The PCRA tool consists of tables 1 to 4 by housework


									Point of Care Risk Assessment Tool for Influenza Like              Table 1: Identification of the Physical Setting and Level of                  Table 2: Identification of the Patient Clinical Status and Source Control Capability
Illness including NOVEL A/H1N1 INFLUENZA
                                                                   Patient Interaction                                                               Patient Clinical Status and Source                   Description                              Patient Presentation
                                                                                                                                                             Control Capability
Prior to any patient interaction, all health care workers           Physical           Description          Example                                                                          Patient recovered from influenza              Influenza-infected patient, beyond the
(HCWs) have a responsibility to assess the infectious risk          Setting and                                                                          Recovered from Influenza                                                          known period of communicability
posed to themselves and to other patients, visitors, and            Level of Patient                                                                                                         1) Patient with symptoms compatible           Cough of any intensity and
HCWs. This risk assessment is based on professional                 Interaction                                                                        Influenza and Compliant               with influenza with cough.                    Adherence with respiratory hygiene
judgement about the clinical situation and up-to-date                                                                                                             or                                                                       Adherence to hand hygiene
information on how the specific healthcare organization has                            Area with no         Non-clinical setting (medical           Weak Cough and Not Compliant             2) Patient with symptoms compatible           Weak or no cough and
designed and implemented engineering and administrative               No Patient       patient access       record department,                                                               with influenza with weak or no cough          No adherence with respiratory hygiene
controls, along with the availability of Personal Protective         Interaction,      (restricted areas)   administrative office, central                                                                                                 No adherence with hand hygiene
Equipment (PPE).                                                     Non-Clinical                           pharmacy, information                                                            Patient with symptoms compatible with         Forceful cough and
Point of Care Risk Assessment (PCRA) is an activity                                                         technology office, central             Influenza and Forceful Cough and          influenza with forceful cough                 Not adherent with respiratory hygiene
performed by the HCW before every patient interaction.                                                      storage area, mail room, central                 Not Compliant                                                                 Not adherent to hand hygiene
                                                                                                            maintenance areas, business                                                      Patient with symptoms compatible with         An Aerosol Generating Medical
The PCRA tool consists of tables 1 to 4. A step-by-step                                                     office, etc.).                                    Influenza and AGMP             influenza                                     Procedure (AGMP) is being performed.
description on how to use them follows:
Step 1: In Table 1, choose one of the physical setting and                                                                                       Note:  If more than one risk level identified (e.g., multiple concurrent patient interactions), select the
level of patient interaction options (in the highlighted column)                       No face-to-face      Hallways, cafeteria, public                 higher level of precautions.
using the description and example columns in the table.                No Direct       interaction and      areas, clinical areas with no
                                                                        Patient        no indirect          patient access (charting room,       Table 3: Level of Precautions Matrix
Step 2: In Table 2, choose one of the patient clinical status       Interaction and    contact with         office, storage room, staff                                                            Physical Setting and Level of Patient Interaction
and source control capability options (in the highlighted             No Indirect      patients.            lounge, medication room, etc.),                                    No Patient      No Direct or     Indirect   Direct Patient      Direct Patient Interaction
column) using the description and patient presentation                  Contact                             totally enclosed reception/triage     Patient Clinical Status     Interaction        Indirect      Contact       Interaction              with AGMP
column in the table.                                                                                        areas with physical barrier           and Source Control          Non Clinical       Patient
Step 3: Using the matrix on Table 3, match the physical                                                     between HCW and patient.              Capability                                   Interaction
setting and level of patient interaction option from Table 1                           No direct patient    Discharge patient room                   Recovered from                I                 I             II             II                       II
(Step 1) with the patient clinical status and source control            Indirect       interactions;        cleaning, equipment cleaning.               Influenza
capability option identified from Table 2 (Step 2), to                  Contact        Indirect contact                                               Influenza and                I                I               II               III                         IV
determine the appropriate level of precautions.                                        only with patient                                           Compliant or Weak
                                                                                       environment or                                                Cough and Not
Step 4: From table 4, determine what specific measures                                 contaminated                                                     Compliant
and person protective equipment are indicated for the level                            inanimate objects                                              Influenza and                I                I               II               IV                          IV
of precautions identified in Table 3 (Step 3).                                         Direct, face-to-     Providing patient care, home           Forceful Cough and
                                                                     Direct Patient    face interaction     visits, assisting with activity of        Not Compliant
                                                                      Interaction      with patient         Daily Living (ADL), diagnostic        Influenza and AGMP               I                I               II               IV                          IV
                                                                                       (within 2m of the    imaging, phlebotomy services,
                                                                                       patient)             physiotherapy, occupational
                                                                                                                                                 Note:  It is anticipated that the majority of patients with H1N1 Flu Virus (Human Swine Flu) will be
                                                                                                            therapy, recreational therapy,              cared for using Level II and III and a minority would be cared for using Level IV precautions.
                                                                                                            intra-hospital                       Table 4: Personal Protective Equipment Required for the Level of Precautions for Human
                                                                                                            transport/portering, non-
                                                                                                            enclosed triage/registration
                                                                                                                                                          Cases of H1N1 Flu Virus (Human Swine Flu)
                                                                                                            area, cleaning patient bedspace                          Hand        Respiratory          N95           Surgical or      Eye          Gown                   Gloves
                                                                                                            while occupied, routine                                 Hygiene       Hygiene          Respirator       Procedure     Protection
                                                                                                            ambulance or inter-facility                                                                               Mask
                                                                                                            transport.                            Level I         Yes           Yes                                 No Patient Contact – Not Required
                                                                                       Performing                                                 Level II        Yes           Yes              No, Except as                   As Per Routine Practices
                                                                     Direct Patient    and/or assisting     See appended list of AGMP                                                            per Additional
                                                                    Interaction with   with Aerosol         (below) and Appendix G of                                                            Precautions*
                                                                      Potential for    Generating           Teaching Tools for further            Level III       Yes           Yes              No, Except as      Yes              Yes as per         As Per Routine
                                                                        Aerosol        Medical              detail.                                                                              per Additional                      Routine            Practices
                                                                       Generation      Procedures                                                                                                Precautions*                        Precautions
                                                                                                                                                  Level IV        Yes           Yes              Yes                No               Yes          As Per Routine
                                                                                                                                                 *Additional Precautions recommend an N95 respirator for known or suspected active tuberculosis, measles or Varicella.

                                                                                                                                                 Adapted from Interim Guidance: Infection Prevention and Control Measures for Health Care Workers in Acute Care Facilities,
                                                                                                                                                 Appendix A, Public Health Agency of Canada, Final May 11, 2009, 1700.

June 18, 2009 2300h
Aerosol Generating Medical Procedures:

Definition: Any procedure carried out on a patient that can induce the production of aerosols of various sizes, including droplet nuclei.

•     In circumstances where emergent resuscitation efforts are anticipated.
•     Non-invasive positive pressure ventilation (BIPAP).
•     Continuous positive pressure airways pressure (CPAP)
•     Endotracheal intubation, including during cardiopulmonary resuscitation;
•     Respiratory/airway suctioning; open airway suctioning;
•     High-frequency oscillatory ventilation {HFOV}
•     Tracheostomy procedure and care
•     Chest physiotherapy
•     Aerosolized or nebulized medication administration
•     Diagnostic sputum induction;
•     Bronchoscopy or other upper airway endoscopy;
•     Autopsy of lung tissue
•     Sputum induction
•     Tube or needle thoracostomy

June 18, 2009 2300h

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