.
4.0 HOSPITAL TELUK INTAN RESPONSE COMMITTEE.
The organization chart is as follow:
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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Chairman
: Hospital Director
Secretary
: Microbiologist & Infection Control sister
Head Medical & Triage
: Physician
Head Pediatrics
: Pediatricians
Head Critical care
: Anesthesiologists
Head screening
: Head of A&E department
Head Pharmacy
: Chief Pharmacist
Head staffing & logistics
: Matron
Head Engineering & Facilities
: Head Hospital Support Service
Head Transportation
: Penyelia I/C A & E
Head Radiology
: Radiologist
Head Training & Education
: Infection control Unit
Head Laboratory
: Microbiologist
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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4.1 The job specification of each job and head units are described as below:
No
1
Job
Chairman
Job Specification
1. Chairing all PI meetings
2. To make managerial decision
2
Dep. Chairman
1. To assist chairman in discharging his duties.
3
Secretary 1
1. To take PI minutes
2. To keep up to date all PI documents
3. To circulate PI minutes & reference documents to all Heads
of Department
4
Secretary 2
1. To assist secretary in discharging her duties
5.
Head Medical
1. To consult & make all clinical decisions
2. To consult & decide on triage
6.
Head Pediatric
1. To consult & make all clinical decisions particularly on
pediatric patients
7.
Head Critical Care
1. To consult & make all clinical decisions particularly on
critical care
2. To manage suspected patient with PI who requires
resuscitation and ventilator support
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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8.
1. To ensure signage /pamphlet/ banners are put up in front of
Head Screening
A&E/OPD to inform the public
2. To create a counter for screening
3. To stockpile PPE
4. To ensure staff under their care has knowledge of PI and
attended PPE training
5. To identify dedicated staff for screening
6. To consult & make all decisions on screening
7. To identify designated ambulance for transporting PI
8. To create a designated route for transportation to PI unit
9.
Head Pharmacy
1. To plan on budget for each PI phase
2. To buy PPE & other equipment needed
3. To acquire antiviral drug when needed
10.
Head Staffing & Logistic
1. To mobilize staff from all department by priority
2. To identify dedicated staff to work in the isolation ward and
triage area/ designated hospitals
3. Roster shall be arranged by the Matron /Penyelia Hospital
accordingly. The number of staff managing should be kept to
a minimum to reduce infection
4. Request the help of Security to control visitors
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Head
Engineering
& 1. To consult on facilities & equipment
Facilities
2. To fulfill the hospital needs and cooperate in controlling PI
3. To ensure staff has knowledge of PI and training of PPE
4. Condone off isolation area and assist designated route
12.
Transportation
1. To list designated ambulance
2. To list designated drivers for PI
3. To arrange and provide designated transportation service
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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and parking area during PI
13.
Head Radiology
1. To provide designated X-ray machine and it services to PI
unit when the need arise
14.
Head
Training
& 1. To train all staff on PPE, Hand hygiene and cough etiquette
Education
2. To train designated MO
3. To train drivers on decontamination of ambulance
15.
Laboratory
1. To provide knowledge and training on PI and PPE
2. To brief staff on how to handle specimen
3. To stock pile reagents and consumables
4. To demonstrate to Doctors and nurses on packing of
specimen
5. To arrange roster for designated lab. Staff during an
outbreak
6. To contact IMR and arrange transport to dispatch specimen
to IMR
5.0 ORGANIZATIONAL RESPONSE TO INFLUENZA PANDEMIC.
The hospital Influenza Pandemic Technical committee should be activated during the Interpandemic period (planning and preparedness) from Phase 3 onwards.
6.0 HOSPITAL OPERATION ROOM
6.1 The operation room acts as the centre where the department coordinate activities,
manage data and ensures communication.
6.2 In phase 1 & 2, operation room will be fully equipped with relevant equipments such as
communication lines, electronic and printed materials and data.
6.3 In phase 2, 4 & 5, the operation room will start to function. The staff is required to
monitor field activities, gather and analyze data and disseminate information to various
stakeholders.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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7.0 TRIAGE CENTRE
A special PI counter outside/ in front of A & E / OPD to screen for suspected PI patients.
The PI counter will be manned by dedicated staff. Signage/ banners will be posted in front
to inform the public. Allow patients with symptoms of PI will be channeled to the PI counter
without ongoing to the main registration counter to minimize contact with other patients.
8.0 STOCKPILING OF CONSUMABLES.
A stockpile of consumables for the epidemic will be prepared. Consumables consisting
mostly of PPE, alcohol based hand rubs and essential drugs.
9.0 RISK MANAGEMENT OF STAFF HANDLING PI PATIENT.
A register of staff handling PI patients will be created. The number of staff handling the
patient will be minimized. Staff will monitor their own body temperature twice a day. If fever
develops within one week fro the date of handling the patients, the staff should see the
physician in charge immediately. This staff will be takeout of the team and treated as
suspect and placed in a single isolation room. Further notification to the Health clinic will be
required for contact tracing.
10.0
MEDIA COMMUNICATION
All staff refrain from talking to the media and press statement released will be by the
Hospital Director.
11.0
SETTING UP OPERATION ROOM
The Hospital Director on receiving confirmation of suspected PI case from specialist will
activate the Pandemic Influenza Operation Room. He will provide information to the District
Health Office Hilir Perak and State Health Department Operation Room. All information on
suspects and probable cases will be noted. To monitor the welfare of the exposed staff to
PI, a registry of staff exposed to Suspected PI and their progress are monitored daily. He
will coordinate all activities related to PI Operation room, l received IMR results, inform and
disseminate results to the appropriate department
11.1 Admission
The registration of admission will be done via phone from the isolation ward. Handle
patient‟s belongings such as I.C in a plastic bag to minimize contamination. Patient
should wear a surgical mask when using common areas ( toilets) and adviced on
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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cough etiquette. Encourage patient to observe Hand hygiene and care of personal
hygiene.
11.2 Discharge Policy
On discharge, a designated ambulance will send the patient home. Clear instructions
must be given to patient. The patient should monitor and record body temperature
twice a day. Convalescent cases should remain at home for 7 days, staying indoors
and minimal contact with others. It they have an elevated temperature of 38⁰C or
above on 2 consecutive occasions, they should report to the Hospital where they are
discharged. The patient should be followed up by the health care facility from which
they were discharged after home quarantine period.
11.3 Transportation of patient to designated Hospitals
11.3.1 Hospital Ambulance
Designated ambulance solely for PI patient. Do not use for other patient or
other purposes even though the ambulance is at stand-by. Park in designated
PI lot. When transporting the PI patient, off the air-conditioning and wind down
all the windows. Staff accompanying and driver transporting PI cases should
wear appropriate PPE. If possible only one staff (fully protected*) to
accompany patient. Staff to sit in front unless patient is ill.
No relatives should accompany the patient in the same ambulance unless the
patient is a child, then one parent accompany child and both should wear
surgical mask. The dedicated nurse accompanying PI patient to designated
hospital
should
admit
patient
straight
into
the
PI
isolation
ward.
After handing over the case she should enquire from the PI receiving nurse of
the designated hospital the whereabouts of the degowning area and remove
all contaminated PPE, bathe and change to clean OT attire before traveling
back to hospital. Driver sending PI patients to designated hospital should
decontaminate /disinfect ambulance using PPE and remove PPE and bathe
before travelling back to their own hospital.
11.3.2 Disinfection Of Ambulance
The ambulance must be disinfected following manufacture‟s recommendation
or with available disinfectant (alcohol 70% / sodium hypochlorite 1000ppm)
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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after every case and air dried with windows wind down. Wash or damp wipe
ambulance. Avoid spraying as that might cause re-aerosolize of infectious
material. Non-patient-care area of the ambulance should be cleaned and
maintained according to manufacturer‟s recommendations. The trolley or
wheelchair used to transport PI patient needs to be disinfected with sodium
hypochlorite 1000 ppm after every case. Staff washing and disinfecting
ambulance should wear full PPE.
12.0
NURSING PROTOCOL
Aim: To minimize staff exposure to PI patients.
12.1 Nursing care plan
Plan appropriately all the nursing care & procedures required for the patient to
minimize prolonged & frequent contacts. Ensure patient‟s care is not compromised.
12.2 Medical Equipment
Use disposable items whenever available. Individual patient care items such as
thermometer, B.P set should be kept inside the isolation room. Reusable equipments
(X-Ray machines) must be decontaminated before use on another patient. Minimize
patient‟s belongings in the room
12.3 Documentation
The patient‟s case notes should be kept outside the isolation room at all times.
Stationeries should not be brought out of the isolation room.
12.4 Patient‟s basic needs
If patient‟s condition allowed, provide the basic necessity that is required such as
entertaining materials, TV or radio. For communication, allow personal hand phone
for personal use and patient alarm call system for patient to communicate with the
staff.
12.5 Health Education
All Health care workers including support service should be trained on isolation
control and adhere strictly to Standard Precaution and Airborne transmission
precaution. Hand hygiene to be performed before and after patient contact, after
removal of gloves and when necessary. All staff to be trained on hand hygiene &
proper use of PPEs.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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12.6 Personal protective equipment (PPE)
Use PPE appropriately and correctly.
TYPE OF PPE
Gloves
USE OF PPE
Use sterile gloves for invasive procedures
Change gloves after each procedure even though on the same patient.
Use non-sterile gloves when handling body fluids, during cleaning and disinfection
and during housekeeping.
Mask
Staff to wear N95 mask when attending to patient
PAPR (powered air purification respirator) may be use during aerosol generating
procedure such as intubation.
Patient to wear surgical mask during transporting or when in contact with others
Face shield
Wear face shield / goggles if splashes are anticipated.
/goggles
Gown
Use long sleeves disposable gown while attending to patient and change after
each patient.
Support services staff to wear long sleeves disposable gown while performing
housekeeping in the isolation room
OT cap
13.0
Worn to protect hair from contamination.
NURSING PROCESS
13.1 Infection Control in the Isolation Room
Support services staff should wear appropriate PPE when collecting linen and waste.
Wash hands after completing task.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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Management Of
All linen used in the isolation room must be placed in the red laundry bag
Soiled Linen
lined with alginate bag. Transport laundry bags in a closed container
directly to the laundry collection area.
Management Of
All disposable items and contaminated waste to be disposed into clinical
Clinical Waste
waste bin and transported in a closed container directly to the storage area
and then to the incineration plant.
Disposal Of Sharps
Housekeeping

All sharps must be disposed only into sharps bin

You use it, you dispose it.

Do not recap or manipulate sharps

Sharps bin should not be ¾ full

Place bin at site of use
Cleaner observed full PPE. Follow cleaning schedule. Keep room / ward
clean. Mop floor every shift and when necessary using detergent and
disinfectant sodium hypochlorite 0.1%.
Terminal disinfection:
All surfaces should be disinfected with sodium hypochlorite 1,000 ppm
(0.1%)
and
leave
to
air
dry
for
at
least
3
hours.
Compressed air / spray that might re-aerosolize infectious material should
not be used for cleaning.
SPILLAGES
Spillages must be attended to immediately: Sprinkle germicep granules
(Sterisorb) over spillages and leave for 10 minutes. Scoop away spillages
and mop area. Mops and buckets should be disinfected after removal of
spill. Use PPE when handling spillages.
Disinfection &
Use disposable items if possible. For reusable items, decontaminate, pack
Sterilization
in double clear plastic bag and label “Biohazard” and sent to CSSU for
disinfection, cleaning and sterilization.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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Decontamination
For
decontamination,
use
disinfectant
as
recommended
by
the
manufacture or available chlorine compound, Sodium hypochloride 0.1%
(1,000 ppm) or alcohol 70%.
14.0
LINES OF COMMUNICATION
14.1 Media Communication
14.1.1 Refrain staff from talking to reporters
14.1.2 Press release coordinated at MOH level
14.2 The „Bilik Gerakan‟/Operations Room at Hospital Teluk Intan, operates office hours
daily with telephone and fax services currently but subject to changes as and when
the need arises. Personnel in „Bilik Gerakan‟ will receive investigation reports from
IMR laboratory and notify the ward concerned. Personnel will provide information and
daily census of all PI admission/discharges and registry of staff exposed to /cares of
PI cases to the State Health Department Operations Room and health office
according to schedule given using format form NIPPP strategies
14.3 Security and Visitors
14.3.1 All isolation facilities will be cordoned off
14.3.2 Security guards stationed
14.3.3 Visitors will be kept to a minimum
14.3.4 Communication with family members by telephones/hand phones
15.0
DEATH POLICY
Notify death in the ward to the relevant person and State Health Office for further
instructions. If post-mortem is required, it should be performed in accordance with the
MOH Guidelines for Post-Mortems involving Unknown/Uncertain Infectious Agents.
Minimum handling of the body. HCWs to wear PPE when handling body. Trolley for
transporting body should be disinfected after use.
16.0
HEALTH CARE WORKERS SURVEILLANCE.
16.1 Monitoring of Staff Handling PI Patients
16.1.1 Create register of staffs attending to PI cases.
16.1.2 Minimum staff nursing patient. And should only be from dedicated team.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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16.1.3 Monitor body temperature twice a day.
16.1.4 Fever within one month, report to Physician/ID Specialist stat.
16.1.5 Fulfill criteria for suspected/probable cases of PI should be notified to the
Hospital Director for further action as part of the hospital surveillance of PI.
16.1.6 A register of all categories of staff attending to cases of PI should be created.
Data of staff‟s identification and duration of contact with PI cases are recorded.
(Refer page 39 & 41 – Medical Strategies – Registry of staff handling PI
patients).
16.1.7 All these staffs are required to monitor their body temperature twice a day
(morning and evening) and record in a temperature chart. Avoid taking own
temperature while on duty inside the isolation room.
16.1.8 Any HCWs who develops fever within one month after nursing or handling PI
patient should be immediately refer to the Physician / Infectious Disease
Specialist at designated hospital as soon as possible.
16.2 Advice for Healthcare workers
16.2.1 Strict adherence to infection control measures: Standard Precaution &
Isolation Precautions.
16.2.2 Observe personal /hand hygiene -: hand washing or alcohol based hand rub
16.2.3 Staff is advised to bath and change clothing before going home.
16.2.4 Observe a healthy life style: maintain good health and balance diet.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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CASE DEFINITIONS:
Suspected case
A person presenting with history of an acute onset of;

High fever (> 38º C)
AND

Dry cough
AND

One or more of the following: sore throat, nasal congestion/blockage,
myalgia, headache, vomiting (infant), fits (infant);
WITH

Close contact* with a person diagnosed with PI within 10 days of the onset of symptoms
or recent history of travel to areas** reporting cases of Pandemic Influenza (PI).
Probable case
A suspected case with limited laboratory confirmation of Influenza A / sub-type
OR

A person with an unexplained respiratory illness resulting in death with history of close
contact* with a person diagnosed with PI within the last 10 days or recent history of
travel to areas** reporting cases of PI.

* Close contact means having cared for, having lived with, or having had direct contact
with secretions and body fluids of person with PI

** Countries identified as affected areas thus far: …
Exclusion criteria
A case should be excluded if an alternative diagnosis can fully explain their illness.
SCREENING OF PATIENTS AT A&E/JPL:
1.
A special counter should be set up in the A&E/JPL for suspected PI patients to whom
patients can come directly. This counter should be manned by dedicated staff
specifically for PI (1 MA or S/N and a JM or attendant). Depending on the phase of the
alert and the number of cases expected, screening counters may need to be set up in
the car park or nearby open spaces.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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2.
All patients who come to A&E/JPL should be screened for suspected PI.
3.
All patients who fulfill the screening criteria for PI should be rapidly diverted designated
triage rooms (old HO quarters) by ambulance to minimize transmission to others. These
patients should be given a surgical mask to wear.
4.
Staff involved in the screening process (at the counter) should wear surgical mask,
plastic apron, disposable gloves and face shield and wash hands before and after
contact with any patient.
5.
Screening must be done in the Doctor‟s room also to ensure that cases missed at
screening counter are picked up.
6.
There must be adequate posters and signage to direct patients to the screening
counters.
7.
(Instructions for activating this screening process will come from the National Influenza
Pandemic Committee (NIPC) through the State Health Department. It is likely to be
called at Phase 3(b) or Phase 4 alert. The Hospital Director will initiate the setting up of
screening counters).
TRIAGE
1.
The designated PI team on-call (includes physician/ pediatrician on-call, 1 MO, 1-2 staff
nurses, 1 MA & 1 attendant) must be ready to receive the screened patients from A&E
and JPL at the triage room (old HO quarters).
2.
The designated PI team must be fully gowned in PPE.
3.
Cases must be rapidly triaged into „suspected PI‟ or „not PI‟ according to the case
definition.
4.
The severity of each suspected PI case must be assessed clinically by the physician/
pediatrician on-call or PI MO. Stable cases/ill cases (intubated or impending,intubation)
will be referred to Hospital Raja Permaisuri Bainun, Ipoh.
5.
The physician/ pediatrician on-call will then call Pengarah, ID specialist (Hospital Ipoh)
and Medical Officer of Health before transferring the case to Hospital Raja Permaisuri
Bainun, Ipoh.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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TRANSPORTING SUSPECTED PI CASES
1.
Once the ID specialist has been informed of a suspected case, the patient will then be
transferred to Hospital Raja Permaisuri Bainun, Ipoh with the designated PI ambulance.
2.
The designated ambulance driver is to wear N95 mask, plastic gown, gloves and
surgical cap.
3.
For stable cases, a SN or MA in full PPE will accompany the patient but he or she should
be seated in front with the driver. For intubated/ unstable cases, the PI MO and a SN or
MA (in full PPE) should accompany the patient in the back of the ambulance.
4.
There must be a partition separating the driver from the patient in the ambulance. The air
conditioning must be turned off and the windows opened.
5.
The ambulance must be cleaned and disinfected with sodium hypochlorite 1000ppm at
the destination hospital (Ipoh) before returning to Hospital Teluk Intan.
TRANSFER CRITERIA
In phase 3 and above:
1.
All suspected PI cases, will be transferred to Hospital Raja Permaisuri Bainun, Ipoh.
(Stable/unstable cases).
2.
Asymptomatic household contacts or other close contacts of the case will be
quarantined at home. They will be monitored and followed up by Pejabat Kesihatan
Teluk Intan.
3.
FOLLOW-UP OF SUSPECT CASES
1.
Any clinic that has referred any suspect cases to the designated PI hospital is required
to follow-up with that hospital (by telephone, daily) on the diagnostic outcome of the
case. If the case is diagnosed as a “probable case”, all his or her contacts at the clinic
will be placed in quarantine*. Guideline on staff monitoring for PI is to be strictly
followed.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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*Quarantine: Quarantine for a clinic staff means isolation in his or her home for a period of 10
days since last contact with a “probable case”.
MANAGEMENT OF SUSPECTED CASES
(Patients will only be admitted to Hospital Teluk Intan in Phase 5 onwards, when a
directive comes from the State Health Director)
1.
A detailed history of the following should be obtained: clinical, travel and contact history,
including occurrence of respiratory disease in contacts during the last 10 days.
2.
Investigations to be taken:
2.1 Basic (as and when necessary): FBC, BUSE, ABG, RBS.
2.2 Chest X-Ray (a portable x-ray machine must be kept in the isolation ward once the
first case is admitted).
2.3 Specific: throat or nasopharyngeal swab (to be put inside viral transport media).
2.4 Others: Blood C&S, Sputum C&S, Mycoplasma, Chlamydia and Legionella serology.
3.
Virology samples should be sent to the Virology Unit, IMR.
4.
Bacteriology samples are processed in the respective hospitals (if assistance is required,
the nearest Public Health Laboratories can be approached).
TREATMENT
Antiviral Therapy
Ideally, influenza antiviral therapy works best when given early. Hence when there is a high
index of suspicion, antiviral drugs can be given early at the discretion of the attending physician.
Indications for antiviral therapy
During Phase 1 and 2 of the PI
1.
Treatment is suggested for all patients admitted.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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2.
The family contacts of the index case are put on house quarantine for 10 days and IF
ANY one of them manifest with flu-like disease, ALL household contacts will then be
provided treatment on-site.
3.
If the contacts have any of the co-morbidities listed above or have severe symptoms,
they will be admitted.
During Phase 3 and above
1.
Since supply is expected to be limited, drugs may be reserved for patients who are ill or
those
with
high
risks
for
influenza-related
complications
(co-morbidities
and
complications).
Antiviral Agents
Preferred Option
1.
For Adults: Oseltamivir 75 mg bid.
2.
For Children: Oseltamivir depending on weight.
3.
Weight
Dose
<15 kg
30 mg bid
>15 kg to 23 kg
45 mg bid
>23 kg to 40 kg
60 mg bid
>40 kg
75 mg bid
The duration of therapy is usually 5 days.
*Because of the unknown effects of influenza antiviral drugs on pregnant women and their
fetuses, oseltamivir should be used during pregnancy only if the potential benefit justifies the
potential risk to the fetus.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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SUPPORTIVE CARE
1.
Supportive care should also be provided when necessary i.e. oxygen and ventilation
support, hydration, blood gas monitoring, nutrition, etc.
2.
To reduce possible spread to healthcare workers, nebuliser use should be avoided.
3.
If CXR reveals pneumonic infiltrates, empirical antibiotics as recommended for
community acquired pneumonia should be commenced (options would include: 2nd / 3rd
generation cephalosporins and macrolide, ß lactam/ß-lactamase inhibitors, doxycycline
or the respiratory fluoroquinolones).
DISCHARGE OF PATIENTS
The following criteria are to be considered prior to making a decision regarding discharge from
hospital regarding a convalescent case:
Clinical symptoms/findings:
1.
Clinically stable for 48 hours
2.
Afebrile for >24 hours
3.
Able to tolerate orally
Laboratory tests if previously abnormal:
1.
White cell count returning to normal
2.
Platelet count returning to normal
3.
Creatine phosphokinase returning to normal
4.
Liver function tests returning to normal
5.
Plasma sodium returning to normal
Radiological findings:
1.
Improving chest x-ray changes
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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FOLLOW-UP FOR CONVALESCENT CASES
1.
Discharged convalescent patients should monitor and record their temperature twice
daily.
2.
If they have an elevated temperature of 38 degrees Celsius or above on two consecutive
occasions they should contact Hospital Teluk Intan Operations Room.
3.
On discharge, a designated ambulance should send the patient home.
4.
As there is a potential for continued carriage (and hence the risk of continuing
transmission) a precautionary approach is warranted. Therefore, following discharge
from hospital, convalescent cases should remain at home for 7 days. During this period
they should stay indoors, keeping contact with others to a minimum.
ISOLATION AND INFECTION CONTROL
Newly diagnosed cases of PI are potentially infectious and should be isolated and
accommodated as follows in descending order of preference:
1.
Negative pressure rooms with the door closed (only available in Hospital Ipoh).
2.
Single rooms with their own bathroom facilities. Single rooms can be fitted with extractor
fans (Hospital Teluk Intan Isolation Ward – Old HO quarters).
3.
Cohort placement (if there are a large number of similar cases) in an area with an
independent air supply, exhaust system and bathroom facilities (Ward 4A/4B Hospital
Teluk Intan).
4.
Turning off air conditioning and opening windows for good ventilation is recommended if
an independent air supply is unfeasible. Windows and extractor fans (if used) should not
open directly into public places. Patients should be nursed according to the Isolation
Procedures as for airborne infections.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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GUIDELINES FOR COHORTING PATIENTS IN HOSPITAL TELUK INTAN (only in Phase 5
and above)
1.
Suspected and probable cases as well as contacts should not be nursed together.
2.
Beds should be placed more than 3 feet apart.
3.
Patients should use a surgical mask when using common areas in the cohort area (e.g.
toilets, etc).
4.
Common areas should be regularly cleaned using standard hypochlorite solutions to
reduce cross contamination.
5.
Good ventilation should be encouraged with air exchanges of at least 6 cycles/min (an
exhaust extractor fan may be useful).
6.
Good hand and personal hygiene is encouraged among patients including regular hand
washing or use of alcohol hand gels.
7.
Strict adherence to the barrier nursing of patients with PI, using precautions for airborne
transmission.
8.
All Health Care Workers (HCW) attending to the patient should adhere to the MOH
Infection Control Policy at all times
9.
All staff, including ancillary staff should be trained in the infection control measures
required for the care of such a patient.
10.
There should be designated ancillary staff.
11.
Movement of patients outside of the isolation unit should be avoided. If moved the
patients should wear a surgical mask.
12.
Visitors should not be allowed into the isolation wards except in very extraordinary
situations. If they are allowed entry, they should be issued with personal protective
equipment (PPE) and their visit supervised.
13.
All non-essential staff (including students) should not be allowed into the unit/ward.
Polisi Pandemik Influenza
Unit Kawalan Infeksi, Hospital Teluk Intan
Review by 2011
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