Check for the latest online updates from the U.S. Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov/swineflu/
(April 27, 2009) In a media conference today the U.S. Centers for Disease Control and Prevention (CDC) reported there are 40 confirmed human cases of swine Influenza A (swH1N1) within the U.S. borders. Those states with confirmed cases include: California, Texas, Kansas, New York and Ohio. Outside the U. S. borders there are confirmed cases in Canada, Mexico and Europe.
In an effort to release federal funds for containment measures of the virus, the Department of Health and Human Services announced a nationwide public health emergency yesterday. This action will allow states to secure items such as antiviral medication, testing and masks for use in mitigating viral outbreaks.
A respiratory disease of pigs, swine flu can be passed to humans and spread from person to person by respiratory droplet very easily. The 2008-09 flu shot does not protect individuals against the swine flu. Swine flu is confirmed by a specialized laboratory test available at the Colorado Health Department. As of this morning, the State Health Department has requested that healthcare professionals only send specimens for testing on patients who have an illness of such severity that we are planning to hospitalize them.
Based on CDC recommendations(http://www.cdc.gov/swineflu/mitigation.htm), medical providers at the Downtown Denver Campus Health Center at Auraria strongly encourage persons who develop influenza-like-illness (ILI) (fever with either cough or sore throat) to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved, whichever is longer. Persons who experience ILI and wish to seek medical care should contact their primary care physician to report illness (by telephone or other remote means) before seeking care at a clinic, physician’s office, or hospital. Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention.
If ill persons must go into the community (e.g., to seek medical care) they should wear a face mask to reduce the risk of spreading the virus in the community when they cough, sneeze, talk or breathe. If a face mask is unavailable, ill persons needing to go into the community should use a handkerchief or tissues to cover any coughing.
Persons in home isolation and their household members should be given infection control instructions: including frequent hand washing with soap and water. Use alcohol-based hand gels (containing at least 60%alcohol) when soap and water are not available and hands are not visibly dirty. When the ill person is within 6 feet of others at home, the ill person should wear a face mask if one is available and the ill person is able to tolerate wearing it.
Health Center officials are monitoring the Downtown Campus community closely and working with the Colorado Department of Public Health to provide information on this situation as it becomes available. To learn more about the swine flu or CDC updates go to http://www.cdc.gov/swineflu/
***INFECTION CONTROL RECOMMENDATIONS FROM UNIVERSITY OF COLORADO HOSPITAL AS OF 8 a.m. 4/27/09
Symptoms of swine flu are those of seasonal influenza: fever, cough, muscle aches, runny nose, AND in a lot of cases, vomiting and diarrhea. Incubation period is 1-3 days, patients may be infectious for 1-2 days prior to symptoms and infectious up to 7 days after symptoms start.
Similar to seasonal influenza those with mild symptoms should stay home, self treat and practice preventative measures to prevent spread of the virus. http://www.cdc.gov/swineflu/general_info.htm
Patients with respiratory distress, prolonged vomiting or are otherwise significantly ill should call their health care provider for guidance.
Effective surface decontamination agents against Swine flu:
-Alcohol hand rubs
-Soap and water
-Hospital disinfectants
-Household disinfectants such as Lysol
PERFORM HAND HYGIENE upon entry and exit from patient rooms and at all other appropriate opportunities.
If you are ill, especially with the above symptoms, do not come to work. See your personal care provider for treatment. Contact Employee Health & Wellness Clinic 720-848-6849 for return-to-work guidance.
Follow CDC guidelines for avoidance of exposure and illness: www.cdc.gov/swineflu
SCREENING
Current recommendations from the CDPHE (conference call 4/26/09) are that patients with mild illness should stay at home regardless of travel history. Patients can contact the Colorado Help Line - COHelp at 1-877-462-2911 for more information.
AMBULATORY CARE CLINICS and ED
Clinic staff:
-Mask (surgical mask for the patient) patients with signs/symptoms of respiratory disease.
-Screen for travel history to Mexico, southern CA, southern TX, other areas currently known to have confirmed cases of swine flu OR history of recent contact with ill persons who have traveled to these places within the last week.
Booking the Appointment:
Consider the possibility of booking/clustering these patients towards the end of the day to minimize exposure to other patients.
Make note in appointment that patient has symptoms of flu to allow front desk and staff to be prepared for the patients arrival and care.
If travel history positive:
-Place patient in exam room as soon as possible after recognition of symptoms and positive travel history.
-Wear gloves, N95 and eye protection to enter exam room.
-After patient leaves the exam room, wipe down horizontal surfaces and other items the patient touched with CaviWipes.
-Perform hand hygiene – alcohol based hand rubs are effective against flu viruses.
For moderately to severely ill patients seen in the ED and clinic systems consider screening for swine influenza based on the current CDC case definition as of 4/24/09:
A suspected case of swine influenza A (H1N1) virus infection 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 swine influenza A (H1N1) virus infection.
Close contact is defined as: within about 6 feet of an ill person who is a confirmed or suspected case of swine influenza A (H1N1) virus infection.
Acute respiratory illness is defined as recent onset of at least two of the following: rhinorrhea or nasal congestion, sore throat, cough (with or without fever or feverishness)
Clinicians should consider swine influenza A (H1N1) virus infection in the differential diagnosis of patients with febrile respiratory disease and who 1) live in San Diego and Imperial Counties, California, or Guadalupe County, Texas, or traveled to these counties or 2) who traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in the two U.S. counties or Mexico in the 7 days preceding their illness onset.
These screening recommendations are focused to avoid overloading the reference laboratory with specimens.
The UCH rapid screen for influenza A will probably not detect swine influenza. There is however still seasonal influenza A in the community. Samples for swine influenza testing must be obtained with nasopharyngeal swab or wash and sent to the CDPHE for testing. Coordinate this with the UCH virology laboratory.
If a patient is sent from the clinic for admission or testing they should wear a surgical mask when out of their room.
INPATIENT CARE
-Airborne and Contact Precautions on admission. If negative pressure room not available, use single bed room with DOOR CLOSED.
-Wear gloves, N95, gown and eye protection to enter patient room.
-Patient should stay in room at all times except for transport to diagnostic tests that cannot be brought to the patient.
-Put surgical mask on patient if necessary to transport patient from room to other department(s). Have patient perform hand hygiene before leaving room.
-Caregivers should perform HAND HYGIENE upon entry and exit from patient room.
-No enhanced housekeeping routines are required. Routine daily and discharge patient room cleans are appropriate.
-Alcohol hand rubs, soap and water and hospital disinfectants are effective against flu viruses.
Treatment
Treat as any other influenza A case, also consider bacterial complicating infections.
The swine influenza virus is resistant to the antiviral medications amantadine and rimantadine, but is sensitive to oseltamivir and zanamivir. The swine flu cases reported in the US have to date been relatively mild with only one hospitalization. If seasonal influenza is a possibility in moderately or severely ill patients consider dual coverage with rimamatidine as seasonal influenza is resistant to oseltamivir.
Supplies of drugs used to treat swine flu are currently being inventoried by the UCH Pharmacy. If we need to prioritize their use, you will be notified.
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