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Pandemic Respiratory Infectious Diseases Plan

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									              Pandemic Respiratory Infectious Disease Readiness Plan
          A Guide Use by ____________________Hospital/Healthcare System




Background: This document outlines a plan for responding to threats posed by respiratory diseases
that have the potential for becoming epidemic or pandemic. Diseases meeting this definition that have
come to the attention of the healthcare community and the public in recent years are SARS (Severe
Acute Respiratory Syndrome) and new strains of influenza. It has become increasingly clear that
_________________________ Hospital/Healthcare System must maintain a level of readiness at all
times for respiratory infections with epidemic/pandemic potential.

This plan has evolved from state and federal guidelines recommending aggressive proactive approaches
of respiratory hygiene practices and universal administration of influenza vaccine to healthcare workers
and high-risk patients in all healthcare facilities whether or not an epidemic is predicted or in progress.

This document outlines a plan of increasing prevention and control activities as the threat of an
epidemic/pandemic increases. It is intended for use by the __________________Hospital/Healthcare
System Preparedness Committee or Incident Command Team to work in conjunction with their
Infection Control Team. These actions should be taken to prevent the spread of contagious respiratory
infections among patients, staff, physicians, volunteers, students and visitors.
Any recommended action should be used in conjunction with the advice and guidance provided by the
local health authority, The Texas Department of State Health Services (DSHS) and the Centers for
Disease Control and Prevention (CDC).




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Influenza Background Information:

Influenza is a common cause of respiratory illness, frequently requiring healthcare visits and
hospitalization. During the influenza season, outbreaks of healthcare associated influenza affect both
patients and personnel in chronic care facilities and hospitals. Unlike influenza type B, type A influenza
has the ability to infect a variety of animals, specifically birds. This unique characteristic can result in
novel strains of avian influenza, capable of causing illness in humans. A number of reports of avian-to-
human transmission of influenza have been documented from countries in Southeast Asia. If human-to-
human transmission occurs with this novel virus, an influenza pandemic could follow.
Human Influenza
       A. Incubation Period
               The incubation period for human influenza virus is usually 1 to 3 days (range 1 -7 days).
               The incubation period for novel viruses is also short; for example, the average time
               between exposure and onset of illness is 3 days (range 2-4 days) for influenza A (H5N1).


       B. Route of Transmission
               Transmission of human influenza is predominately by large respiratory droplets (>5
               microns nuclei) and to a lesser degree by the fine droplet nuclei that are expelled from the
               respiratory tract during coughing, sneezing and even talking. Transmission also occurs
               through direct contact with contaminated respiratory secretions followed by touching the
               eyes, nose, or mouth. Recent outbreaks of influenza A (H5N1) have not suggested a role
               for airborne transmission of disease.




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Definitions
      Antiviral medication - A medication that destroys or inhibits the growth and reproduction of
      viruses.

      Confirmed case – Refers to a laboratory-confirmed influenza virus infection in a person with
      influenza-like illness. A diagnosis of influenza is usually made on a clinical basis, particularly if
      influenza has been reported in the community.

      Contact – A person who has been exposed to an influenza case in some way during the
      infectious period.

      Contact – close – A person who has had direct exposure to respiratory secretions or body fluids
      or a person who has touched or talked to a person with confirmed influenza within 3 feet. For
      instance, a person who has cared for or lived with an influenza patient is considered a close
      contact.

       Contact – household – A type of close contact where direct exposure occurs through such
      additional actions as kissing or hugging, sharing eating or drinking utensils.
      Working in the same building, walking by, or sitting across a room from a person with influenza
      is NOT considered a direct exposure and, therefore, is considered a contact only.

      Flu Terms Defined:

      Seasonal (or common) influenza (flu) is a respiratory illness that can be transmitted person to
      person. Most people have some immunity due to its annual occurrence. A vaccine is available
      and must be received annually.

      Avian (or bird) flu is caused by influenza viruses that occur naturally among wild birds. The
      H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. There is
      no human immunity and no vaccine is currently available.

      Pandemic flu is virulent flu that causes a global outbreak or pandemic of serious illness.
      Because there is little natural immunity, the disease can spread easily from person to person.
      Currently, there is no pandemic flu virus circulating.

      Isolation – Refers to the separation and restriction of movement of people with a specific
      communicable disease to contain the spread of that illness to susceptible people; known as the
      contain and confine principle of prevention. People in isolation may be cared for in their homes,
      in hospitals, at designated health care facilities, or other dedicated facilities.

      Quarantine – The confinement of people who may have been exposed to an infectious agent
      and may be infected, but are not yet ill, to their home. Quarantine usually occurs in the home but
      can be a dedicated facility or hospital. The term ―quarantine‖ also can be applied to restrictions
      of movement into or out of buildings, other structures, and public conveyances. In addition,
      specific areas or communities may be quarantined. Quarantine is initiated by the Public Health
      Authority.


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Incubation period – Refers to the time from exposure to an infectious disease to symptom
onset. The incubation period for influenza is usually 2 days, but can vary from 1 to 5 days.

Influenza-like illness (ILI) – Describes a combination of symptoms that include 1) a fever >
100° F and 2) cough and/or sore throat in the absence of a known cause.

Influenza pandemic – A worldwide outbreak of a novel influenza virus causing sudden,
pervasive illness that can severely affect otherwise healthy individuals in all age groups.
Influenza pandemics occur infrequently and at irregular intervals and has the potential for
substantial impact resulting in increased morbidity and mortality, significant social disruption,
and severe economic cost.

Respiratory Etiquette – This CDC initiative includes covering your mouth with a tissue or
coughing/sneezing into your sleeve, using a tissue to contain secretions, wearing a mask, and
washing your hands to prevent the spread of upper respiratory diseases..




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                                         Pandemic Respiratory Infection
                                                           ALERT MATRIX

              WHO Phase
Alert Color   Pandemic                Transmissibility           Case Location                         Hospital Actions
              Interpandemic      Present in animal hosts.        Outside US, Canada, and Mexico        See Intrapandemic
GREEN         Phase 1            No new influenza in humans.                                           Hospital Preparation
                                 Low risk for human infection.                                         Phases 1 and 2
              Interpandemic      Circulating animal influenza                                          See Intrapandemic
              Phase 2            virus.                          Outside US, Canada, and Mexico        Hospital Preparation
GREEN                            No new influenza in humans.                                           Phases 1and 2
                                 Substantial risk for human
                                 infection.
              Pandemic Alert     New human viral infection.      Most cases outside US, Canada,        See Pandemic Alert
GREEN         Period             No or rare human to human       and Mexico                            Hospital Preparation
              Phase 3            transmission.                   May have occasional cases             Phase 3
                                                                 within US
              Pandemic Alert     Small human-to-human            Most cases outside US, Canada,        See Pandemic Alert
YELLOW        Period             transmission; clusters.         and Mexico                            Hospital Preparation
              Phase 4            Localized spread.               May have occasional cases within US   Phase 4
              Pandemic Alert     Large clusters of human-to-     Most cases outside US, Canada,        See Pandemic Alert
              Period             human spread.                   and Mexico                            Hospital Preparation/Actions
ORANGE        Phase 5            Localized spread.                                                     Phase 5
                                 Substantial risk of pandemic    Increasing cases within US
                                 transmissibility.
              Pandemic Period    Increases sustained                                                   Hospital Preparation/Actions
              Phase 6            transmission in general         Texas                                 Phase 6 a
RED                              population                      Local community                       Phase 6 b
                                                                 Within facility                       Phase 6 c
              Subsided Periods   Between waves                                                         See Subsided Period
                                                                                                       Hospital Actions
              Post-pandemic      End of pandemic and return to                                         See Intrapandemic
              Period             Interpandemic Period                                                  Phases 1 and 2



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                     INTRAPANDEMIC HOSPITAL PREPARATION
                                 PHASES 1-2



Interpandemic Phase 1                             Present in animal hosts.
                                                  No new influenza in humans.
                                                  Low risk for human infection.
Interpandemic Phase 2                             Circulating animal influenza virus.
                                                  No new influenza in humans.
                                                  Substantial risk for human infection.

Baseline Activities to Ensure Preparedness:

Access Control
   1. Utilize identification badges for all staff, physicians, volunteers, students, and vendors.
   2. Develop plan to limit access through lock down and monitoring of entrances and exits.


Influenza Vaccination
    3. Estimate and order routine influenza vaccine stock
    4. Know facility/system vaccine availability for standard influenza strains
    5. Have plan in place to distribute vaccine to patients, staff, and staff family members in routine
       and pandemic state
    6. Know current flu vaccine status of employees


Surveillance Screening and Triage
   7. System of syndromic surveillance implemented (electronic or manual)
   8. System to monitor employee absence during influenza season or in presence of a respiratory
       disease outbreak.
   9. Monitor current influenza status in US and local community through Public Health Reports
   10. Keep hospital administration informed of community influenza status
   11. Screen all outpatients for cough; provide mask and/or tissues at entry to institution. Provide
       supplies for hand hygiene at screening site and at numerous sites within the facility.
   12. Establish an Occupational Medicine/Employee Health policy specifying whether employees with
       upper respiratory symptoms may work. Screen all staff that present for cough; provide with
       mask and/or tissues; and determine continued work status.
   13. Communicate with patients’ family members and/or visitors with fever and cough to defer
       visiting inpatients until illness resolved. This information should also be included in Patient
       Admission materials.
   14. Coordinate with local and State Public Health system for latest CDC recommendations.


Infection Control/Precautions
    Establish Airborne Precautions criteria for implementation in outpatient and inpatient settings
       (See Appendix 1, Precautions for Communicable Diseases).
    Use visible doorway precautions signs to alert individuals entering the room to don Personal
       Protective Equipment (PPE). See Appendix 2-1, Pandemic Flu Precautions Door Signs and
       Appendix 2-2, Donning and Doffing PPE information sheet for staff and visitors.

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      Establish and maintain adequate supplies of surgical masks, antiseptic hand rub, and tissues
       throughout the outpatient and inpatient clinical areas at all times.
      Test air handling system capability

Communication/Education
   Develop an educational program for staff, visitors and patients, highlighting respiratory etiquette
    (See Appendix 2-3, Respiratory Etiquette Education Cards to hand out to patients, visitors and/or
    staff) hand hygiene, and routine influenza vaccination
   Post Pandemic Flu Phase


Preparedness
    Establish a facility specific Pandemic Influenza Plan
       Develop a list of required supplies and medications preparing for pandemic respiratory
          infectious disease outbreak
       Ensure Laboratory Services has established and updated their emergency plan to deal with
          surge capacity of patients with Pandemic Respiratory Infectious Disease (PRID).
    Identify a list of current staff immediate family members and provide to Human Resources
    Develop alternative staffing resources if 25% or 50% of staff absent
       Ensure contract agency staff understands they will be required to have the same vaccination
          or prophylaxis as facility staff
       Establish alternative locations for patients in residence for chronic or hospice care.
    Determine if current non-clinical facility space will be converted to patient care areas as part of
      increased surge capacity.
    Develop listing of services that will be curtailed/eliminated in event of pandemic
      influenza/respiratory disease outbreak
    Participate in scheduled community Emergency Exercises
    Identify and update individuals and contact numbers for Hospital Emergency Incident Command
      System (HEICS) call roster




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                         PANDEMIC HOSPITAL PREPARATION
                                    PHASE 3




Pandemic Alert Period                 Human infection with new virus.
Phase 3                               No or rare human to human transmission

See Intrapandemic Hospital Preparation Phases 1 and 2 and add the following:

Access Control
    All staff, volunteers, physicians, students, and vendors are required to wear identification while
       in institution.

Influenza Vaccination
     Any staff or patients who have not been vaccinated for seasonal strains will be vaccinated upon
       request, if vaccine is available

Surveillance Screening and Triage
    Respiratory Etiquette questions are updated as appropriate (See Appendix 2-4, Screening
       Questionnaire).

Infection Control/Precautions
    Monitor implementation of Respiratory Etiquette
    Notify Employee Health or Occupational Medicine when returning to duty if staff traveled to an
       area where new pandemic respiratory disease is present
    Admit any case of potential new pandemic respiratory disease to Airborne Precautions and a
       private room

Communication (PIO)/Education
   Identify the Public Affairs Officer (PAO)/Public Information Officer (PIO) to participate in the
    Emergency Management Joint Information Center (JIC)
   Identify a subject matter expert and back-up to support the PAO/PIO
   Increase frequency of facility Emergency Preparedness Committee meetings to brief on status of
    hospital preparation and patient census with suspect Pandemic Respiratory Infections (PRI).
   Prepare, develop, and print Pandemic Respiratory Infectious Disease (PRID) Phase signs and
    notification of visitation status for families and visitors

Preparedness
    Test Hospital Emergency Incident Command System (HEICS) call roster
    Identify reservists on staff, who could be activated in the event of an emergency
    Verify staff is trained on Web Emergency Operations Center (WebEOC) usage and data
      collection procedures to convey necessary data to staff doing WebEOC reporting.




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                         PANDEMIC HOSPITAL PREPARATION
                                    PHASE 4

See Intrapandemic Hospital Preparation Phases 1, 2 and 3 and add the following:
Pandemic Alert Period                   Small clusters of human-to-human transmission.
Phase 4                                 Localized spread
Access Control
    No change at this time


Influenza Vaccination
     Establish Employee Health /Occupational Medicine campaign to increase voluntary influenza
       vaccination numbers among hospital staff

Surveillance Screening and Triage
    Set up or obtain pre-made viral collection kits with instructions for use and surveillance
    Establish baseline facility level of patients presenting with Upper Respiratory Infections (URI)
       from Syndromic Surveillance

Infection Control/Precautions
    Increase monitoring of Respiratory Etiquette implementation
    Begin placement of patients who present with Upper Respiratory Infection (URI) symptoms in
       separate waiting areas
    Listen to Clinician Outreach and Communication Activity (COCA) calls from CDC
    Initiate Airborne Precautions and a private room for any case of suspect pandemic respiratory
       disease (Refer to Appendix 1, Precautions for Communicable Diseases; See Appendix 2-1,
       Pandemic Flu Precautions Door Signs; and Appendix 2-2, Donning and Doffing PPE
       information sheet for staff and visitors).

Communication (PIO)/Education
   Alert Infection Control/hospital Education to begin just-in-time training on recognizing flu
    symptoms, using respiratory viral illness algorithm (Appendix 2-6, Pandemic Respiratory
    Infectious Disease Algorithm), donning and doffing Personal Protective Equipment (PPE)
    [Appendix 2-2, Donning and Doffing PPE information sheet for staff and visitors] and re-
    emphasizing hand hygiene practices
   Begin frequent scheduled message to staff re: status of novel Pandemic Respiratory Infectious
    Disease (PRID)
   Establish an internal referral system for patients with questions (i.e., separate phone numbers or
    bank of numbers suggested)
   Designate Infection Control to post signs on Pandemic Respiratory Infectious Disease (PRID)
    Phase Status and notification of visitation for family and visitors (See Appendix 2-5, Staff
    Education Phase Signs).
   Work with Laboratory to educate staff how to collect viral specimens for suspected influenza


       Preparedness
      Monitor Web Emergency Operations Center (WebEOC) when activated
      Test Hospital Emergency Incident Command System (HEICS) call roste



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                         PANDEMIC HOSPITAL PREPARATION
                                    PHASE 5



Pandemic Alert Period                 Large clusters of human-to-human spread.
Phase 5                               Localized spread.
                                      Substantial risk of pandemic transmissibility.

See Intrapandemic Hospital Preparation Phases 1-4 and add the following:

Access Control
    Review need to restrict in-house visitation by vendors, outside conferences, and meeting
       participants
    Begin checking staff for identification and reminding visitors to limit family members coming to
       facility

Influenza Vaccination
     No change at this time.
     Review current plan and supplies for mass clinic vaccination/prophylaxis of staff, patients, and
       families

Surveillance Screening and Triage
    Establish baseline facility level of patients presenting with Upper Respiratory Infections (URI)
       from Syndromic Surveillance
    Screen patients arriving for non-urgent (elective) appointments for a new cough within the last 2
       weeks; refer patients responding yes to their clinician. (See Appendix 2-4, Screening
       Questionnaire).
    Notify Manager and Employee Health/Occupational Medicine if staff become ill at work or
       when returning from sick leave if reason includes cough and/or fever
        After evaluation, no employee with cough or fever will remain at the facility unless requiring
          hospitalization
        Employee’s Supervisor keeps Employee Health/Occupational Medicine informed of
          employee status on daily basis

Infection Control/Precautions
    Increase monitoring for Respiratory Etiquette compliance and check supplies to sustain the
       implementation process
    Check distribution of flu specimen kits to ensure proper distribution for use
    Report all laboratory confirmed influenza to local health reporting authority and identify as FLU
       A, B, UNK
    Collaborate with Employee/Occupational Health to educate staff re: rationale for reporting ILI
       (becoming ill at work and return to work after illness)

Communication (PIO)/Education
   Monitor Web Emergency Operations Center (EOC) when activated



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      Begin routine messages (i.e., e-mail, section chief/department head briefings, etc.) to staff re:
       status of novel Pandemic Respiratory Infectious Disease (PRID)
      Infection Control/Education Service will continue just-in-time training on recognition of
       symptoms for Pandemic Respiratory Infectious Disease (PRID); use of respiratory viral illness
       algorithm (Appendix 2-6, Pandemic Respiratory Infectious Disease Algorithm); how to don and
       doff Personal Protective Equipment (PPE) [Appendix 2-2, Donning and Doffing PPE
       information sheet]; and re-emphasize Hand Hygiene.
      Conduct daily briefings and/or updates of facility status to Administration/Corporate
       Headquarters


Preparedness
    Activate facility Hospital Emergency Incident Command System (HEICS) as soon as local
      Emergency Management activates Emergency Operation Center (EOC)
    Emergency Preparedness Officer, Infection Control Professional, and facility Pharmacist verify
      stock levels and availability of Personal Protective Equipment (PPE), supplies and
      pharmaceuticals
    Engineering or Facilities Management begins to add additional negative pressure units and
      airflow changes within the facility in areas with high-risk procedures that cause aerosolization of
      secretions (i.e., intubation, open suction, etc.) as directed or coordinated with Infection Control
    Ensure there is a mechanism to feed staff and patients if outside vendors begin to restrict services
    Physicians are notified of possible need to discharge all patients who are clinically able to be sent
      home as influx of respiratory cases increase sharply.




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                         PANDEMIC HOSPITAL PREPARATION
                                   (PHASE 6)



Pandemic Period      Increase sustained                                   Hospital
Phase 6              transmission in general   Texas                      Preparations/Actions
                     population                                           Phase 6 a
                                               Local community            Phase 6 b
                                               Within facility            Phase 6 c
See Baseline Activities Intrapandemic Hospital preparation Phases 1-5 and add the following:
Phase 6A—Remain at Phase 5, but elevated awareness and increased monitoring for PPE use and
compliance with Respiratory Etiquette and hand hygiene.

Phase 6B -- Institute the following:
Access Control:
    Restrict facility entry to the following:
        Employees with a valid identification badge who are scheduled for duty
        Patients arriving by ambulance
        One parent with hospitalized child, but cannot come and go from the facility
        One adult may accompany an emergency room patient, but cannot come and go from the
           facility
        Patients who receive regular life sustaining treatments (i.e., dialysis, transfusion dependent
           patients, etc.)
        Screen all individuals who enter the facility for cough, Upper Respiratory Infection (URI)
           symptoms using standardized questionnaire (See Appendix 2-4, Screening Questionnaire),
           and temperature
    Permit all individuals who clear screening with some form of verification allowing them to enter
       the facility (i.e. stamp their hand with date, pass, sticker, etc.)
    Lock all entrances, except one designated entrance
    Station security guards at the open entrance to enforce restrictions
    Suspend all non-emergency surgeries, admissions, outpatient appointments and transfers at the
       direction of the local health authority
    Suspend all on-site construction activities until further notice
    Suspend all on-site student rotations with possible re-deployment of clinical students to areas of
       need

Surveillance Screening and Triage
    Screen all persons each time they enter the facility
    Screen all personnel for respiratory symptoms at the end of each shift as they leave




Infection Control/Precautions
    Require all persons to perform hand hygiene upon entry to the facility
    Require all staff and any authorized family members to wear respiratory protection continuously
       while in designated high risk units, such as Neonatal Intensive Care Unit (NICU), Transplant,
       Bone Marrow units, etc.
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      Meticulously practice hand hygiene at all times in the facility as stated in the Hospital Infection
       Control Plan
      Keep administration informed of the status of vaccine: whether available and the priority of those
       who should receive vaccine/prophylaxis
      Advise hospital administration on the necessity for cohorting and implementation of separate
       units to accommodate surge capacity.


Communications/Education
   Solicit information from the facility Infection Control Professional for
   Daily or more frequent updates to staff and Public information Officer (PIO) as determined by
    the facility Hospital Emergency Incident Command System (HEICS)
   Continue emphasizing Respiratory Etiquette and hand hygiene to staff, visitors, and patients
    (e.g., through periodic information sent out to staff, signs posted for visitors and patients, etc.).
    See Appendix 2-3, Respiratory Etiquette Education Cards.

Preparedness
    Stage supplies for mass clinics to activate for vaccination and/or prophylaxis
    Update and prepare preliminary orders for staff and families when SNS arrives
    Redeploy staff from areas where activities have been suspended or limited to other areas of need
      as determined by Hospital Emergency Incident Command System (HEICS)


Phase 6c -- Initiate the following:

      Assess breaks in Infection Control measures as spread is occurring within the facility
      Investigate whether the respiratory disease was incubating when the patient was admitted if
       Healthcare Associated/Acquired Infection (HAI) cases are identified within 48 hours after
       admission to the institution




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                        PANDEMIC HOSPITAL PREPARATION
                                 Subsided Period




Subsided Periods     Between waves
                     Decrease in number of cases; may not have clearly defined period, except
                     in retrospect
                     May occur at different times for different facilities or regions. Individual
                     facility or region may have to make decision on the occurrence of this
                     period

Actions:

      Maintain Infection Control Procedures as in Phase 6.
      Continue vaccination efforts if vaccine is available.
      Debrief key staff for lessons learned
      Adjust plans before next wave, if time permits
      Maintain syndromic surveillance.
      Decide if elective procedures are suspended according to Public Health Authority and local
       healthcare institutions.
      Review logistical status
      Restock in preparation for next wave if possible.




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                         PANDEMIC HOSPITAL PREPARATION

                                       Post Pandemic Period




PostPandemic Period        End of pandemic
                           Return to Interpandemic Period
Actions:

      Public Health Authority announces end of Pandemic.
      Debrief staff
      Update plans
      Insure non-clinical areas that were used to house patients are cleaned with germicidal solutions.
      Restock supplies
      Return to Interpandemic Phase 1




                                                            15 of 39
                   APPENDIX 1




Appendix 1-1 Precautions for Communicable Diseases Overview

             Appendix 1-2 Contact Precautions

             Appendix 1-3 Droplet Precautions

             Appendix 1-4 Airborne Precautions




                                   16 of 39
                                          Appendix 1-1

                   Precautions for Communicable Diseases Overview

                                  Contact/Droplet/Airborne
Infection control guidelines should include detailed procedures in accordance with a person’s
responsibilities, expected contact with suspected cases, and the known pathology of the disease.

In cases of unknown or poorly understood agents, information about the pathology of disease
transmission may be poorly understood and thus, determining appropriate level of infection control may
be difficult. In these cases, medical and public health officials may choose to recommend the highest
level of precaution to ensure safety until the pathology becomes clearer and update and re-issue
guidance as necessary. Thus, at the beginning of an outbreak, the highest level of protection may be
initiated or recommended; but as more is learned about the novel organism, the degree of protection may
be lessened.

It is better to relax high levels of protection than to handle the consequences of too little or no
protection.




                                                        17 of 39
                                                 Appendix 1-2

                                          Contact Precautions
Excerpted from Guideline for Isolation Precautions in Hospitals (January 1996)

Background

Contact Precautions are designed to reduce the risk of transmission of epidemiologically important
microorganisms by direct or indirect contact. Direct-contact transmission involves skin-to-skin contact and
physical transfer of microorganisms to a susceptible host from an infected or colonized person, such as occurs
when personnel turn patients, bathe patients, or perform other patient-care activities that require physical
contact. Direct-contact transmission also can occur between two patients (e.g., by hand contact), with one
serving as the source of infectious microorganisms and the other as a susceptible host. Indirect-contact
transmission involves contact of a susceptible host with a contaminated intermediate object, usually inanimate,
in the patient's environment. Contact Precautions apply to specified patients known or suspected to be infected
or colonized (presence of microorganism in or on patient but without clinical signs and symptoms of infection)
with epidemiologically important microorganisms than can be transmitted by direct or indirect contact.

V. Contact Precautions

Use Standard Precautions, or the equivalent, for the care of all patients. Category IB

   a.   Patient Placement
   b.   Gloves and Handwashing (Hand Hygiene)
   c.   Gown
   d.   Patient Transport
   e.   Patient-Care Equipment

   A. Patient Placement

        Place the patient in a private room. When a private room is not available, place the patient in a room
        with a patient(s) who has active infection with the same microorganism but with no other infection
        (cohorting). When a private room is not available and cohorting is not achievable, consider the
        epidemiology of the microorganism and the patient population when determining patient placement.
        Consultation with infection control professionals is advised before patient placement. Category IB

   B. Gloves and Handwashing (Hand Hygiene)

        In addition to wearing gloves as outlined under Standard Precautions, wear gloves (clean, nonsterile
        gloves are adequate) when entering the room. During the course of providing care for a patient, change
        gloves after having contact with infective material that may contain high concentrations of
        microorganisms (fecal material and wound drainage). Remove gloves before leaving the patient's room
        and wash hands immediately with an antimicrobial agent or a waterless antiseptic agent. After glove
        removal and handwashing (or use alcohol based hand rub if no soiling is present), ensure that hands do
        not touch potentially contaminated environmental surfaces or items in the patient's room to avoid
        transfer of microorganisms to other patients or environments. Category IB
                                                              18 of 39
    C. Gown

        In addition to wearing a gown as outlined under Standard Precautions, wear a gown (a clean, nonsterile
        gown is adequate) when entering the room if you anticipate that your clothing will have substantial
        contact with the patient, environmental surfaces, or items in the patient's room, or if the patient is
        incontinent or has diarrhea, an ileostomy, a colostomy, or wound drainage not contained by a dressing.
        Remove the gown before leaving the patient's environment. After gown removal, ensure that clothing
        does not contact potentially contaminated environmental surfaces to avoid transfer of microorganisms to
        other patients or environments. Category IB

    D. Patient Transport

        Limit the movement and transport of the patient from the room to essential purposes only. If the patient
        is transported out of the room, ensure that precautions are maintained to minimize the risk of
        transmission of microorganisms to other patients and contamination of environmental surfaces or
        equipment. Category IB

    E. Patient-Care Equipment

        When possible, dedicate the use of noncritical patient-care equipment to a single patient (or cohort of
        patients infected or colonized with the pathogen requiring precautions) to avoid sharing between
        patients. If use of common equipment or items is unavoidable, then adequately clean and disinfect them
        before use for another patient. Category IB

Guideline for Isolation Precautions in Hospitals

Julia S. Garner, RN, MN, and the Hospital Infection Control Practices Advisory Committee

From the Public Health Service, US Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta,
Georgia. Garner JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect
Control Hosp Epidemiol 1996; 17:53-80, and Am J Infect Control 1996; 24:24-52.




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                                                Appendix 1-3

                                          Droplet Precautions
Background

Droplet Precautions are designed to reduce the risk of droplet transmission of infectious agents. Droplet
transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a
susceptible person with large-particle droplets (larger than 5 µm in size) containing microorganisms generated
from a person who has a clinical disease or who is a carrier of the microorganism. Droplets are generated from
the source person primarily during coughing, sneezing, or talking and during the performance of certain
procedures such as suctioning and bronchoscopy. Transmission via large-particle droplets requires close contact
between source and recipient persons, because droplets do not remain suspended in the air and generally travel
only short distances, usually 3 ft or less, through the air. Because droplets do not remain suspended in the air,
special air handling and ventilation are not required to prevent droplet transmission. Droplet Precautions apply
to any patient known or suspected to be infected with epidemiologically important pathogens that can be
transmitted by infectious droplets.

In addition to Standard Precautions, use Droplet Precautions, or the equivalent, for a patient known or suspected
to be infected with microorganisms transmitted by droplets (large-particle droplets [larger than 5 µm in size]
that can be generated by the patient during coughing, sneezing, talking, or the performance of procedures).
Category IB
In addition to Standard Precautions, use Droplet Precautions, or the equivalent, for a patient known or suspected
to be infected with microorganisms transmitted by droplets (large-particle droplets [larger than 5 µm in size]
that can be generated by the patient during coughing, sneezing, talking, or the performance of procedures).
Category IB

   A. Patient Placement

       Place the patient in a private room. When a private room is not available, place the patient in a room
       with a patient(s) who has active infection with the same microorganism but with no other infection
       (cohorting). When a private room is not available and cohorting is not achievable, maintain spatial
       separation of at least 3 ft between the infected patient and other patients and visitors. Special air
       handling and ventilation are not necessary, and the door may remain open. Category IB (ICP note:
       Cohort Influenza type A with A—type B with B etc. as long as possible)

   B. Mask

       In addition to wearing a mask as outlined under Standard Precautions, wear a mask when working
       within 3 ft of the patient. (Logistically, some hospitals may want to implement the wearing of a mask to
       enter the room.) Category IB

   C. Patient Transport

       Limit the movement and transport of the patient from the room to essential purposes only. If transport or
       movement is necessary, minimize patient dispersal of droplets by masking the patient, if possible.
       Category IB
                                                             20 of 39
                                                 Appendix 1-4

                                         Airborne Precautions
Excerpted from Guideline for Isolation Precautions in Hospitals (January 1996)

Background

Airborne Precautions are designed to reduce the risk of airborne transmission of infectious agents. Airborne
transmission occurs by dissemination of either airborne droplet nuclei (small-particle residue [5 µm or smaller
in size] of evaporated droplets that may remain suspended in the air for long periods of time) or dust particles
containing the infectious agent. Microorganisms carried in this manner can be dispersed widely by air currents
and may become inhaled by or deposited on a susceptible host within the same room or over a longer distance
from the source patient, depending on environmental factors; therefore, special air handling and ventilation are
required to prevent airborne transmission. Airborne Precautions apply to patients known or suspected to be
infected with epidemiologically important pathogens that can be transmitted by the airborne route.

III. Airborne Precautions

In addition to Standard Precautions, use Airborne Precautions, or the equivalent, for patients known or
suspected to be infected with microorganisms transmitted by airborne droplet nuclei (small-particle residue [5
µm or smaller in size] of evaporated droplets containing microorganisms that remain suspended in the air and
that can be dispersed widely by air currents within a room or over a long distance). Category IB

   A. Patient Placement

       Place the patient in a private room that has 1) monitored negative air pressure in relation to the
       surrounding areas, 2) 6 to 12 air changes per hour, and 3) appropriate discharge of air outdoors or
       monitored high-efficiency filtration of room air before the air is circulated to other areas in the hospital.
       Keep the room door closed and the patient in the room. When a private room is not available, place the
       patient in a room with a patient who has active infection with the same microorganism, unless otherwise
       recommended, but with no other infection. When a private room is not available and cohorting is not
       desirable, consultation with infection control professionals is advised before patient placement.
       Category IB

   B. Respiratory Protection

       Wear respiratory protection (N95 respirator) when entering the room of a patient with known or
       suspected infectious pulmonary tuberculosis. Susceptible persons should not enter the room of patients
       known or suspected to have measles (rubeola) or varicella (chickenpox) if other immune caregivers are
       available. If susceptible persons must enter the room of a patient known or suspected to have measles
       (rubeola) or varicella, they should wear respiratory protection. Persons immune to measles (rubeola) or
       varicella need not wear respiratory protection. Category IB

   C. Patient Transport

       Limit the movement and transport of the patient from the room to essential purposes only. If transport or
       movement is necessary, minimize patient dispersal of droplet nuclei by placing a surgical mask on the
       patient, if possible. Category IB
                                                              21 of 39
                    APPENDIX 2

   Appendix 2-1 Special Precautions for Emerging Pathogens

   Appendix 2-2 Donning and Doffing PPE information sheet

      Appendix 2-3 Respiratory Etiquette Education Cards

         Appendix 2-4 Screening Tool (Questionnaire)

          Appendix 2-5 Staff Education - Phase Signs

Appendix 2-6 Pandemic Respiratory Infectious Disease Algorithm




                                  22 of 39
Appendix 2-1 Special Precautions for Emerging Pathogens

(Print duplex copy on paper or card stock in bright red color)

                 See next 2 pages.




                                  23 of 39
                         SPECIAL
                       PRECAUTIONS
                  for Emerging Pathogens
  VISITORS MUST REPORT TO NURSING STATION BEFORE ENTERING


To enter the Negative Pressure Room, you MUST WEAR:
      N-95 Respirator
      Gloves
      Gown
      Protective Eyewear: Face Shield/Goggles within 3 feet of patient
      [Powered Air Purifying Respirators (PAPRs) are recommended for
      doing invasive aerosolizing procedures, such as bronchoscopies,
      intubations, etc.]

Reminder: Perform hand hygiene before entering the patient’s room AND after
removing gloves.
   1. PATIENT PLACEMENT:
           Require private room.
           Place patient in negative pressure isolation room (if none available, place
            portable HEPA filtration unit in room.)
           Monitor and record negative air pressure DAILY.
   2. VISITOR PROTECTION:
           Limit visitors to immediate family and other persons significant to patient.
           Instruct visitors to wear appropriate protective attire.
   3. PATIENT TRANSPORT:
           The patient should not be transported outside the room unless medically
            necessary.
           The patient, transport staff, and receiving department must follow isolation
            precautions.
           The patient should wear a cup style surgical mask.



                For questions, call Infection Control
                                 _______________________




                                                               24 of 39
4. PATIENT CARE EQUIPMENT:
       Dedicate the use of stethoscope, blood pressure cuff, thermometer, and other
          non-critical patient care equipment to a single patient.
       Do not share equipment.
       Clean and disinfect equipment that MUST be used between patients in an
          emergency situation.
5. FURNITURE:
       Remove all non-essential furniture.
6. RECORD KEEPING:
       Place a recording sheet at the entrance of the isolation room.
       Instruct all persons entering the room to document their name and date/time of
          visit.
7. LINEN:
       Bag at the point of use in a plastic, fluid resistant, color-coded bag.
8. WASTE:
       Place in a regular waste container.
9. DISEASES:
       Examples would include, but not limited to: SARS, PANDEMIC INFLUENZA




                                                          25 of 39
Appendix 2-2 Donning and Doffing PPE information sheet

                 See next page.




                                 26 of 39
27 of 39
 Appendix 2-3 Respiratory Etiquette Education Cards
(Add your facility logo and/or name to all of the boxes on both the English and
                        Spanish version before printing.)




                                              28 of 39
Put logo here          How can I keep myself and my               Put logo here          How can I keep myself and my
                         family from getting sick?                                         family from getting sick?
1.   Use a tissue to cover your mouth and nose when you           1.   Use a tissue to cover your mouth and nose when you
     sneeze or cough.                                                  sneeze or cough.
2.   Put your used tissue in the waste basket.                    2.   Put your used tissue in the waste basket.
3.   Wash hands with soap and water or clean with alcohol         3.   Wash hands with soap and water or clean with alcohol
     based hand sanitizer.                                             based hand sanitizer.
4.   Offer a tissue to others who may be coughing or              4.   Offer a tissue to others who may be coughing or
     sneezing.                                                         sneezing.
5.   Remind others to wash their hands frequently.                5.   Remind others to wash their hands frequently.
6.   Don’t visit hospitalized friends or family if you’re sick.   6.   Don’t visit hospitalized friends or family if you’re sick.


Put logo here          How can I keep myself and my               Put logo here          How can I keep myself and my
                         family from getting sick?                                         family from getting sick?
1.   Use a tissue to cover your mouth and nose when you           1.   Use a tissue to cover your mouth and nose when you
     sneeze or cough.                                                  sneeze or cough.
2.   Put your used tissue in the waste basket.                    2.   Put your used tissue in the waste basket.
3.   Wash hands with soap and water or clean with alcohol         3.   Wash hands with soap and water or clean with alcohol
     based hand sanitizer.                                             based hand sanitizer.
4.   Offer a tissue to others who may be coughing or              4.   Offer a tissue to others who may be coughing or
     sneezing.                                                         sneezing.
5.   Remind others to wash their hands frequently.                5.   Remind others to wash their hands frequently.
6.   Don’t visit hospitalized friends or family if you’re sick.   6.   Don’t visit hospitalized friends or family if you’re sick.


Put logo here          How can I keep myself and my               Put logo here          How can I keep myself and my
                         family from getting sick?                                         family from getting sick?
1.   Use a tissue to cover your mouth and nose when you           1.   Use a tissue to cover your mouth and nose when you
     sneeze or cough.                                                  sneeze or cough.
2.   Put your used tissue in the waste basket.                    2.   Put your used tissue in the waste basket.
3.   Wash hands with soap and water or clean with alcohol         3.   Wash hands with soap and water or clean with alcohol
     based hand sanitizer.                                             based hand sanitizer.
4.   Offer a tissue to others who may be coughing or              4.   Offer a tissue to others who may be coughing or
     sneezing.                                                         sneezing.
5.   Remind others to wash their hands frequently.                5.   Remind others to wash their hands frequently.
6.   Don’t visit hospitalized friends or family if you’re sick.   6.   Don’t visit hospitalized friends or family if you’re sick.


Put logo here          How can I keep myself and my               Put logo here          How can I keep myself and my
                         family from getting sick?                                         family from getting sick?
1.   Use a tissue to cover your mouth and nose when you           1.   Use a tissue to cover your mouth and nose when you
     sneeze or cough.                                                  sneeze or cough.
2.   Put your used tissue in the waste basket.                    2.   Put your used tissue in the waste basket.
3.   Wash hands with soap and water or clean with alcohol         3.   Wash hands with soap and water or clean with alcohol
     based hand sanitizer.                                             based hand sanitizer.
4.   Offer a tissue to others who may be coughing or              4.   Offer a tissue to others who may be coughing or
     sneezing.                                                         sneezing.
5.   Remind others to wash their hands frequently.                5.   Remind others to wash their hands frequently.
6.   Don’t visit hospitalized friends or family if you’re sick.   6.   Don’t visit hospitalized friends or family if you’re sick.




                                                                       29 of 39
Put logo here         ¿Cómo puedo evitar de que yo y mi            Put logo here         ¿Cómo puedo evitar de que yo y mi
                         familia nos enfermemos?                                            familia nos enfermemos?
1.   Use un pañuelo para cubrir su boca al toser o estornudar.     1.   Use un pañuelo para cubrir su boca al toser o estornudar.
2.   Bote el pañuelo usado en el cesto de basura.                  2.   Bote el pañuelo usado en el cesto de basura.
3.   Lávese las manos con agua y jabón o límpielas con un gel de   3.   Lávese las manos con agua y jabón o límpielas con un gel de
     alcohol.                                                           alcohol.
4.   Ofrezca un pañuelo a las personas que esten tosiendo o        4.   Ofrezca un pañuelo a las personas que esten tosiendo o
     estornudando.                                                      estornudando.
5.   Recuerde a los demás que deben lavarse las manos con          5.   Recuerde a los demás que deben lavarse las manos con
     frecuencia.                                                        frecuencia.
6.   No visite a familiares y amigos hospitalizados si se siente   6.   No visite a familiares y amigos hospitalizados si se siente
     enfermo.                                                           enfermo.

Put logo here         ¿Cómo puedo evitar de que yo y mi            Put logo here         ¿Cómo puedo evitar de que yo y mi
                         familia nos enfermemos?                                            familia nos enfermemos?
1.   Use un pañuelo para cubrir su boca al toser o estornudar.     1.   Use un pañuelo para cubrir su boca al toser o estornudar.
2.   Bote el pañuelo usado en el cesto de basura.                  2.   Bote el pañuelo usado en el cesto de basura.
3.   Lávese las manos con agua y jabón o límpielas con un gel de   3.   Lávese las manos con agua y jabón o límpielas con un gel de
     alcohol.                                                           alcohol.
4.   Ofrezca un pañuelo a las personas que esten tosiendo o        4.   Ofrezca un pañuelo a las personas que esten tosiendo o
     estornudando.                                                      estornudando.
5.   Recuerde a los demás que deben lavarse las manos con          5.   Recuerde a los demás que deben lavarse las manos con
     frecuencia.                                                        frecuencia.
6.   No visite a familiares y amigos hospitalizados si se siente   6.   No visite a familiares y amigos hospitalizados si se siente
     enfermo.                                                           enfermo.

Put logo here         ¿Cómo puedo evitar de que yo y mi            Put logo here         ¿Cómo puedo evitar de que yo y mi
                         familia nos enfermemos?                                            familia nos enfermemos?
1.   Use un pañuelo para cubrir su boca al toser o estornudar.     1.   Use un pañuelo para cubrir su boca al toser o estornudar.
2.   Bote el pañuelo usado en el cesto de basura.                  2.   Bote el pañuelo usado en el cesto de basura.
3.   Lávese las manos con agua y jabón o límpielas con un gel de   3.   Lávese las manos con agua y jabón o límpielas con un gel de
     alcohol.                                                           alcohol.
4.   Ofrezca un pañuelo a las personas que esten tosiendo o        4.   Ofrezca un pañuelo a las personas que esten tosiendo o
     estornudando.                                                      estornudando.
5.   Recuerde a los demás que deben lavarse las manos con          5.   Recuerde a los demás que deben lavarse las manos con
     frecuencia.                                                        frecuencia.
6.   No visite a familiares y amigos hospitalizados si se siente   6.   No visite a familiares y amigos hospitalizados si se siente
     enfermo.                                                           enfermo.

Put logo here         ¿Cómo puedo evitar de que yo y mi            Put logo here         ¿Cómo puedo evitar de que yo y mi
                         familia nos enfermemos?                                            familia nos enfermemos?
1.   Use un pañuelo para cubrir su boca al toser o estornudar.     1.   Use un pañuelo para cubrir su boca al toser o estornudar.
2.   Bote el pañuelo usado en el cesto de basura.                  2.   Bote el pañuelo usado en el cesto de basura.
3.   Lávese las manos con agua y jabón o límpielas con un gel de   3.   Lávese las manos con agua y jabón o límpielas con un gel de
     alcohol.                                                           alcohol.
4.   Ofrezca un pañuelo a las personas que esten tosiendo o        4.   Ofrezca un pañuelo a las personas que esten tosiendo o
     estornudando.                                                      estornudando.
5.   Recuerde a los demás que deben lavarse las manos con          5.   Recuerde a los demás que deben lavarse las manos con
     frecuencia.                                                        frecuencia.
6.   No visite a familiares y amigos hospitalizados si se siente   6.   No visite a familiares y amigos hospitalizados si se siente
     enfermo.                                                           enfermo.




                                                                          30 of 39
Appendix 2-4: Screening Tool (Questionnaire)

            See next page.




                            31 of 39
                 PANDEMIC INFLUENZA SCREENING TOOL
                                                            YES     NO                 COMMENTS
1. Within the last 24 hours, have you had any of the
following symptoms:
    a. Cough?
    b. Runny nose?
    c. Sore throat?
    d. Chest tightness and/or shortness of breath?
    e. Fever (>100.5F)/chills?
    f. Muscle/joint pain?
2. Is anyone living with you currently ill with any of
the above symptoms?
3. Within the last 2 weeks, any travel outside of the                     Countries/areas for review:
U.S.? List location(s)

4. Have you had your influenza vaccination this year?
5. Are you currently taking any antiviral medication                         Date medication started __________
for influenza?                                                               Name of medication ______________
6. Are you a:
     a. Family member of a patient?
     b. Visitor?
     c. Healthcare worker?
           At this facility?
                 If Yes, what is the physical location/unit in the hospital? _______________________
       If No, where do you work? _________________________________________________
       Do you work at any other health care facility? ________________________________
                         Address: _________________________________________________________
                         Contact Number: __________________________________________________

PERSONAL CONTACT INFORMATION:
Name: ______________________________________________________________________________
Current Resident Address: ______________________________________________________________
City/State: ___________________________________________________________________________
Telephone Contact Number: Home (____) ______________ Business (___) ______________
                                    Cell/Mobile (____) ______________
Name of Nearest Relative________________________________
Contact # of Nearest Relative _____________________________
Address of Nearest Relative _____________________________________________________________
*************************************************************************************
Temperature: ________               Date/Time: ________________
                  _______                         ______________
DISPOSITION:
WORK: _____ HOME: _____
Admit to HOSPITAL: _____ UNIT: ______                    Date/Time: ________________________

                                                         ___________________________________________
                                                         (Signature of staff completing or verifying the form)
                                                               32 of 39
Appendix 2-5 Staff Education - Phase Signs




                           33 of 39
      PANDEMIC FLU ALERT
           P hase 4
 Small local clusters of human to human spread

CONTROL MEASURES:
  Get vaccine for seasonal influenza

  Clean your hands (soap/water or hand sanitizer) at
   EVERY opportunity

  Perform and enforce Respiratory Etiquette
     Cover nose and mouth with tissue when coughing or
    sneezing (or cover with upper sleeve) - not hands
     Provide masks for patients who are coughing or
    sneezing
     Confine patients with cough and fever in separate
    waiting areas

  Place patients with suspected flu in a private room with
   Airborne Precautions until influenza is ruled out.

  Get educated!




                                    34 of 39
       PANDEMIC FLU ALERT
            Phase 5
  Large local clusters of human to human spread

CONTROL MEASURES:
  Place patients with suspected flu in a private room with
    Airborne Precautions until influenza is ruled out.
   Get vaccination for seasonal influenza
   Clean your hands (soap/water or hand sanitizer) at
    EVERY opportunity
   Perform and enforce Respiratory Etiquette
         Cover nose and mouth with tissue when coughing
            or sneezing (or cover with upper sleeve) - not
            hands
         Provide masks for patients who are coughing or
            sneezing
         Confine patients with cough and fever in separate
            waiting areas
   Screen patients for elective procedures for flu symptoms
    within last 2 weeks
         If positive, refer to their physician
   Screen ALL EMPLOYEES
         If become ill at work with fever and/or cough
         When returning to work from sick leave




                                    35 of 39
       PANDEMIC FLU ALERT
            Phase 6A
       Transmission in General Population and
                  Cases in Texas

CONTROL MEASURES:
  Place patients with suspected flu in a private room with
    Airborne Precautions until influenza is ruled out.
   Clean your hands (soap/water or hand sanitizer) at
    EVERY opportunity
   Perform and enforce Respiratory Etiquette
         Cover nose and mouth with tissue when coughing
           or sneezing (or cover with upper sleeve) - not
           hands
         Provide masks for patients who are coughing or
           sneezing
         Confine patients with cough and fever in separate
           waiting areas
   Screen ALL EMPLOYEES
         If become ill at work with fever and/or cough
         When returning to work from sick leave
   BE SURE you and those around you are using correct
    PPE properly




                                    36 of 39
PANDEMIC FLU ALERT
        Phase 6B
      Transmission in General Population and
                  Local Cases!

CONTROL MEASURES:
  ALL persons entering facility are screened and must use
    hand sanitizer!
   ONE adult may accompany the patient into the facility
   STAFF and VISITORS wear masks in high risk areas!
   Clean your hands (soap/water or hand sanitizer) at
    EVERY opportunity
   Perform and enforce Respiratory Etiquette
        Cover nose and mouth with tissue when coughing
          or sneezing (or cover with upper sleeve) - not
          hands
        Provide masks for patients who are coughing or
          sneezing
        Confine patients with cough and fever in separate
          waiting areas
   BE SURE you and those around you are using correct
    PPE properly
   Screen ALL STAFF at end of shift for respiratory
    symptoms




                                  37 of 39
Appendix 2-6: Pandemic Respiratory Infectious Disease Algorithm

                     See next page.




                                     38 of 39
               Pandemic Respiratory Infectious Disease (PRID) Algorithm
                Reception: Patient enters ED or Clinic with Cough
                Provide surgical mask, facial tissues, and hand sanitizer. Teach proper mask usage to patient or family member as
                appropriate for patient age/function level. Place in separate waiting area when possible or place three feet from other
                patients. If respiratory illness is of unknown etiology, evaluate based on criteria below:




                                                        NO                               Temperature
                                                                                         >100.4º F (38ºC)

                                                                                                      YES
                                                                                                             AND
Evaluate as routine community                                             In the 10 days prior to illness onset did the patient travel to an area or
acquired respiratory illness.                                             have contact with someone who traveled to an area with documented or
                                                        NO                suspected Pandemic Respiratory Infectious Disease? (List Countries)
Staff: wear mask if patient is                                            __________________________________________________________
coughing or sneezing.                                                     __________________________________________________________
                                                                          _________________________________________________________


                                                                                                      YES

                                                                                                       AND
                                                                               One or more findings of respiratory illness [cough, shortness of
                                                        NO                     breath, difficulty breathing, hypoxia or radiographic findings of either
                                                                               pneumonia or Acute Respiratory Distress Syndrome (ARDS)]

                                                                YES

                                                                                                    Special Precautions for Emerging Pathogens
                                                           ISOLATION                                Standard: Hand Hygiene for Staff and Patients
                                                          PRECAUTIONS                               Airborne: Staff: wear N-95 respirator
                                                                                                    Contact: Gowns, gloves and eye protection
                                                                                                    (See ―Special Precautions for Emerging
                                                                                                    Pathogens‖ sign in Appendix 2-1)




                Immediately Notify:                                                                                         AND
                Infection Control __________________________                                      If family members/contacts are identified with similar
                Infectious Disease __________________________                                     symptoms, provide mask and confirm that Pandemic
                Other ____________________________________                                        Influenza Screening Tool has been completed
                                                                                                  (including contact information). Refer symptomatic
                (Infection Control Department will notify Local Health                            persons to their physician (consult first by phone) or
                Department/Reporting Authority of suspect case.)                                  to designated sites/clinics for screening.
                                                                                                  __________________________________________




                                          Initiate Diagnostic Evaluation:
                                          Chest X-ray (ensure use of Airborne
                                          Precautions), pulse oximetry, blood                                Consult laboratory if instructions
                                          cultures, sputum gram stain and culture,                           needed for viral collection
                                          nasal washings for Influenza A and B,                              _________________________
                                          RSV, and/or other infectious disease
                                          testing as age appropriate


                                                                                                 Continue Special Precautions as a
                                                                                                 presumptive PRID case. Use Negative
Airborne Precautions                                 Has Alternative                             Airflow Room as available.
may be down graded           YES                     Diagnosis Been            NO
to Droplet Precautions                                   Made?
or discontinued. Treat
as indicated for                                                                                                                     NO
disease process.                                           YES                                Has PRID been ruled out?


                                                                                               39 of 39

								
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