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KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
10 Jumada Al Thani 1430
(03 June 2009)
REPLACES NUMBER:
New
APPLIES TO:
Medical and Clinical Affairs
Environmental Services
MCO-MC-INF-04-073
APPROVED BY:
(signature on file)
Executive Director
Medical & Clinical Affairs
2
PURPOSE:
Provide infection control guidance for health-care workers (HCWs) in health-care facilities evaluating or providing care for
patients with suspected or confirmed Swine Influenza type A H1N1.
DEFINITIONS:
Swine Influenza A H1N1 is a respiratory disease of pigs caused by type A Influenza virus that regularly causes outbreaks of
influenza in pigs.
Swine flu case definition-Appendix 1
High-risk aerosol generating procedures-Appendix 3
Respiratory hygiene/cough etiquette –Appendix 4
RT- PCR - reverse transcription polymerase chain reaction
Unprotected high-risk exposure-presence in the same room as a probable Swine influenza A H1N1 infected patient during an
aerosol generating procedure or event where infection control precautions were either absent or breached.
HEPA filter – high efficiency particulate air
AII room – Airborne infection isolation with negative air pressure
BiPAP –Bi-level positive airway pressure
CPAP – Continuous positive airway pressure
Cohort – a group of individuals sharing a common characteristic
DEM –Department of Emergency Medicine
MCA – Medical and Clinical Affairs
REFERENCES:
WHO Interim Infection Control and Prevention Guidelines for Epidemic- and Pandemic-Prone Acute Respiratory Diseases in
Health Care, June 2007 Available at http://www.who.int/csr
Center for Disease Control and Prevention Guideline for Isolation Precautions: preventing Transmission of Infectious Agents in
the Health-Care Settings, June 2007. Available at http://www.cdc.gov/ncidod/dhqp/gl_isolation.html
Ministry of Health Directive 34981/19 preventive measure for swine flu epidemics AH1N1 dated 09/05/1430
Center for Disease Control and Prevention Key facts about Swine Influenza (Swine Flu) 2009 available at
http://www.cdc.gov/swineflu/key_facts.htm
IPP MCO-MC-INF-04-027 Hand Hygiene Procedures
IPP LAB-MV-02-3 Guidelines for Handling and processing Specimens Suspected of Containing swine flu virus
IPP LAB-DM-03-15 Avian Flu H5/N1 Real-time PCR
IPP SS-07-01-01 Infection Control Policies and procedures Mortuary
Appendix 2 Standard Precautions English/Arabic
Appendix 3 Respiratory Protection
Appendix 4 Respiratory Hygiene/Cough Etiquette
Appendix 5 PPE Placement and Removal English/Arabic
Appendix 6 Specimen Collection
Appendix 7 Healthcare Worker Illness Monitoring Form
Appendix 8 Triage Questions for Suspected Avian Influenza Patients
Appendix 9 Contact Log
Figure 1 Initiation of AI Infection Control Precautions in Health-care Facilities
Figure 2 Department of Emergency Medicine Algorithms
Figure 3 Department of Family Medicine and Polyclinics Swine Flu Alert and Epidemic Response
Table 1 Barrier Precautions for Providing Care to Patients with Respiratory Illness
Table 2 Location of Negative Pressure Airborne Isolation Rooms by Unit
Table 3 Emergency Room Procedures
COMMENTS/POLICY:
1.
Available evidence suggests that transmission of human influenza viruses & Swine flu occurs through multiple
routes including large droplets, direct and indirect contact, and droplet nuclei.
Form 810-06 (Rev. 10-06) IC 202164
Page 1 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
APPLIES TO:
Medical and Clinical Affairs
Environmental Services
MCO-MC-INF-04-073
APPROVED BY:
(signature on file)
Executive Director
Medical & Clinical Affairs
2
1.1.
1.2
1.3
1.4
1.5
Studies suggest that droplet transmission is the major mode of transmission in the healthcare setting.
Standard precautions plus Droplet precautions are recommended for the care of patients with human
influenza.
No sustained efficient human-to-human transmission of avian influenza A is known to have occurred and
therefore, there is no evidence to suggest airborne transmission from humans to humans.
In swine flu the transmission from human to human occurs through coughing or sneezing of people infected
with the influenza virus. People may become infected by touching surfaces contaminated with the H1N1 virus.
Contact precaution and Droplet precautions are recommended in H1N1 virus.
2.
Early recognition, isolation, and reporting of possible H1N1 virus cases
2.1
Prompt identification and isolation of patients, HCWs, or visitors who may be infected with H1N1 virus is
critical to minimize the risk of nosocomial transmission and to enable efficient public health response.
2.2
Any persons entering KFSH facilities, including patients, visitors, and staff who are experiencing
respiratory symptoms of coughing and sneezing should cover the cough/sneeze using tissues and
clean their hands with soap and water or alcohol hand rub.
2.3
Posters advising these control measures are posted in public areas and locations throughout the outpatient
waiting areas of the DEM, Family Medicine, KFSH East and outpatient clinics.
2.4
If staff notice frequent and uncontrolled coughing by patients or visitors, tissues and/or a disposable surgical
mask will be provided to these individuals.
2.5
Ensure early assessment and investigation of possible H1N1 cases (Appendix 1 Case definitions).
2.6
Initiate infection control precautions promptly when H1N1 infection is suspected (Figure 1).
2.7
The Medical Director of Infection Control and Environmental Health will communicate cases to the MOH, and
MCA.
2.8
If H1N1 infections in animals or humans are verified to be in Saudi Arabia, consider the diagnosis of Swine flu:
2.8.1
in all patients who present with severe acute febrile respiratory illness (e.g. fever greater than
38 degrees centigrade, cough, shortness of breath) or other severe unexplained illness (e.g.
encephalopathy or diarrhea)
2.8.1.1 in patients with a history of pig exposure
2.8.1.2 Exposure to known or suspected H1N1infected patients
2.8.1.3 exposure to other severely ill people within the two weeks prior to symptom onset
2.9
Family members who accompany suspected H1N1-infected patients to the hospital can be assumed to have
been potentially exposed to the H1N1 virus and will be referred to the MOH for assessment of H1N1infection.
2.10
If symptoms and exposure history support the possibility of H1N1 infection, such patients will be put under
isolation precautions and will be moved away from other persons and evaluated as soon as possible.
3.
Personal Protective Equipment (PPE) is mandatory :
3.1
direct close contact with the patient is anticipated
3.2.
when entering the room where aerosol-producing procedures in H1N1-infected patients are being performed.
4.
Standard and Droplet precautions are the minimum level of precautions to be used when providing care for
patients with acute febrile respiratory illness, regardless of whether H1N1is suspected (Appendix 2).
5.
Standard and Droplet plus Contact precautions will be used for suspected or confirmed H1N1-infected patients.
See Table 1 , Appendix 3, and Appendix 5.
6.
Patient Placement
6.1
Suspected or confirmed infected patients should be placed in a room with adequate ventilation
(Isolation room) or area if available. (Table 2).
6.2
Suspected and confirmed infected patients may share rooms in designated multi-bed rooms
or wards.
6.2.1
Doors to any room or area housing suspected or confirmed infected patients must be kept closed
when not being used for entry or departure.
Form 810-06 (Rev. 10-06) IC 202164
Page 2 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
APPLIES TO:
Medical and Clinical Affairs
Environmental Services
MCO-MC-INF-04-073
APPROVED BY:
(signature on file)
Executive Director
Medical & Clinical Affairs
2
6.2.2
6.2.3
6.2.4
6.2.5
The number of persons entering the isolation room should be limited to the minimum number
necessary for patient care and support.
If single rooms are not available, patients infected with the same organisms can share rooms.
6.2.3.1 Decisions to initiate patient cohorting will be made by the attending physician and on-call
Infectious Diseases physician in consultation with the Infection Control Coordinator.
These rooms shall be in a well-defined area that is clearly segregated from other patient-care areas
used for uninfected patients.
Designated units or areas will be used for cohorting AI- or H1N1infected patients (suspected and
confirmed
will be housed separately).Confirmed cases will be placed in an Airborne Infection Isolation room.
6.2.5.1 the distance between beds will be at least one meter.
6.2.5.2 whenever possible, HCWs assigned to cohorted patient-care units will be experienced
employees who will not “float” or be assigned to other patient-care areas. Only employees
who have had Influenza vaccine will be assigned to cohorted patients.
6.2.5.3 the number of persons entering the cohorted area will be limited to the minimum number
necessary for patient care and support.
6.2.5.4 portable X-ray equipment will be available in cohort areas.
7.
8.
Preparation of the Isolation Room/Area
7.1
Droplet and Contact Isolation Signs will be placed on the room door.
7.2
An isolation cart will be placed outside the room.
7.3
A log for contact tracing if necessary will be kept at the room door entrance area of HCWs and visitors
entering the isolation room. See Appendix 9.
7.3.1 the log will indicate the patient medical record number, unit and room location, and
current date and will be sent daily by fax to the Infection Control offices.
7.3.2
the individual will print their name, hospital badge number, and contact number
(cell phone , telephone, pager ) on the log.
7.3.3
visitors will be requested to print their name and a contact number (telephone or cell phone)
7.4
Alcohol hand rub will be placed in the room in small bottles if there is no dispenser in room.
7.5
Any equipment that requires disinfection and/or sterilization will be placed in a designated container with lid
that will be stored on top of the isolation cart.
7.6
Disposable cleaning cloths and a disinfectant agent will be stored inside the isolation room for use by
nursing or support staff. .
Ambulatory Care/DEM
8.1
Signs will be posted to alert persons with severe acute respiratory illness to notify staff immediately and to use
respiratory hygiene/cough etiquette (Appendix 4)
8.2
Patients with acute febrile respiratory illness will be evaluated promptly (Figure 2)
8.3
Any patient who meets the criteria for persons at risk for H1N1infection will be placed in a negative pressure
room
8.4
assessment.
8.5
or in a single exam room if negative pressure exam room is not available.
8.3.1
The door of the exam room will be kept closed except for entry and departure until:
8.3.1.1 admission to hospital
8.3.1.2 discharge home
8.3.1.3 Possibility of H1N1 infection has been excluded
An infectious disease (ID) physician consult will be obtained promptly if H1N1is suspected based on
8.4.1
the ID consultant will determine if the case definition is met and if the patient requires admission.
8.4.2
If the patient is to be admitted the head nurse of the receiving unit will be notified.
8.4.3
If the patient is to be admitted the Infection Control Coordinator will be notified.
Patients with acute febrile respiratory illness will be separated from other persons in waiting areas. (Figure 1)
8.5.1
A 3 feet (1 meter) distance should be maintained between these patients and other patients in any
waiting area.
Form 810-06 (Rev. 10-06) IC 202164
Page 3 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
APPLIES TO:
Medical and Clinical Affairs
Environmental Services
MCO-MC-INF-04-073
APPROVED BY:
(signature on file)
Executive Director
Medical & Clinical Affairs
2
8.6
8.7
8.8
8.9
8.10
8.11
8.12
8.13
9.
.
8.5.2
Place the patient in an exam room as soon as possible with door closed.
8.5.3
Priority for exam rooms will be for any patient with a tracheostomy.
Tissues will be provided in the waiting area with waste receptacles for disposal of used tissues
Alcohol-based hand cleansers will be provided in waiting areas and patients will be encouraged to clean
hands after contact with respiratory secretions.
Cleaning of environmental surfaces in waiting areas will be performed by Housekeeping staff daily and when
they look soiled/dirty.
Any medical devices that are not disposable and used on patients will be cleaned and disinfected by the
nursing staff between patient use.
Patients will be asked to wear disposable surgical masks if they are capable of wearing them.
HCWs will use standard and droplet precautions when providing care, in close contact, for patients with acute
febrile respiratory illness.
8.11.1 movement of patients through the facility will be limited. If the patient must be transported the patient
will wear a surgical mask
8.11.2 If the patient is ventilated the ventilator will have a HEPA exhaust filter.
8.11.3 portable X-rays will be used when possible.
If a patient with suspected or confirmed H1N1infection is admitted or referred to another health-care facility,
the receiving unit or that facility will be notified by the attending physician.
High-risk aerosol generating procedures in patients with severe acute febrile respiratory illness will not be
performed in the ambulatory setting unless they are necessary to save a life and no alternative exists
8.13.1 If such a procedure is performed in this setting, an Airborne Infection Isolation room will be used
if available (Table 2)
8.13.2 HCWs will use PPE accordingly. (Appendix 3)
Specimen Collection/Transport/Handling
9.1
During inter-pandemic and pandemic alerts periods as defined in the WHO Global Influenza Preparedness
Plan, laboratory results for suspected H1N1infections should be confirmed by an approved laboratory.
9.2
Specimen quality, stage of disease, clinical condition and epidemiological exposure must be taken into
account in the interpretation of test results, especially for negative laboratory results in the context of clinical
suspicion. Consider additional investigations on a case by case basis.
9.3
The strategy for initial laboratory testing of each specimen should be to diagnose Influenza A virus infection
rapidly and exclude other common viral respiratory infections.
9.4
Laboratory results should ideally be available within 24 hours.
9.5
Assays available for diagnosis of H1N1 will be done only in clinical cases that meet the case definition and in
consultation with the infectious diseases physician. Only human samples will be tested.
9.5.1.1 Testing for seasonal influenza stains and other atypical subtypes of respiratory pathogens
is recommended.
9.6
Multiplex PCR for respiratory viruses
9.7
Avian influenza Real-time PCR assay
9.8
Viral Culture
9.9
Oropharyngeal swab specimens and lower respiratory tract specimens (e.g. bronchoalveolar lavage or
tracheal aspirates) are preferred because they appear to contain the highest quantity of virus for
Influenza H1N1 detection.
9.10.
Nasal or nasopharyngeal wash/aspirates are acceptable but may contain less virus and are not optimal.
9.11
Specimens are optimally collected within the first 3 days of onset of illness.
If possible, serial specimens should be obtained over several days from the same patient.
9.11.1 For collection and transport of specimens from the upper respiratory tract (Appendix 6).
9.12
Laboratory personnel will handle al patient specimens with suspected AI in a Biosafety Level 3 Laboratory.
9.12.1 Standard precautions will be followed and PPE will be used (Appendix 2).
9.13
Sera collection for influenza diagnosis:
9.13.1 An acute-phase serum specimen ( 3 to 5 mL of whole blood) should be taken soon after onset
of clinical symptoms and not later than 7 days after onset.
9.13.2 A convalescent-phase serum specimen should be collected 14 days after onset of the symptoms.
Form 810-06 (Rev. 10-06) IC 202164
Page 4 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
APPLIES TO:
Medical and Clinical Affairs
Environmental Services
MCO-MC-INF-04-073
APPROVED BY:
(signature on file)
Executive Director
Medical & Clinical Affairs
2
9.13.3
Where patients are near death, a second ante-mortem specimen should be collected.
10.
Radiology
10.1
The following procedure will be used for portable X-ray examinations and the technologist will:
10.1.1 Request assistance from nursing staff before entering the room.
10.1.2 Clean hands, and put on PPE. (Appendix 3)
10.1.3 Place cassettes needed for requested exam in a plastic bag and tape closed.
10.1.4 Enter room and take X-ray (s).
10.1.5 Peel back plastic bag without touching cassette and hand to nurse at the room doorway.
10.1.6 Discard plastic bag in room waste receptacle.
10.1.7 Remove soiled gloves turning them inside out.
10.1.8 Clean hands with alcohol hand rub (MCO-MC-INF-04-027).
10.1.9 Put on clean disposable gloves and clean the machine surfaces with disinfectant.
10.1.10 Remove gloves turning inside out and remove and discard gown (Appendix 3).
10.1.11 Clean hands with alcohol hand rub (MCO-MC-INF-04-027).
10.1.12 Exit room with machine and remove mask or respirator (Appendix 3).
11.
Family Medicine
11.1
Healthcare workers should be vaccinated against seasonal influenza and vaccine uptake monitored.
11.2
All persons who enter an isolation room will sign the contact log kept on top of the isolation cart.
11.3
Staff who care for patients with H1N1and who adhere to infection control precautions will be asked to perform
daily self-checks for fever, respiratory symptoms, and/or conjunctivitis for10 days following the last patient
contact, (Appendix 7)
Health-care worker absenteeism for health reasons will be monitored, especially in HCWs providing care for H1N1
infected patients.
11.5
Screening of all HCWs providing care to H1N1 infected patients for influenza-like symptoms by their
immediate supervisor who will refer any symptomatic employees to Family Medicine for clearance.
11.6
AI antiviral prophylaxis will be given on a case by case basis.
11.7
All suspected cases who are admitted will be managed in collaboration with an Infectious Disease physician.
11.8
Any other testing will be performed in collaboration with the MOH.
11.9
HCWs who are at high risk for complications of influenza (e.g. pregnant women, immunocompromised
persons and persons with respiratory diseases) will be informed about the medical risks and offered work
assignments that do not involve providing care for H1N1-infected patients.
11.10 HCWs who have underlying clinical conditions that increase their risk for severe influenza disease will
not be involved in direct patient care.
11.4
12.
Prioritizing the Use of PPE
12.1
Provision of necessary PPE supplies should be an institutional priority.
12.2
Reuse of disposable PPE will be avoided.
12.3
If sufficient supply of PPE items is not available, consideration will be given to reuse of
some disposable items only as an urgent, temporary solution and only if the item has not been
obviously soiled or damaged.
12.4
Surgical and procedure masks will be worn once and discarded.
12.4.1 Change masks when they become moist.
12.4.2 Do not leave masks dangling around the neck.
12.4.3 After touching or discarding a used mask, perform hand hygiene.
12.5
If supplies of gloves are limited, reserve gloves for situations where there is a likelihood of contact with
blood or body fluids, including during aerosol-generating procedures.
12.6
Use other barriers (e.g. disposable paper towels, paper napkins) when there is no direct contact with
patient’s respiratory secretions (e.g. to touch equipment linked to the patient).
12.7
If supplies of gowns are limited, gown use will be prioritized for aerosol-generating procedures and
for activities that involve holding the patient close (e.g. .in pediatric settings),or when other extensive
body-to-body contact is anticipated.
Form 810-06 (Rev. 10-06) IC 202164
Page 5 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
APPLIES TO:
Medical and Clinical Affairs
Environmental Services
MCO-MC-INF-04-073
APPROVED BY:
(signature on file)
Executive Director
Medical & Clinical Affairs
2
12.8
12.9
13.
13.2
14.
If there is a shortage of gowns, gowns may also be worn in the care of more than one patient in a cohort area
if there is no direct contact between the gown and the patients.
Reusable eye protective equipment poses a potential risk for cross-infection.
12.9.1 Any such item must be cleaned and disinfected after each use when leaving an isolation room/area,
using agents effective against influenza.
12.9.1.1 Cleaning must precede disinfection.
12.9.1.2 Hand hygiene must be performed after disposal or cleaning of eye protective equipment.
Family Member /Visitor Recommendations
13.1
Visitors will not be permitted.,
If an exception is made by the attending physician, the visitor will be advised about the possible risk of acquiring the
swine flu infection
Transmission and will be instructed on use of PPE and in hand hygiene prior to entry into the patient’s
isolation room or area.
13.3
If a visitor is permitted by the attending physician and does not comply with directions about PPE use
and hand hygiene ,visiting privileges will be withdrawn.
13.4
Parents of pediatric patients will be strongly supported to accompany the patient throughout the
hospitalization.
13.5
Parents will be advised by the attending physician not to go into other patient rooms or the unit kitchens.
13.6
Because family members may have been exposed to AI via the patient or similar environmental exposures,
all patient escorts will be referred to the Ministry of Health (MOH) designated/allocated healthcare
center/hospitals for screening and clearance.
Care of the Deceased
14.1
Removal of the body from isolation room
14.1.1 PPE to be used by the HCWs
14.1.1.1 N95 mask if the HCW removes the body from the isolation room/area immediately after the
patient’s death.
14.1.1.2 surgical or procedure mask is sufficient if air in the isolation room has been exchanged.
Allow one hour for air change if in Airborne Infection Isolation room.(12 AC per hour)
Allow three hours in regular single room (AC 4-6 per hour)
14.1.1.3 Disposable long-sleeved cuffed gown (water-proof, if outside of body is visibly contaminated
with potentially infectious secretions or excretions).If no waterproof gown available,
use a waterproof apron.
14.1.1.4 non-sterile gloves (single layer) should cover cuffs of gown.
14.1.1.5 If splashing of body fluid is anticipated, use beard cover and mask with visor.
14.2
The body should be fully sealed in an impermeable body bag prior to removal from the isolation room/area
and prior to transfer to the morgue. If impermeable body bag not available, use double body bag.
14.3
No leaking of body fluids should occur and the outside bag should be kept clean.
14.4
After removing PPE perform hand hygiene.
14.5
Transfer to the morgue should occur as soon as possible after death.
14.6
If the family of the patient wishes to view the body after transfer to the morgue from the isolation room/area,
they may be allowed to do so.
14.7
If the patient died during the infectious period, the family should wear gloves and gown and perform hand
hygiene in the morgue.
14.8
Body washing will be performed in the morgue area of the hospital by body washers wearing PPE.
14.9
Family members will be provided with a supply of PPE and instructions on use.
Form 810-06 (Rev. 10-06) IC 202164
Page 6 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
MCO-MC-INF-04-073
APPLIES TO:
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
RESPONSIBILITY
The responsibility of implementing and ensuring compliance with this Policy and Procedure lies with the Influenza
Preparedness Committee, Infection Control and Environmental Health, and Medical and Clinical Operations.
Responsibility for updating and archiving this policy rests with the Department of Infection Control and Environmental
Health.
SIGNATORY APPROVALS
Initiating Department:
Name:
Signature:
Title:
Department:
Abdullah Al Hokail
Signature on file
Medical Director
Infection Control & Environmental Health
Collaborating Departments:
Name:
Signature:
Title:
Department:
Name:
Signature:
Title:
Department:
Name:
Signature:
Title:
Department:
Khaled Abu Haimed, MD
Signature on file
Chairman
Department of Emergency
Medicine
Judy Moseley
Signature on file
Executive Dirtector
Nursing Affairs
Waleed Attya
Signature on file
A/Administrator
Logistics Services
Form 810-06 (Rev. 10-06) IC 202164
Name:
Signature:
Title:
Department:
Name:
Signature:
Title:
Department:
Abdulaziz Al Nasser, MD
Signature on file
Chairman
Department of Family Medicine
and Polyclinics
Jan Kazan-Jammal
Signature on file
Director
Clinical Services
Name:
Moudy Al Suliman
Signature:
Title:
Department:
Signature on file
Administrator
Support Services
Page 7 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
APPLIES TO:
MCO-MC-INF-04-073
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Appendix 1. Case Definitions
Person under investigation. A person whom public health authorities have decided to investigate for possible H1N1
infection.
A confirmed case (notify WHO) of H1N1infection is defined as a person with an acute febrile respiratory illness with
laboratory confirmed infection by one or more of the following tests:
1.
2.
real-time RT-PCR
viral culture
A probable case of H1N1infection is defined as a person with an acute febrile respiratory illness who is positive for influenza A,
but negative for H1 and H3 by influenza RT-PCR
A suspected case of H1N1infection is defined as a person with acute febrile respiratory illness with onset



within 7 days of close contact with a person who is a confirmed case of H1N1infection, or
within 7 days of travel to community either within the United States or internationally where there are one or more
confirmed cases of H1N1infection, or
resides in a community where there are one or more confirmed cases of H1N1infection.
Form 810-06 (Rev. 10-06) IC 202164
Page 8 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
MCO-MC-INF-04-073
APPLIES TO:
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Appendix 2. Standard Precautions English
Component
Hand hygiene
Personal protective equipment (PPE)
Gloves
Mask, eye protection, face shield
Gown
Soiled patient-care equipment
Environmental control
Textiles (linen and laundry)
Needles and other sharps
Patient resuscitation
Patient placement
Respiratory hygiene/cough etiquette (source
containment of infectious respiratory secretions in
symptomatic patients, beginning at initial point of
encounter)
Recommendations
After touching blood, body fluids, secretions, excretions,
contaminated items; immediately after removing gloves; between
patient contacts
For touching blood, body fluids, secretions, excretions,
contaminated items; for touching mucous membranes and nonintact skin
During procedures and patient-care activities likely to generate
splashes or sprays of blood, body fluids, secretions
During procedures and patient-care activities when contact of
clothing/exposed skin with blood/body fluids, secretions, and
excretions is anticipated
Handle in a manner that prevents transfer of micro-organisms to
others and to the environment; wear gloves if visibly contaminated;
perform hand hygiene
Follow routine procedures for routine care, cleaning, and
disinfection of environmental surfaces, especially frequently
touched surfaces in patient-care areas
Handle in a manner that prevents transfer of micro-organisms to
others and to the environment
Do not recap, bend, break, or hand-manipulate used needles; use
safety features when available; place used sharps in punctureresistant container
Use mouth-piece, resuscitation bag, other ventilation devices to
prevent mouth contact
Prioritize for single patient room if patient is at increased risk of
transmission, is likely to contaminate the environment or does not
maintain appropriate hygiene, or is at increased risk of acquiring
infection or developing adverse outcome following infection
Instruct symptomatic persons to cover mouth/nose when
sneezing/coughing; use tissues and dispose in no-touch
receptacle; observe hand hygiene after soiling of hands with
respiratory secretions; wear surgical mask if tolerated or maintain
spatial separation, greater than 3 feet if possible
Recommendations for Application of Standard Precautions for the Care of All Patients in All Healthcare Settings
May 3,2005 CDC
Form 810-06 (Rev. 10-06) IC 202164
Page 9 of 25
‫)‪INTERNAL POLICIES AND/OR PROCEDURE (IPP‬‬
‫‪KING FAISAL SPECIALIST HOSPITAL‬‬
‫‪AND RESEARCH CENTRE‬‬
‫‪TITLE/DESCRIPTION:‬‬
‫‪INDEX NUMBER:‬‬
‫‪PLAN FOR SWINE INFLUENZA TYPE A H1N1‬‬
‫‪MCO-MC-INF-04-073‬‬
‫‪APPROVED BY:‬‬
‫)‪(signature on file‬‬
‫‪APPLIES TO:‬‬
‫‪Medical and Clinical Affairs‬‬
‫‪Environmental Services‬‬
‫‪REPLACES NUMBER:‬‬
‫‪New‬‬
‫‪EFFECTIVE DATE:‬‬
‫‪10 Jumada Al Thani 1430‬‬
‫)‪(03 June 2009‬‬
‫‪Executive Director‬‬
‫‪Medical & Clinical Affairs‬‬
‫‪2‬‬
‫‪Appendix 2. Standard Precautions in Arabic‬‬
‫توصياتُ لوضعُ اإلجراءات الوقائية القياسيةُ لعنايةُ كلُ المرضى في كلُ أماكنُ الرعاية الصحيةُ ‪.‬‬
‫التوصيات ُ‬
‫المكونات‬
‫َب ْعد ََ لمس الدم‪َ ,‬ب ْعد ََ لمس سوائل و إفرازات الجسم‪َ ,‬ب ْعد‬
‫تنظيفُاليدين ُ‬
‫ََ لمس مواد اإلخراج‪َ ,‬ب ْعد ََ لمس المواد الملوثة‪ ,‬فورا َب ْعدَ إزالة‬
‫القفازات بَيْنَ االتصاالت بالمرضى‬
‫ُ‬
‫أجهزةُالوقايةُالشخصية ُ‬
‫القفازات ُ‬
‫قناع حمايةُالعينُُو درعُ الوجه ُ‬
‫الرداءُالواقي أثناء اإلجراءات الطبية و العناية بالمريضُ‬
‫أجهزةُ العناية بالُمريضُُالملوثة ُ‬
‫السيطرة البيئية ُ‬
‫غسلُالمالبسُواألغطية ُ‬
‫اإلبرُواألدواتُالحادةُاألخرى ُ‬
‫إنعاشُالمريض ُ‬
‫أينُيتمُوضعُالمريض ُ‬
‫النظافةُالتنفسية‪ُ/‬طرقُاحتواءُالسعال‬
‫( مصدر احتواء اإلفرازات التنفسية المعدية للمريض المصاب‪,‬‬
‫أبتدئ من استقباله للمرة األولى مثال استقبال الطوارئ إلى مكتب‬
‫الطبيب)‬
‫‪Page 10 of 25‬‬
‫عند لمس الدم‪ ,‬عند لمس سوائل و إفرازات الجسم‪ ,‬عند لمس مواد‬
‫اإلخراج‪ ,‬عند لمس المواد الملوثة أو لَ ْمس األغشية المخاطية و‬
‫الجلد الغير سليم‪.‬‬
‫أثناء الفحوصات أو العناية بالمريض‪ ,‬عندما يكون من المحتمل‬
‫تول ْد البق َع أَو رشات من الدم‪,‬أو سوائل الجسم و إفرازاته‪.‬‬
‫ينصح بوضع قناع الوجه عند إجراء عملية القسطرة أو أثناء حقن‬
‫مادة في النخاع الشوكي (مثال‪::‬أثناء عملية تخدير الحبل الشوكي‬
‫أو سحب مادة النخاع الشوكي)‬
‫يستخدم أثناء اإلجراءات الطبية أو نشاطات العناية بالمريض‬
‫عندما يكون ألتماس المالبس أو الجلد المكشوف بالدم أو إفرازات‬
‫الجسم‪ ,‬أو مواد اإلخراج متوقعان‬
‫يتم التعامل بطريقة تمنع انتقال الميكروبات إلى المرضى أو‬
‫غيرهم أو البيئة المحيطة‪ .‬قم بلبس القفازات إذا كان التلوث‬
‫ظاهر‪ ,‬ثم قم بتنظيف اليدين‪.‬‬
‫قم بتطوير اإلجراءاتَ للعناية الروتينية للتنظيف وللتطهير البيئي‬
‫لألسطح‪ ،‬خصوصا المتكرر اللمس في مناطق العناية بالمريض ‪.‬‬
‫يتم التعامل بطريقة تمنع انتقال الميكروبات لآلخرين أو للبيئة‪.‬‬
‫يمنع إعادة تغطية اإلبر المستخدمة أو ثنيها أو كسرها أو مسكها‬
‫باليد‪ ,‬وإذا كان البد من التغطية فيجب استخدام طريقة اليد الواحدة‬
‫فقط‪ .‬يجب استخدام وسائل السالمة المتوفرة‪ ,‬ويجب وضع اإلبر‬
‫المستخدمة في حاوية ضد الثقب‪.‬‬
‫أستخدم قطعة الفم‪ ,‬كيس نفخ الهواء‪ ,‬وأدوات اإلنعاش األخرى‬
‫لمنع االحتكاك بفم المريض أو إفرازاته‪.‬‬
‫األولوية بالنسبة للغرف ذات السرير الواحد عندما يكون هناك‬
‫احتمالية انتقال العدوى للمريض‪,‬أو احتمالية تلوث البيئة‪ ,‬أو ال‬
‫يستطيع المريض المحافظة على النظافة المناسبة‪ ,‬أو يكون أعلى‬
‫خطورة من غيره الكتساب العدوى أو حصول أضرار له منها‪.‬‬
‫يتم إخبار المريض المصاب بتغطية الفم واألنف أثناء السعال أو‬
‫العطس‪ .‬استخدام المناديل ووضعها في المكان المخصص مع‬
‫مالحظة نظافة اليد من التلوث بعد العطس‪ .‬قم بلبس القناع‬
‫حسب االستطاعة أو أبق على األقل على بعد ثالثة أقدام من‬
‫المريض إن أمكن‪.‬‬
‫‪Form 810-06 (Rev. 10-06) IC 202164‬‬
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
APPLIES TO:
New
Medical and Clinical Affairs
Environmental Services
MCO-MC-INF-04-073
APPROVED BY:
(signature on file)
Executive Director
Medical & Clinical Affairs
2
٢ ‫انظر إلى الملحق رقم‬
ُ ‫طريقةُالحقنُالسليمة‬
Appendix 3. Donning and Removing Personal Protective Equipment (PPE)
DONNING PPE
‫ارتداءُأجهزةُالوقايةُالشخصية‬
Type of PPE used will vary based on the level of precautions required e.g. Standard and Contact, Droplet or Airborne
Isolation Precautions Sequence of Donning and Removing PPE DHQP CDC May 7,2004dix 3.
GOWN
Fully cover torso from neck to knees,
arms to end of wrist, and wrap around
the back.
Fasten in back at neck and waist
MASK OR RESPIRATOR
Secure ties or elastic band at middle of
head and neck.
Fit flexible band to nose bridge
Fit snug to face and below chin
ُ :‫الرداء‬
‫دع الرداء يغطي من أعلى الرقبة‬
‫إلى الركبة والذراع إلى المعصم ثم‬
‫ اربط الرداء من‬.‫قم بتغطية الظهر‬
‫الظهر عند العنق‬
‫والخصر‬
ُ :‫الكمام‬
‫أحكم ربط الكمامة عند منتصف الرأس‬
.‫والعنق‬
‫ثبت الجسر المخصص لألنف‬
‫ثبت الكمامة حول الوجه وأسفل الذقن‬
ُ
Fit-check respirator
GOGGLES/FACE SHIELD
Put over face and eyes
and adjust to fit.
GLOVES
Extend to cover wrist of isolation gown
SAFE WORK PRACTICES
Keep hands away from face.
Limit touching of surfaces.
Change gloves when torn or heavily
contaminated.
Perform hand hygiene.
Form 810-06 (Rev. 10-06) IC 202164
:‫النظاراتُالواقية‬
‫ثبت النظارة الواقية حول العينين‬
‫في الوضع المناسب‬
ُ
ُ
ُ :‫القفازات‬
‫دع القفازات تمتد لتغطي كم الرداء‬
‫الواقي‬
ُ ‫أرشاداتُالعملُبأمان‬
‫أبعد اليدين عن الوجه‬
‫تجنب لمس األسطح‬
‫قم بتغيير الرداء في حال التمزق أو التلوث‬
.‫تنظيف اليدين بطريقة صحيحة‬
Page 11 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
MCO-MC-INF-04-073
APPLIES TO:
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Appendix 3.
REMOVING PPE
‫نزعُأجهزةُالوقايةُالشخصية‬
Remove PPE at doorway before leaving patient room or in anteroom;
Remove respirator outside of room
GLOVES
Outside of gloves are contaminated!
Grasp the outside of glove with opposite
gloved hand; peel off
Hold removed glove in gloved hand
Slide fingers of ungloved hand under
remaining glove at wrist
GOGGLES/FACE SHIELD
Outside of goggles or face shield are
contaminated!
To remove, handle by “clean” head
band or ear pieces.
Place in designated receptacle for
reprocessing or in waste container.
GOWN
Gown front and sleeves are
contaminated!
Unfasten neck, the waist ties
Remove gown using a peeling motion;
pull gown from each shoulder toward
the same hand, gown will turn inside
out. Hold removed gown away from
body, roll into a bundle and discard into
waste or linen receptacle.
MASK OR RESPIRATOR
Front of mask/respirator is contaminated
– DO NOT TOUCH!
Untie the lower knot first followed by the
upper knot.
Remove the respirator and dispose in
the designated waste container.
Form 810-06 (Rev. 10-06) IC 202164
ُ ‫القفازات‬
!‫الجزء الخارجي من القفازات ملوث‬
‫أمسك الجزء الخارجي من القفازات ولفه‬
.‫بحيث يصبح مقلوبا أثناء نزعه من اليد‬
‫أمسك فردة القفاز المنزوعة باليد األخرى‬
.‫التي عليها قفاز‬
‫زحلق أصابع اليد التي تم نزع القفاز عنها تحت القفاز اآلخر‬
.‫عند المعصم وانزعه كالطريقة السابقة‬
ُ ‫النظاراتُالواقية‬
!‫الجزء الخارجي من النظارة ملوث‬
‫ابدأ بنزع الجزء الموجود حول األذن‬
‫ضع النظارة في سلة المهمالت أو المكان‬
.‫المخصص إلعادة التصنيع‬
ُ ‫الرداء‬
! ‫الجزء األمامي والذراعان ملوثان‬
‫فك العقد عند العنق والخصر‬
‫انزع الرداء بحيث تستخدم اليدين إلمساك‬
‫الرداء من الداخل عند الكتفين ثم يسحب‬
‫لألمام يجب أن يتم السحب بحيث يصبح‬
‫الجزء الداخلي من الرداء معكوسا‬
‫أبعد الرداء المنزوع عن الجسم‬
‫لفه ثم ضعه في سلة المهمالت أو المكان‬
.‫المخصص‬
ُ ‫الكمامة‬
!!‫ ال تلمسه‬.‫الجزء األمامي ملوث‬
‫فك العقدة التي باألسفل أوال ثم العلوية‬
.‫انزع الكمام وضعه في سلة المهمالت‬
Page 12 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
MCO-MC-INF-04-073
APPLIES TO:
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Appendix 4. Respiratory Hygiene/Cough Etiquette
The term cough etiquette is derived from recommended source control measures for Mycobacterium tuberculosis.
The elements of Respiratory Hygiene/Cough Etiquette include:
1.
Education of healthcare staff, patients and visitors.
ُ :‫الرداء‬
Posted signs, in language(s) appropriate to the population served with instructions to patients and accompanying
‫يغطي‬
‫الرداء‬
‫دع‬
family members or friends.
Fully cover
torso from
neck
to
3. Source
control
measures
(e.g. covering the mouth/nose with a tissue when coughing and prompt disposal
of
used
‫من أعلى الرقبة‬
knees, arms
to endusing
of wrist,
tissues,
surgical masks on the coughing person when tolerated and appropriate).
، ‫إلى الركبة‬
and wrap
4. around
Hand hygiene
the back
after contact with respiratory secretions.
‫والذراع إلى‬
5. Spatial separation, ideally greater than 3 feet (1 meter), of persons with respiratory infections in common waiting
Fasten in back
at
neck
‫المعصم وقم‬
areas when possible.
GOWN2.
‫بتغطية‬
and waist
Healthcare facilities should ensure the availability of materials for adhering to respiratory hygiene/cough etiquette in
MASK waiting
OR RESPIRATOR
areas for patients and visitors:
‫الظهر‬
tissues and no-touch receptacles (i.e., waste container with pedal-operated
or uncovered
plastic
‫والخصر‬lid‫العنق‬
‫من الظهر عند‬
‫الرداء‬-lined
‫اربط‬
Secure1.tiesProvide
or elastic
band at
waste container) for used tissue disposal.
middle 2.
of head
andconveniently
neck
Provide
located dispensers of alcohol-based hand rub.
3. band
Provide
disposable towels for hand washing where sinks are available.
Fit flexible
tosoap
noseand
bridge
Fit snug
to face and below chin
http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf
Fit-check respirator
GOGGLES/FACE SHIELD
Put over face and eyes and
adjust to fit
GLOVES
Extend to cover wrist of
isolation gown
SAFE WORK PRACTICES
Keep hands away from face
Limit surfaces touched
Change when torn or heavily
contaminated
Perform hand hygiene
Form 810-06 (Rev. 10-06) IC 202164
ُ :‫الكمام‬
‫أحكم ربط الكمام‬
‫عند منتصف‬
‫الرأس ولعنق‬
‫ثبت الجسر المخصص لألنف‬
‫ثبت الكمام حول الوجه وأسفل الذقن‬
ُ
:‫النظاراتُالواقية‬
‫ثبت النظارة‬
‫الواقية حول‬
‫العينين في‬
‫الوضع المناسب‬
ُ :‫القفازات‬
‫دع القفازات‬
‫تمتد لتغطي كم‬
‫الرداء الواقي‬
ُ ‫أرشاداتُالعملُبأمان‬
‫أبعد اليدين عن الوجه‬
‫تجنب لمس األسطح‬
‫الرداء في حال التمزق أو التلوث‬
‫قم بتغيير‬
Page 13 of 25
.‫تنظيف اليدين بطريقة صحيحة‬
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
10 Jumada Al Thani 1430
(03 June 2009)
REPLACES NUMBER:
APPLIES TO:
New
Medical and Clinical Affairs
Environmental Services
MCO-MC-INF-04-073
APPROVED BY:
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Appendix 5. Respiratory Protection
1. High-risk aerosol generating procedures increase the potential for dissemination of small-particle respiratory aerosols (droplet
nuclei) in the immediate vicinity of an AI patient.
Examples of aerosol-generating procedures include:
1.1. endotracheal intubation
1.2. administration of aerosolized or nebulized medication (this administration route is strongly discouraged in AI-infected
patients
If appropriate airborne precautions cannot be guaranteed.
1.3. bronchoscopy
1.4. airway suctioning
1.5. tracheostomy care
1.6. chest physiotherapy
1.7. nasopharyngeal aspiration
1.8. positive pressure ventilation via face mask (e.g. BiPAP, CPAP)
1.9. high-frequency oscillatory ventilation
1.10. resuscitation manoeuvres
1.11. postmortem excision of lung tissue
2 .Respiratory protection for aerosol generating procedures
2.1 An N95 particulate respirator is the minimum level of respiratory protection required of HCWs performing aerosol
generating procedures.
2.2 A user seal check should be performed each time a disposable N95 respirator is worn, before entering the isolation room.
2.3 The N95 mask should seal tightly to the face to fully protect HCWs from exposure to small-particle respiratory aerosols.
2.4 Facial hair prevents a good fit and the seal may not be achieved significantly decreasing the efficiency of the N95
respirator.
3 . Environmental Controls for aerosol-generating procedures
3.1 Perform the procedure in an adequately ventilated room (equal to or greater than 12 air changes (AC) per hour) room
if available (Table 2).
3.2 If an adequately ventilated room/area is not available:
3.2.1
perform the procedure in a single room with a door that closes and away form other patients.
3.2.2
if possible increase AC and avoid recirculation of the room air (exhaust air outside).
3.2.3
if recirculation of air from such rooms is unavoidable, pass the air through a HEPA filter before recirculation.
3.2.4
keep doors closed except when entering or leaving the room, and minimize entries and departures during the
procedure.
3.2.5
closed ventilation systems (HEPA filter on expiratory end of ventilator) will be used with ventilated patients.
4. Surgical and procedure masks
4.1 surgical or procedure masks are indicated when providing care for patients infected by droplet transmitted diseases
Form 810-06 (Rev. 10-06) IC 202164
Page 14 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
APPLIES TO:
Medical and Clinical Affairs
Environmental Services
MCO-MC-INF-04-073
APPROVED BY:
(signature on file)
Executive Director
Medical & Clinical Affairs
2
4.2
and/or as part of facial protection during patient-care activities that are likely to generate splashes or sprays
of blood, body fluids, secretions or excretions.
Surgical and procedure masks do not offer appropriate respiratory protection against small-particle aerosols (droplet
nuclei) and should not be used unless N95 respirators are not available when dealing with diseases transmitted by the
airborne route; if an N95 respirator is not available, use a tightly fitting mask.
Source: Avian Influenza, Including Influenza (H5N1), in Humans: WHO Interim Infection Control Guideline for Health Care
Facilities, Most recent Amendment: 10 May 2007, World Health Organization
Appendix 6. Collecting Specimens for the Upper Respiratory Tract
Nasal Wash
1.
2.
3.
4.
5.
6.
7.
8.
9.
HCW applies PPE as indicated in Table 1 for aerosol generating procedures.
The patient should sit in a comfortable position with the head tilted slightly backward have patient hold their breath and
instill 1.0 to 1.5 mL non-bacteriostatic saline ( pH 7.0 ) into one nostril.
The patient tilts his/her head forward and lets the washing fluid flow into a specimen cup.
The process is repeated with the alternate nostril until a total of 10 to 15 mL of washing fluid has been used.
Label the container “Avian flu testing” and double-bag in biohazard bags.
Enter the specimen in the ICIS system as “ Avian Flu testing “
Notify the Microbiology Laboratory that a specimen is on the way. Page Microbiology Supervisor on pager 6868 or
Microbiology section head on pager 6262.
Specimens will be hand-carried to the Microbiology Laboratory immediately after collection and placed at 4 degrees C.
The pneumatic tube system will NOT be used to transport specimens from suspected or confirmed cases of AI.
Nasopharyngeal Aspirate
1.
2.
3.
4.
5.
HCW applies PPE as indicated in Table 1 for aerosol generating procedures.
Nasopharyngeal secretions are aspirated through a catheter connected to a mucous trap and fitted to a vacuum source.
Insert the tubing into the nostril parallel to the palate.
Apply vacuum and slowly withdraw nasopharyngeal secretions in a rotating motion.
Repeat this procedure for the other nostril using the same catheter.
Follow steps 5 through 10 noted under nasal wash.
Nasopharyngeal or Oropharyngeal Swabs
1.
2.
3.
4.
5.
6.
7.
8.
9.
HCW applies PPE as indicated in Table 1 for aerosol generating procedures.
Use only sterile Dacron or rayon swabs with plastic shafts. Use the available viral transport swab ensuring the tube
packaging indicates for viral cultures.
Do NOT use calcium alginate swabs or swabs with wooden sticks as they may contain substances that inactivate some
viruses and inhibit PCR testing.
Insert a viral swab into the nostril parallel to the palate.
Leave the swab in place for a few seconds to absorb secretions.
Withdraw the swab slowly using a rotating motion.
A second swab will be used for the second nostril.
To obtain an oropharyngeal swab, swab the posterior pharynx and tonsillar areas, avoiding the tongue.
Place the swabs immediately into the viral transport media.
Form 810-06 (Rev. 10-06) IC 202164
Page 15 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
MCO-MC-INF-04-073
APPLIES TO:
New
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
10. Ensure the cap is tight on the viral culture tube.
11. Follow steps 5 through 10 noted under nasal wash.
WHO Guidelines for the collection of human specimens for laboratory diagnosis of avian influenza infection 12 January
2005http:llwww.who.int/csr/disease/avain_influenza/guidelines/humanspecimens/en/print.html
Appendix 7. HCW Influenza-like Illness Monitoring Form
Name and Badge number: ______________________________ Home telephone or cell phone number: ____________________
Job title: _______________________________________ Work location/Unit: _____________________________
Date/s of exposure (list all, use back of page if necessary): ____/____/________ ____/____/________
Type of contact with AI patient, patient environment, or virus:
__________________________________________________________________________________________
Was personal protective equipment (PPE) used: No ______ Yes ______
If yes, list PPE used (e.g. gown, gloves, particulate respirator, medical mask, eye protection, etc):
__________________________________________________________________________________________
List any non-occupational exposures (i.e. exposure to birds or persons with severe acute febrile respiratory illness):
____________________________________________________________________________
Please check your temperature twice a day (morning, AM; evening, PM) for 10 days after providing care for an
AI-infected patient (including 10 days after your last exposure), and also monitor yourself for any of the
following influenza-like illness symptoms including:
cough
acute onset of respiratory illness
sore throat
thralgia
gastrointestinal symptoms (e.g., diarrhea, vomiting, abdominal pain)
If any symptoms of influenza-like illness (ILI) occur, immediately limit your interactions with others, exclude
yourself from public areas, and notify the Head Nurse of Family Medicine at _______________
Day 1
Date ___/___/____
AM temperature
Day 2
Date ___/___-/____
AM temperature
Day 3
Date ____/____/___
AM temperature
Day 4
Date ____/___/___
AM temperature
Day 5
Date ____/____/___
AM temperature
PM temperature
PM temperature
PM temperature
PM temperature
PM temperature
ILI illness
Yes
ILI illness
Yes
ILI illness
Yes
ILI illness
Yes
ILI illness
Yes
No
No
Day 6
Form 810-06 (Rev. 10-06) IC 202164
No
Day 7
No
Day 8
No
Day 9
Day 10
Page 16 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
MCO-MC-INF-04-073
APPLIES TO:
New
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Date ___/___/____
AM temperature
Date ___/___-/____
AM temperature
Date ____/____/___
AM temperature
Date ____/___/___
AM temperature
Date ____/____/___
AM temperature
PM temperature
PM temperature
PM temperature
PM temperature
PM temperature
ILI illness
Yes
ILI illness
Yes
ILI illness
Yes
ILI illness
Yes
ILI illness
Yes
No
No
No
No
No
WHO Interim Infection Control Guidelines, May 2007
Appendix 8. Triage Questions for Suspected Avian Influenza Patient
MRN _______________
Date _____________
Questions
1.
Close contact (within 1 meter) with a person (e.g. caring for, speaking
with, or touching) who is suspected, probable, or confirmed H1N1 case?
2.
Exposure (e.g. handling, slaughtering, de-feathering, butchering,
preparation for consumption) to poulty or wild birds or their remains or to
environments contaminated by their feces in an area where H1N1
infections in animals or humans have been suspected or confirmed in the
last month?
3.
Consumption of raw or undercooked poultry products in an area where
H1N1 infections in animals or humans have been suspected or proven in
the last month?
4.
Close contact with a confirmed H1N1 infected animal other than poultry
or wild birds (e.g. cat or pig*)?
Yes
No
*For non-Muslim patient who just returned from abroad.
5.
Handling samples (animal or human) suspected of containing H1N1 virus
in a laboratory or other setting?
Form 810-06 (Rev. 10-06) IC 202164
Page 17 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
APPLIES TO:
MCO-MC-INF-04-073
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Appendix 9. Contact Log
Patient MRN _____________
Name of Person Entering
the Room
Form 810-06 (Rev. 10-06) IC 202164
Unit/Room Number _______________
Badge Number
(if staff member)
Contact Numbers
(Cellphone/Telephone/Pager)
Date ________________
Time-In of
Entry to the
Room
Time-Out of the
Room
Page 18 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
10 Jumada Al Thani 1430
(03 June 2009)
REPLACES NUMBER:
New
APPLIES TO:
MCO-MC-INF-04-073
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Note: Please change log sheet daily. Send log sheet to Infection Control daily by fax # 23898.
Table 1.
Barrier Precautions for Persons Providing Care for patients with Acute Febrile Respiratory Illness, including Patients with
Suspected or Confirmed AI Infection
Form 810-06 (Rev. 10-06) IC 202164
Page 19 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
10 Jumada Al Thani 1430
(03 June 2009)
REPLACES NUMBER:
New
MCO-MC-INF-04-073
APPLIES TO:
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
*Bird exposure in regions with AI infections in animals or exposure to AI-infected patients
a.
Barrier precautions
Hand hygienec
Gloves
Apron
Gown
Hair cover
Medical mask
(on HCW)
Particulate
respirator
Eye protection
Medical mask
(on patient)
b.
c.
d.
e.
f.
g.
h.
i.
Application of barrier precautions depending on type of patient contact
Close contact
(greater than 1
metre) with
patients with acute
febrile respiratory
illness who have
no known AI ,
H1N1 risk factors*
Entry to isolation
H1N1room/area, but
no anticipated patient
contact
Close contact
(greater than 1
metre) with
H1N1infected
patient in or out
of isolation
room/area
Yes
Not routinelyd
Not routinely
Not routinely
Not routinely
Yes
Risk assessment
Risk assessmente
Risk assessmente
Not routinely
Yes
Yes
Not routinelye
Yesf
Not routinely
Yes
Yes
Not routinelyf
Yesf
Optional
Yes
Not routinely
Not routinely
Not routinely
Not routinely
No
No
Yesg
Risk assessment
Risk assessmenth
Yes
Yes
Not routinelyi
No
Not routinelyi
No
Performance of
aerosol-generating
procedure on H1N1
patient a,b
Aerosol-generating procedures create aerosols of different sizes (large and small-particle aerosols)
(Appendix 3). Examples of aerosol-generating procedures include: endotracheal intubation; aerosolized
or nebulized medication administration; diagnostic sputum induction; bronchoscopy; airway suctioning;
tracheostomy care; chest physiotherapy; nasopharyngeal aspiration; positive pressure ventilation via face
mask (e.g. BIPAP, CPAP); high-frequency oscillatory ventilation; post-mortem excision of lung tissue.
Whenever possible, aerosol-generating procedures should be performed in adequately ventilated
(equal to or less than 12 air changes per hour) rooms, side rooms or other closed single-patient areas
with minimal staff present (Appendix 3). PPE should cover the torso, arms, and hands as well as the eyes,
nose and mouth. (Appendix 4.)
Standard precautions are the minimum level of precautions indicated for all patients at all times (Appendix 2).
Gloves should be worn in accordance with standard precautions. If glove demand is likely to exceed supply, glove use
should always be prioritized for contact with blood and body fluids (ambidextrous non-sterile gloves), and contact with
sterile sites (sterile gloves).
Gloves and gown or apron should be worn during cleaning procedures.
If splashing with blood or other body fluids is anticipated, and gowns that are not fluid-resistant are used, a waterproof
apron should be worn over the gown.
If particulate respirator is not available, avoid aerosol-generating procedures as much as possible.
Use eye protection if close contact (greater than 1 metre) with patient if possible.
Provide medical mask for patient (if tolerated), when patient is outside the isolation room/area.
Avian Influenza, Including Influenza (H5N1), in Humans: WHO Interim Infection Control Guideline for Health Care Facilities, Most
recent Amendment: 10 May 2007, World Health Organization
Form 810-06 (Rev. 10-06) IC 202164
Page 20 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
MCO-MC-INF-04-073
APPLIES TO:
New
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Table 2. Units with Negative Pressure Rooms
Intensive Care Units
Inpatient Units
Inpatient Units
Unit/Area
Room #
Unit/Area
Room #
Unit/Area
Room #
NICU
5
B3
34
CVT
44
PICU
1
36
2
50
D4
2
3
52
D3-1
24
D3-2
50
14
B3 I
16
15
A1
50
46
66
18
CSICU
19
CCU
30
Cardiac Step down
1
MICU-C
17
SSCU-B
F1
39
50
40
52
41
50
42
18
52
27
19
76
20
80
26
A3
A4
14
F2
43
44
F3
26
32
50
27
33
52
43
34
44
34
MICU-D
52
A2
B1
35
36
40
50
17
41
52
25
42
26
44
27
50
28
52
29
42
B2
C1
DEM
9
54
56
C2
50
52
C3
50
52
Updated: 11 March 2008
Form 810-06 (Rev. 10-06) IC 202164
Page 21 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
APPLIES TO:
MCO-MC-INF-04-073
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Table 3. Emergency Room Procedures
EMERGENCY INFECTION CONTROL MEASURES:
Suspected patients will wear a surgical mask and be placed in an Airborne Infection Isolation room
Health care worker within 3 feet (1 meter) of the patient will take the following measures;

Wear gown, surgical mask or N95 respirator, eye protection and gloves
Suspected or confirmed H1N1 virus patient /escort with symptoms treated as suspected case
Suspected or confirmed H1N1 virus patient /asymptomatic escort or family should be listed for contact
follow-up
Do not discharge any patient suspected to have H1N1 virus without Infectious disease clearance
Outpatient or discharged patients must be isolated in the home setting under the supervision of public health
INITIATION OF DISASTER PLAN:
1-




If DEM isolation capacity is overwhelmed
DEM Chairman or delegate in consultation with Infectious Diseases and Infection
control informs MCA to announce partial or full CODE AMBER activation.
Measures taken through incident command center will include
Determination of need for unit cohorting in the hospital and discharge or transferof
patients from unit or units to provide cohorting areas.
Ensure availability of mechanical ventilators with HEPA exhaust filters
Ensure adequate supplies of Surgical masks
Communicate with Pharmacy about supplies of Tamiflu
Measures to coordinate with the MOH and authorities if Institution capacity overwhelmed.
DEM will accept transferred cases from:


Family Medicine after being diagnosed by the attending physician and directed immediately to an
Airborne Infection Isolation room in the DEM.
Employees and eligible dependents will be managed at KFSH.

Suspected Polyclinic or outpatient cases will not be accepted in the DEM, will be directed to MOH
hospitals for further care, and will be well informed and educated about their potential illness.

In outpatient clinics, when a patient registers for scheduled appointment she/he will be questioned
about flu-like illness by the Registration clerk; if flu-like illness is present clerk refers immediately to
Outpatient nurse to assess the patient as per case definitions. If H1N1I suspected, the patient will
be denied their appointment and rescheduled and diverted to MOH hospitals.
Form 810-06 (Rev. 10-06) IC 202164
Page 22 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
MCO-MC-INF-04-073
APPLIES TO:
New
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Figure 1. Initiation of AI Infection Control Precautions
INFECTION CONTROL MEASURES
PATIENT
Patient enters triage with
symptoms of acute febrile
respiratory illness
Follow standard and droplet precautions
1. HCWs should use facial protection
(surgical/procedure mask, goggles/face shield)
2. Place a surgical/procedure mask on the patient when
in the waiting room; if no masks are available, ask the
patient to cover mouth and nose with a tissue when
sneezing or coughing
3. If possible, accommodate patient in a place
that is separate from other patients
Plus exposure history
Patient admitted for
investigation of influenza
H1N1
1. Siingle room adequately ventilated (equal to or less
than 12 air changes per hour) room, if possible
2. If single room is not possible, cohort patients
3. Staff should use barrier precautions*
Report to Ministry of Health authorities
Patient confirmed as having
H1N1infection
(See case definition)
Other diagnosis
Reassess precautions
Infection control precautions to remain in place for the
required duration
Adult greater than 12 years
yearsgreater12yearsyearsyears
Infection control yearsyears
precautions to remain
in place for 7 days after the resolution
of fever
Child equal to or less than 12 years
Infection control precautions to remain in place
for 21* days after the onset of illness
*Young children can shed virus at high titres for up to
21 days
*Barrier precautions = hand hygiene, use of gowns, clean gloves, medical mask and eye protection if splashes are anticipated. If
aerosol-generating procedures are performed, PPE should include particulate respirator instead of medical mask.
Form 810-06 (Rev. 10-06) IC 202164
Page 23 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
New
MCO-MC-INF-04-073
APPLIES TO:
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Avian Influenza, Including Influenza (H5N1), in Humans: WHO Interim Infection Control Guideline for Health Care Facilities, Most
recent Amendment: 10 May 2007, World Health Organization
Figure 2. Department of Emergency Medicine Algorithms
DEM patients
DEM Registration Desk
No flu -like illness
NO
Patient
with
febrile
respiratory
illness
YES
Education materials,
surgical mask, facial
tissues and hand sanitizer
given to the patient
Routine triage and
DEM care
Designated waiting area
and surgical mask
always on
Triage away policy will
be implemented as per
DEM
NO
Flu
YES
Triage
Case not suspected
Case suspected
(See Appendix 1)
DEM Consultant to confirm
case definition
Form 810-06 (Rev. 10-06) IC 202164
1.
2.
3.
4.
5.
6.
Swine flu protection measures and safe transport to Airborne Infection Isolation Room in the DEM.
Infectious Disease consultation and notification of the Chair of Infection Control Committee.
Laboratory tests per Infectious Disease (ID) consultant.
ID confirmation to carry out necessary investigations and disposition of patient.
Admission to appropriate room (Airborne Infection Isolation room).
MCO notification and reporting to authorities (MOH and WHO).
Page 24 of 25
KING FAISAL SPECIALIST HOSPITAL
AND RESEARCH CENTRE
INTERNAL POLICIES AND/OR PROCEDURE (IPP)
TITLE/DESCRIPTION:
INDEX NUMBER:
PLAN FOR SWINE INFLUENZA TYPE A H1N1
EFFECTIVE DATE:
REPLACES NUMBER:
10 Jumada Al Thani 1430
(03 June 2009)
MCO-MC-INF-04-073
APPLIES TO:
New
APPROVED BY:
Medical and Clinical Affairs
Environmental Services
(signature on file)
Executive Director
Medical & Clinical Affairs
2
Figure 3.
Department of Family Medicine & Polyclinics Avian Flu Alert and Epidemic Response
AII Patients
ُ Triage Nurse Station
ُ
No flu- like illness
NO
Flu- like
illness
patient
YES
Routine triage and
waiting area
Designated waiting area
(old Toxicology area)
and surgical mask
always on
NO
Triage
Physician
Case not suspected
Second opinion by
FM/Pediatric
Consultant
Education materials,
surgical mask,
facial tissues and hand
sanitizer
given to the patient
Treatment by Triage
Physician
YES
Case suspected
FM Consultant/Pediatrician to
confirm diagnosis
1. Swine flu protection measures and
Discharge
Form 810-06 (Rev. 10-06) IC 202164
safe transport
2. Contact DEM for Airborne Infection
Isolation Room and DEM will take over.
Page 25 of 25