Download H1N1 Flu PPT - New Jersey Primary Care Association

“All the Flu that is fit to print”
and some that is not…
Amelia Muccio
Director of Disaster Planning
NEW JERSEY PRIMARY CARE ASSOCIATION
Seasonal Influenza
• Influenza (the flu) is a contagious respiratory illness
caused by influenza viruses.
• It can cause mild to severe illness, and at times can lead to
death.
• The best way to prevent seasonal flu is by getting a
seasonal flu vaccination each year.
• Each year in the U.S. on average, 5% to 20% of the
population gets the flu; on average, more than 200,000
people are hospitalized from flu-related complications,
and about 36,000 people die from flu-related causes.
• Some people, such as older people, young children, and
people with certain health conditions, are at high risk
for serious flu complications.
Influenza A
• The Influenza A virus subtypes that have been confirmed
in humans, ordered by the number of known human
pandemic deaths, are:
• H1N1 caused "Spanish Flu" and 2009 H1N1 outbreak
• H2N2 caused "Asian Flu"
• H3N2 caused "Hong Kong Flu"
• H5N1 is "bird flu", endemic in avian
• H7N7 has unusual zoonotic potential
• H1N2 is currently endemic in humans and pigs
• H9N2, H7N2, H7N3, H10N7 (avian)
• The Influenza A virus subtypes are labeled according to
an H number (for hemagglutinin) and an N number (for
neuraminidase).
Influenza B
• Influenza B viruses are only known to infect humans and
seals giving them influenza.
• This limited host range is apparently responsible for the
lack of Influenza virus B caused influenza pandemics in
contrast with those caused by the morphologically similar
Influenza virus A as both mutate by both genetic drift and
reassortment.
• Further diminishing the impact of this virus in man,
influenza B viruses evolve slower than A viruses and
faster than C viruses.
• Influenza virus B mutates at a rate 2-3 times lower than
type A.
Influenza C
• Influenza C viruses are known to infect humans
and pigs giving them influenza.
• Flu due to the type C species is rare compared to
types A or B, but can be severe and can cause
local epidemics.
Influenza Symptoms
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Fever
Cough
Sore Throat
Runny or Stuffy Nose
Body Aches
Headache
Chills
Fatigue
Diarrhea
Vomiting
Seasonal Flu Vaccine
• The annually updated trivalent influenza vaccine
consists of hemagglutinin (HA) surface
glycoprotein components from influenza H3N2,
H1N1, and B influenza viruses.
• The dominant strain in January 2006 is H3N2.
• Measured resistance to the standard antiviral
drugs amantadine and rimantadine in H3N2 has
increased from 1% in 1994 to 12% in 2003 to
91% in 2005.
Who Should Get Seasonal Flu Shot?
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Children aged 6 months up to their 19th birthday
Pregnant women
People 50 years of age and older
People of any age with certain chronic medical conditions
People who live in nursing homes and other long-term
care facilities
• People who live with or care for those at high risk for
complications from flu, including:
– Health care workers
– Household contacts of persons at high risk for complications from
the flu
– Household contacts and out of home caregivers of children less
than 6 months of age (these children are too young to be
vaccinated)
Who Should NOT Get Seasonal Flu Shot?
• People who have a severe allergy to chicken eggs.
• People who have had a severe reaction to an
influenza vaccination in the past.
• People who developed Guillian-Barre syndrome
within 6 weeks of getting an influenza vaccine
previously.
• Children less than 6 months of age (influenza
vaccine is not approved for use in this age group).
• People who have a moderate or severe illness
with a fever should wait to get vaccinated until
their symptoms lessen.
H5N1 “Avian/Bird Flu”
• Avian influenza is an infection caused by avian (bird)
influenza (flu) viruses.
• These influenza viruses occur naturally among birds.
• Wild birds worldwide carry the viruses in their intestines,
but usually do not get sick from them.
• However, avian influenza is very contagious among birds
and can make some domesticated birds, including
chickens, ducks, and turkeys, very sick and kill them.
• Avian influenza is transmissible to humans (this requires
extremely close contact with infected birds, particularly
feces).
• H7N1 and H9N2 (also bird flu)
H1N1 “Swine Flu”
• 2009 H1N1 (referred to as “swine flu” early on) is a new
influenza virus causing illness in people.
• This new virus was first detected in people in the United
States in April 2009.
• This virus is spreading from person-to-person worldwide,
probably in much the same way that regular seasonal
influenza viruses spread.
• On June 11, 2009, the WHO signaled that a pandemic of
2009 H1N1 flu was underway.
H1N1
• This virus was originally referred to as “swine flu”
because laboratory testing showed that many of the genes
in this new virus were very similar to influenza viruses
that normally occur in pigs (swine) in North America.
• But further study has shown that this new virus is very
different from what normally circulates in North
American pigs.
• It has two genes from flu viruses that normally circulate in
pigs in Europe and Asia and bird (avian) genes and human
genes
• Scientists call this a "quadruple reassortant" virus
Summer Flu? (Sept 10, MMWR)
• During the last 2 weeks of August,
influenza activity increased in the
southeastern United States to levels of ILI
usually seen during winter seasonal
influenza peaks
• Approximately 97% of all influenza viruses
currently circulating in the United States
are pandemic H1N1 viruses that are
sensitive to Oseltamivir or Zanamivir
The Makings of a Pandemic
• The gene’s segmented nature facilitates genetic
reassortment which leads to genetic diversity in type A.
– Antigen drifts (minor)
– Antigen shifts (major)
• The major antigenic variations underlie the deadly
worldwide pandemics (1918 ‘Spanish’, 1957 ‘Asian’,
1967 ‘Hong Kong’) due to population’s lack of immunity
to novel virus subtype.
• New concerns regarding disease epidemiology surfaced in
1997 as direct disease transmission from animals to
humans caused fatalities in Hong King.
• In pandemic, virus is transmissible human to human.
Pandemic Influenza
• An influenza pandemic is an epidemic of an influenza
virus that spreads on a worldwide scale and infects a large
proportion of the human population.
• The 1918 Spanish flu is the most serious pandemic in
recent history, killing 50 million people (500,000 U.S.
deaths).
• There have been about three influenza pandemics in each
century for the last 300 years.
• The most recent ones were the Asian Flu in 1957 (70,00
U.S. deaths) and the Hong Kong Flu in 1968 (34,000 U.S.
deaths).
More Flu…
• The “canine influenza virus” is an influenza H3N8
influenza virus (not a human influenza virus) that was
originally an equine (horse) influenza virus.
• This virus has spread to dogs and can now spread between
dogs.
• Vaccination is available .
• H7N7 and H3N8 “Horse Flu”
• The disease has a nearly 100% infection rate in an
unvaccinated horse population with no prior exposure to
the virus.
• While equine influenza is historically not known to affect
humans, the impact of an outbreak among even the animal
population would have been devastating.
Seasonal Influenza vs. H1N1Influenza
• One thing that appears to be different from
seasonal influenza is that adults older than 64
years do not yet appear to be at increased risk of
2009 H1N1-related complications thus far.
• CDC laboratory studies have shown that no
children and very few adults younger than 60
years old have existing antibody to 2009 H1N1
flu virus; however, about one-third of adults
older than 60 may have antibodies against this
virus.
Estimated influenza activity levels reported by state epidemiologists, by level of
activity --- United States, week ending August 29, 2009
Current Situation
• Visits to doctors for influenza-like illness (ILI) are increasing
nationally. Visits to doctors for influenza-like illness are higher than
what is expected during this time of year and have increased for five
consecutive weeks now. This is very unusual for this time of year.
“In Their Prime”
• The information analyzed by CDC supports
the conclusion that 2009 H1N1 flu has
caused greater disease burden in people
younger than 25 years of age than older
people.
• At this time, there are few cases and few
deaths reported in people older than 64
years old, which is unusual when compared
with seasonal flu.
Medical Complications
• The virus targets and reproduces in the respiratory
tract.
• Medical complications due to the flu include
• Pneumonia (viral and secondary bacterial)
• Sinusitis, croup, bronchitis
• Myocarditis, myositis, pericarditis
• Reye Syndrome
• Fatigue (persists for weeks)
• Subsequent convalescence phase can last for
weeks with lingering respiratory symptoms and
malaise (post-influenza asthenia).
H1N1 Hospitalizations Reported to the CDC: Underlying Medical Conditions, as of
June 19, 2009 (N=268)
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Asthma H1N1 Hospitalized, 32%
COPD H1N1 Hospitalized, 32%
Diabetes, H1N1 Hospitalized, 15%
Chronic CVD, H1N1 Hospitalized 14%
Immunocompromised, H1N1 Hospitalized, 13%
Current Smoker, H1N1 Hospitalized, 10%
Chronic Renal Dis III/IV, H1N1 Hospitalized, 9%
Obesity, H1N1 Hospitalized, 8%
Neurocognitive Dis. H1N1 Hospitalized, 7%
Pregnant, H1N1 Hospitalized, 6%
Seizure, H1N1 Hospitalized, 6%
Cancer, H1N1 Hospitalized, 3%
High Risk Conditions
• High-risk conditions. Because persons with intellectual
disabilities may not be able to communicate that they feel sick,
additional attention needs to be devoted to recognizing when they
are ill.
– Neurodevelopmental delays, including Down syndrome
– Asthma or other problems of the lungs
– Any condition that affects respiratory function
– Diabetes
– Heart disease
– Chronic kidney disease
– Underlying metabolic disorder
– Immune suppression (including HIV/AIDS)
– Sickle cell disease
– Children taking long-term aspirin therapy for chronic disorders
Emergency Signs
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In adults, emergency warning signs that need urgent medical attention include:
Difficulty breathing or shortness of breath
Pain or pressure in the chest or abdomen
Sudden dizziness
Confusion
Severe or persistent vomiting
Flu-like symptoms improve but then return with fever and worse cough
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In children, emergency warning signs that need urgent medical attention include:
Fast breathing or trouble breathing
Bluish or gray skin color
Not drinking enough fluids
Severe or persistent vomiting
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with fever and worse cough
Prioritized H1N1 Vaccine
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Pregnant women because they are at higher risk of complications and can potentially
provide protection to infants who cannot be vaccinated;
Household contacts and caregivers for children younger than 6 months of age
because younger infants are at higher risk of influenza-related complications and
cannot be vaccinated. Vaccination of those in close contact with infants younger than 6
months old might help protect infants by “cocooning” them from the virus;
Healthcare and emergency medical services personnel because infections among
healthcare workers have been reported and this can be a potential source of infection
for vulnerable patients. Also, increased absenteeism in this population could reduce
healthcare system capacity;
All people from 6 months through 24 years of age
– Children from 6 months through 18 years of age because cases of 2009 H1N1
influenza have been seen in children who are in close contact with each other in
school and day care settings, which increases the likelihood of disease spread, and
– Young adults 19 through 24 years of age because many cases of 2009 H1N1
influenza have been seen in these healthy young adults and they often live, work,
and study in close proximity, and they are a frequently mobile population; and,
Persons aged 25 through 64 years who have health conditions associated with
higher risk of medical complications from influenza.
H1N1 Vaccination
– Vaccination is VOLUNTARY.
– Clinical trials for the H1N1 vaccine are underway, and if found to be safe and
effective, the first doses of vaccine are expected to be available in mid-October,
2009.
– Federal government is providing the H1N1 vaccine, syringes, gauze and sharps
containers to providers at NO CHARGE.
– Providers may charge a fee to administer the vaccine; insurance companies have
made an initial commitment to cover the administration fee. This includes
Medicare beneficiaries and NJ Medicaid – patients in fee-for-service Medicaid as
well as Medicaid HMOs and NJ Family Care.
– Some parents of young children may be concerned about Thimerosol in the H1N1
vaccine. The multi-dose vials of H1N1 vaccine do have a small amount
Thimerosol (which is a preservative). However, there is no Thimerosol in the
single-dose vials. If parents are concerned about this, they should request that
their child receive the injection from a single-dose vial.
– Because of a shortage of the H1N1 vaccine, the CDC has determined that
members of the following priority groups will receive this vaccine first. (NOTE:
There is no shortage of vaccine for the seasonal flu, and that vaccine is expected to
be widely available in September, 2009.)
H1N1 Vaccine
• Five manufacturers are producing vaccine
for the U.S.: Sanofi Pasteur, Novartis,
GSK, Medimmune and CSL.
Influenza A (H1N1) 2009 Monovalent Vaccines
• Injectable Vaccines
• Influenza A (H1N1) 2009 Monovalent Vaccine (CSL
Limited)
• Influenza A (H1N1) 2009 Monovalent Vaccine (Novartis
Vaccines and Diagnostics Limited)
• Influenza A (H1N1) 2009 Monovalent Vaccine (Sanofi
Pasteur, Inc.)
• Intranasal Vaccine
• Influenza A (H1N1) 2009 Monovalent Vaccine
(MedImmune LLC)
• For the injectible vaccines, or shots, the virus is inactivated
(killed), using the same processes the manufacturers use for
seasonal influenza vaccines. The vaccine administered via nasal
spray contains a live, attenuated virus.
How to Diagnosis the Flu?
• Diagnosis is often based on clinical
presentation (symptoms).
• Rapid viral diagnostic tests (viral subtype
not detected)
– Enzyme immunoassays (EIA)
• Tissue cultures (viral subtype detected)
– Novel viruses
20 to 1
• It is estimated that there are 20 cases of the H1N1 flu
for every confirmed case. Currently, testing to confirm
that the ill person has the H1N1 influenza is being done
only for hospitalized and other seriously ill persons. No
testing is being done on people who can be appropriately
treated in the community. Therefore, in discussing the
number of persons who are ill and who are likely to have
the H1N1 influenza, health care professionals are using
the term ILI, which stands for “influenza-like illness”.
Communicability
• The virus is spread by respiratory secretions from
an infected person who is coughing and sneezing.
• People infected with seasonal and 2009 H1N1 flu
shed virus and may be able to infect others from 1
day before getting sick to 5 to 7 days after.
• This can be longer in some people, especially
children and people with weakened immune
systems and in people infected with the new
H1N1 virus.
Fomite
• A fomite is any inanimate object or
substance capable of carrying infectious
organisms (such as germs or parasites) and
hence transferring them from one
individual to another
• Studies have shown that influenza virus
can survive on environmental surfaces
and can infect a person for 2 to 8 hours
after being deposited on the surface
• Door knobs/Toys/Phones
Flu Etiquette
• Cover your nose and mouth with a tissue when
you cough or sneeze; dispose of the tissue.
• If you don't have a tissue, cough or sneeze into
your sleeve.
• Avoid touching your eyes, nose, or mouth. Avoid
sharing or lending pens.
• Bring your own writing utensils to meetings.
• If you get the flu, avoid exposing others—stay
home from work!
Hand Washing Etiquette
• Frequently washing your hands dislodges and
washes away germs that you've picked up from
other people or contaminated surfaces.
• Happy Birthday Song (time needed to wash
hands)
• Wash hands with soap and water or use alcohol
based hand sanitizers before direct patient contact,
after contact with respiratory secretions, after
removal of gloves, or after contact with
contaminated surfaces.
• Wash hands before eating and drinking.
“Swine Flu Parties”
• Gatherings during which people have close contact with a
person who has 2009 H1N1 flu in order to become
infected with the virus
• The intent of these parties is for a person to become
infected with what for many people has been a mild
disease, in the hope of having natural immunity 2009
H1N1 flu virus that might circulate later and cause more
severe disease
• CDC does not recommend "swine flu parties" as a way to
protect against 2009 H1N1 flu in the future
N-95s and Fit-Testing
• All respirators that rely on a mask-to-face seal need to be
annually checked with either qualitative or quantitative
methods to determine whether the mask provides an
acceptable fit to a wearer.
• The qualitative fit test procedures rely on a subjective
sensation (taste, irritation, smell) of the respirator wearer
to a particular test agent while the quantitative use
measuring instruments to measure face seal leakage.
PPE
• Personal protective equipment is designed to protect employees from
serious workplace injuries or illnesses resulting from contact with
biological, chemical, radiological, physical, electrical, mechanical, or
other workplace hazards.
– Face shields, booties, goggles, aprons, gloves, vests, and
respirators.
• Proper Selection
• Proper Training
• Proper Usage (when and where)
• Proper Maintenance
• What PPE would use need for pandemic influenza outbreak? How
much? What do you do when PPE becomes a scarce resource?
• Has all staff been FIT-TESTED on N-95s???
Treatment—Antiviral Use
• Oseltamivir or Zanamivir for the treatment and/or
prevention of infection with 2009 H1N1 flu virus.
• Antiviral drugs are prescription medicines (pills, liquid or
an inhaled powder) that fight against the flu by keeping flu
viruses from reproducing in your body.
• If you get sick, antiviral drugs can make your illness
milder and make you feel better faster.
• They may also prevent serious flu complications.
Antivirals
• Clinical judgment is an important factor in antiviral
treatment decisions for all patients presenting for medical
care who have illnesses consistent with influenza.
• Treatment should be initiated as early as possible because
studies show that treatment initiated early (i.e., within 48
hours of illness onset) is more likely to provide benefit.
– No role for antiviral treatment in patients with mild flu.
– Patients hospitalized with suspected or confirmed
H1N1 flu should be treated with oseltamivir (Tamiflu)
or zanamivir (Relenza).
– Duration of treatment: 5 days.
– “High risk” outpatients with suspected or confirmed
H1N1 virus infection.
Antiviral Chemoprophylaxis
• Consideration of antiviral chemoprophylaxis: prescribing
antiviral medication to prevent the H1N1 flu in healthy persons
who are at high risk of becoming ill
– Health care professionals should consider prophylactic treatment
with antiviral medication for:
• Close contacts of patients with the flu when the non-ill person
is at high risk for complications of influenza.
• Health care personnel, public health workers, and first
responders with unprotected close contact exposure to an ill
person during infectious period.
– Duration of prophylactic treatment: for 10 days after last known
exposure.
The “Must Have” Kit this Fall
• Assembly a Flu Kit
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Hand sanitizers
Cough drops
Tea bags
Gatorade
Facial tissues
Masks (N-95)
Gloves
Chicken soup
Prevention messages
NJDHSS
• NJDHSS HIPER—is responsible of the
command, control and coordination of state health
operations.
– MCCs
– Pharmaceutical/Medical/Antiviral distribution sites
(SSS and SNS)
– DHSS emergency call center
• State EOC (ROIC)
– Exchange health and health support information
– JIC is located
• MCC/HCC/HACC (backbone)
– HACC includes NJPCA
H1N1 and the Healthcare Continuum
• Hospitals
• FQHCs
– Acute flu cases only
– POD
• Home Care
– Mass vaccinations
– Valuable resource and
– Alternate care sites
option for caring for the
– Treat non-acute
sick at home
– Screen and triage
– Home care increases social
worried well
isolate and can reduce
– Serve existing
transmission
population (stay
• Long Term Care
open)
– Surge for hospitals
(accommodate discharges)
Triage Policies
• Ask patients if they have influenza-like illnesses to
identify themselves upon arrival.
• Ensure that patients with ILI are evaluated expeditiously.
• Consider scheduling patients with ILI at the end of the day
or at a time separate from well visits.
• Consider having patients with ILI arrive through a
separate entrance or wait in separate areas.
• Ensure that a member of your staff calls ahead if you are
referring a patient with an ILI to another facility.
• Encourage your staff and your patients with ILI to remain
at home.
Flu Signage
• Place signs in waiting
areas describing
Universal Respiratory
Precautions and
Respiratory Etiquette.
• What else can we do
to flu-proof the
waiting areas?
Flu-Proof Waiting Areas
• Provide tissues in
waiting areas
• Provide no-touch
receptacles
• Provide alcohol based
hand sanitizers
• Provide symptomatic
individuals with a
surgical mask
• Encourage staff with
direct patients contact
to wear masks (ILI)
Incident Command System
Who Are You?
• Incident Commander
(IC)
• Safety (SNO)
• Public Information
Officer (PIO)
• Liaison (LNO)
• Planning
• Operations
• Logistics
• Finance/Administration
Job Action Sheets
• Developing good JAS that are
appropriate for a specific
agency’s personnel and
emergency response role can
take a lot of time, effort, and
collaboration.
• Lets planners and potential
responders (the people who are
actually going to perform roles)
clarify responsibilities and
identify gaps or overlaps.
• They can also serve as guides
for the development of a
training curriculum.
Sample JAS for Safety Officer
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Safety Officer: Reports to: Agency Incident Commander
Mission: Develop and recommend measures for assuring health department personnel safety
(including psychological and physical), and to assess and/or anticipate hazardous and unsafe
situations.
Immediate:
Receive appointment from Agency Incident Commander.
Read this entire Job Action Sheet and review organizational chart.
Obtain a briefing from Agency Incident Commander.
Establish Safety Command Post in proximity to the agency Emergency Operations Center (EOC).
Review the Incident Action Plan (IAP) for safety implications.
Intermediate:
Exercise emergency authority to stop and prevent unsafe acts.
Keep all staff alert to the need to identify and report all hazards and unsafe conditions and ensure
that all accidents involving personnel are investigated and actions and observations documented.
Arrange with Logistics to secure areas all areas as needed to limit unauthorized access.
Advise the Agency Incident Commander and Section Chiefs immediately of any unsafe, hazardous
situation (review Hazardous Materials Plan).
Schedule routine briefings with Agency Incident Commander.
Schedule routine briefings with Finance/Administration Section Chief.
Extended:
Observe all staff, for signs of stress. Report issues to Agency Incident Commander. Provide rest
periods and relief for staff.
Prepare end of shift report and present to oncoming Safety Officer.
Mental Health Resources
• What mental health
resources do you need for
your staff?
– Families?
– Patients?
• Are these resources
realistically available?
• What trainings might help
staff and patients cope?
• What else can you do to
keep up morale and
hinder burnout?
Psychological First Aid
• When you work with people during and after a disaster,
you are working with people who may be having reactions
of confusion, fear, hopelessness, sleeplessness, anxiety,
grief, shock, guilt, shame, and loss of confidence in
themselves and others.
• Your early contacts with them can help alleviate their
painful emotions and promote hope and healing.
• Your goal in providing this psychological first aid is to
promote an environment of safety, calm, connectedness,
self-efficacy, empowerment, and hope.
Psychological First Aid
• Promote Safety:
• Help people meet
basic needs for food
and shelter, and obtain
emergency medical
attention.
• Provide repeated,
simple, and accurate
information on how to
get these basic needs.
• Promote Calm:
• Listen to people who wish to
share their stories and
emotions, and remember that
there is no right or wrong way
to feel.
• Be friendly and compassionate
even if people are being
difficult.
• Offer accurate information
about the disaster or trauma,
and the relief efforts underway
to help victims understand the
situation.
Psychological First Aid
• Promote Connectedness:
• Help people contact friends and
loved ones.
• Keep families together.
• Keep children with parents or
other close relatives whenever
possible.
• Promote Self-Efficacy:
• Give practical suggestions that
steer people toward helping
themselves.
• Engage people in meeting their
own needs.
• Promote Help:
• Find out the types and
locations of
government and
nongovernment
services
and direct people to
those services that are
available.
Risk/Crisis Communication
4 Key Steps in Communicating an PH Emergency
1. Type of public health
information provided
2. Perceived and actual
reliability and
scientific soundness
of information
3. Source of
information
4. Timeliness of
information
Influenza Plan
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Identify a workplace coordinator who will be responsible for dealing with
2009 H1N1 flu issues and their impact at the workplace, including contacting
local health department and health care providers in advance and developing
and implementing protocols for response to ill individuals. The coordinator
should not wait for flu season to start in order to establish those contacts and
relationships, and check online resources of local public health officials
immediately to learn what you should be doing.
Examine policies for leave, telework, and employee compensation and
review with all employees so they are up-to-date on sick leave policies and
employee assistance services that are covered under any of your employeesponsored health plans. Leave policies should be flexible, non-punitive, and
well-communicated. They should allow workers who have the flu to stay
home and away from co-workers. Also, plan to have workers stay home if
they have to care for sick family members. Be prepared, in the event that
there are school closures, to allow workers flexible schedules or other
accommodations so they can mind their children and keep them safe at home.
Explore the possibility of some of your workers working from home with
appropriate infrastructure support.
Influenza Plan
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Identify essential employees, essential business functions, and other critical inputs
(e.g. raw materials, suppliers, subcontractor services/products, and logistics) required to
maintain business operations should there be disruptions during the 2009 H1N1 flu
outbreak – and make plans on how to communicate with people that perform essential
tasks to provide them assignments and work direction. Explore other ways you can
continue business operations if there are supply chain or other disruptions.
Share your pandemic plans with employees and clearly communicate expectations.
It is important to let your employees know your plans and expectations when 2009
H1N1 flu outbreaks occur in communities where you have a workplace. Consider ways
to communicate with employees who do not speak English or those with disabilities.
Prepare business continuity plans so that if there is significant absenteeism or
changes in the way you need to conduct business in the workplace during this outbreak
you can maintain operations. School dismissals and childcare provider closures may
increase absenteeism in the workplace. Health officials may also advise that
workplaces take multiple steps to increase the space between people and decrease the
frequency of contact among people, also known as “social distancing” to reduce the
spread of illness during a more severe outbreak.
Establish an emergency communications plan. This plan includes identification of
key contacts (with back-ups), chain of communications (including suppliers and
customers), and processes for tracking and communicating business and employee
status.
Minimal Components of a Private Sector/Critical
Infrastructure Plan
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Essential Services Provided
Essential Services Required
Reduced Staffing Plans
Contact Phone Trees
Social Distancing Plans (workplace separations and
shutdown of common areas)
Infection Control Policies and Procedures
Employee Support (HR) (pay, leave, family support, work
from home and mental health services)
Security Protocols
Interoperable Communications
Vital Records
10 Steps You Can Take: Actions for Novel H1N1 Influenza Planning and
Response for Medical Offices and Outpatient Facilities
• Develop a Business Continuity Plan – Novel H1N1 flu
outbreaks will impact your organization, employees,
suppliers of critical material, and your family. Identify
your office/clinic’s essential functions and the individuals
who perform them. Make sure you have trained enough
people to properly work in these essential functions
and allow for potential absenteeism. Develop a plan that
will sustain your core business activities for several
weeks. Make sure you have alternate plans for critical
supplies in case there is disruption in your supply chains.
For information about planning see:
http://www.ready.gov/business/plan/index.html
10 Steps You Can Take: Actions for Novel H1N1 Influenza Planning and
Response for Medical Offices and Outpatient Facilities
• Inform employees about your plan for coping
with additional surge during pandemic –
Provide clear and frequent communication to
ensure that your staff are aware and understand
the plan. Explain any policies and procedures that
will be used to protect staff and your patients, and
to manage a surge of patients. Improve the
resiliency of your staff by advising that
employees have a pandemic family plan or
personal plans.
10 Steps You Can Take: Actions for Novel H1N1 Influenza Planning and
Response for Medical Offices and Outpatient Facilities
• Plan to operate your facility if there is
significant staff absenteeism – Are you
ready for 20 to 40% of your employees not
being able to come to work? Cross
training your staff is key to resilience
here. What else can be done to assure
continuity of operations with reduced staff?
10 Steps You Can Take: Actions for Novel H1N1 Influenza Planning and
Response for Medical Offices and Outpatient Facilities
• Protect your workplace by asking sick
employees to stay home – Be sure to ask sick
staff to stay home. All personnel should self
monitor daily for signs and symptoms of
febrile respiratory illness. Staff who develop
these symptoms should be instructed not to report
to work, or if at work, should cease patient care
activities and notify their supervisor. Be sure to
align your sick leave policies so ill staff can stay
home.
10 Steps You Can Take: Actions for Novel H1N1 Influenza Planning and
Response for Medical Offices and Outpatient Facilities
• Plan for a surge of patients and increased
demands for your services –Consider using your
telephone system to deliver messages to incoming
callers about when to seek medical care at your
facility, when to seek emergency care, and where
to go for information about caring for a person
with flu at home. Consider extending your
hours of operation to include telephone triage
of patients during a community outbreak.
10 Steps You Can Take: Actions for Novel H1N1 Influenza Planning and
Response for Medical Offices and Outpatient Facilities
• Care for patients with novel H1N1 flu in your
facility – Make plans to screen patients for
signs and symptoms of febrile respiratory
illness at entry to the facility. If feasible, use
separate waiting and exam rooms for possible
novel H1N1 flu patients; plan to offer surgical
masks to symptomatic patients who are able to
wear them (adult and pediatric sizes should be
available), provide facial tissues, receptacles for
their disposal, and provide hand hygiene products
in waiting areas and examination rooms.
10 Steps You Can Take: Actions for Novel H1N1 Influenza Planning and
Response for Medical Offices and Outpatient Facilities
• Take steps to protect the health of your
workforce during an outbreak of H1N1 –
All healthcare personnel who come in close
contact with patients who may have novel
H1N1 flu should take precautions to
include use of respiratory and eye
protection for all patient care activities.
10 Steps You Can Take: Actions for Novel H1N1 Influenza Planning and
Response for Medical Offices and Outpatient Facilities
• Provide immunization against seasonal flu at
no cost to your staff – In the fall there may be
several influenza strains circulating at the same
time. Although seasonal flu immunization will
not provide protection to novel H1N1 influenza,
annual influenza vaccination is recommended for
health care professionals and will likely protect
against seasonal influenza strains.
10 Steps You Can Take: Actions for Novel H1N1 Influenza Planning and
Response for Medical Offices and Outpatient Facilities
• Make sure you know about the pandemic planning and
response activities of the hospitals, outpatient facilities
and local public health in your community – Actively
seek information from and coordinate with key medical,
clinical facilities and public health departments in your
community to learn about how they will manage patients
during a pandemic. Medical offices, emergency rooms,
urgent care centers and hospitals in communities with
outbreaks will likely have difficulty managing a large
influx of patients; a coordinated community response is
important to manage surge and assure optimal patient
care. Develop a plan to manage your patients who do not
need to seek emergency services.
10 Steps You Can Take: Actions for Novel H1N1 Influenza Planning and
Response for Medical Offices and Outpatient Facilities
• Plan now so you will know where to turn to for
reliable, up-to-date information in your local
community – Staff in healthcare settings should
monitor the CDC H1N1 Flu website and local and
State health department websites for the latest
information.
Additional Guidelines
• Develop other flexible policies to allow workers to telework (if
feasible) and create other leave policies to allow workers to stay
home to care for sick family members and children if schools close.
• Provide education and training materials in an easy to understand
format and in the appropriate language and literacy level for all
employees and patients.
• Instruct employees who are well but who have an ill family
member at home with the flu that they can go to work as usual.
These employees should monitor their health every day, and notify
their supervisor and stay home if they become ill.
Additional Guidelines
• Encourage employees to get the 2009 H1N1 vaccine.
• If an employee does become sick while at work, place
the employee in a separate room or area until they can go
home, away from other workers. If the employee needs to
go into a common area prior to leaving, he or she should
cover coughs/sneezes with a tissue or wear a facemask if
available and tolerable. Ask the employee to go home as
soon as possible.
When Can I Go Back to Work?
• CDC recommends that people with
influenza-like illness remain at home
until at least 24 hours after they are free
of fever (100° F [37.8°C]), or signs of a
fever without the use of fever-reducing
medications.
Keeping Healthy
• Maintain a healthy lifestyle; attention
to rest, diet, exercise, and relaxation
helps maintain physical and emotional
health.
• Resilience