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IS SWINE FLU Headed Your Way?

We’re all aware that a new flu virus of swine origin (H1N1) has been surfacing in the United States, and worldwide. This new flu was first detected in April, 2009 and has been spreading via person-to-person contact.

Illness signs and symptoms have consisted of influenza-like illness— fever and respiratory tract illness (cough, sore throat, runny nose), headache, muscle aches—and some cases have had vomiting and diarrhea. Cases of severe respiratory disease, including fatal outcomes, have been reported.

CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this new virus in the coming days and weeks because the population has little to no immunity against it. Novel influenza A (H1N1) activity is now being detected in two of CDC’s routine influenza surveillance systems as reported in the May 8, 2009 FluView. FluView is a weekly report that tracks U.S. influenza activity through multiple systems across five categories.

 WHAT YOU CAN DO TO STAY HEALTHY
  • Stay informed. The CDC Web site at http://www.cdc.gov is updated regularly as information becomes available.
  • Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
  • Take everyday actions to stay healthy.
  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
  • Avoid touching your eyes, nose or mouth. Germs spread that way.
  • Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
  • Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
  • Find healthy ways to deal with stress and anxiety.
  • Call 1-800-CDC-INFO for more information.

WHAT DOES THIS MEAN TO YOU?
The CDC has released, Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Novel Influenza A (H1N1) Virus Infection in a Healthcare Setting. This document provides interim guidance for healthcare facilities (e.g., hospitals, long-term care and outpatient facilities, and other settings where healthcare is provided). You will find appropriate excerpts below.

LAUNDRY
Although influenza viruses can persist on porous materials, the transfer of these viruses from sheets, bedding, and clothing is not as efficient a process as that involving non-porous surfaces (1). Therefore, management of laundry in healthcare facilities and in the home can be accomplished with existing procedures appropriate for these settings (2, 3):

  • Handle soiled clothing and linens during collection with a minimum amount of agitation and fluffing;
  • Healthcare workers and laundry personnel should follow established facility safety procedures (minimum recommendation is for glove use) when handling soiled linens.
  • Handwashing or hand hygiene should be done in the home after sorting laundry and adding the clothing and linens to the washer.
  • Use detergents, laundry additives, and appropriate water temperature as per routine laundry procedures. Follow manufacturer instructions for detergent and bleach use.
  • Use a temperature setting for drying clothes and linens appropriate for the fabrics in the load. Line- or air-drying can be used to dry items when machine drying is not indicated.
  • Clean your hands before removing clean laundry from the washer or dryer, especially if you have coughed or sneezed onto your hands.

ROUTINE SOLID WASTES AND REGULATED MEDICAL WASTES
There is no evidence to suggest that either pandemic influenza virus or seasonal influenza viruses can be spread via contact with either routine solid wastes or regulated medical wastes generated either in a healthcare facility or in a home, school, or business. Therefore, current waste management strategies can continue to be used while influenza viruses are in circulation (2,3):
Healthcare Facilities:

  • Use Standard Precautions when working with solid waste that may be contaminated with influenza virus outside of patient isolation areas.
  • Use PPE as is currently required by your state (e.g., gloves) when handling open waste containers.
  • No changes in waste containment need be made during periods of influenza activity (e.g., single bag lining for routine clinic wastes, appropriate labeled containment for regulated medical wastes).
  • Current medical waste treatment procedures can be used to treat regulated medical waste in accordance with state and federal regulations.
  • Treated medical waste can be safely deposited in municipal solid waste landfills as per normal procedures.

IMPLEMENTATION OF RESPIRATORY HYGIENE/COUGH ETIQUETTE
To prevent the transmission of all respiratory infections in healthcare settings, including novel H1N1, respiratory hygiene/cough etiquette infection control measures should be implemented at the first point of contact with a potentially infected person. They should be incorporated into infection control practices as one component of Standard Precautions.
Healthcare facilities should establish mechanisms to screen patients for signs and symptoms of febrile respiratory illness at any point of entry to the facility. Provisions should be made to allow for prompt isolation and assessment of symptomatic patients.

IMPLEMENTATION OF FACILITY CONTINGENCY PLANS
The current situation with novel H1N1 flu in the United States is evolving quickly. Staff in healthcare settings should monitor the H1N1 Flu website and state and local health department websites for the latest information. Health-care facilities should be reviewing and making plans to implement their facility contingency response and/or pandemic response plans. This should include making plans for managing increasing patient volume and potential staffing limitations.

INTERIM INFECTION CONTROL RECOMMENDATIONS
If the patient is presenting in a community where novel H1N1 transmission is occurring (based upon information provided by state and local health departments), these infection control recommendations should apply to all patients with febrile respiratory illness (defined as fever [greater than 37.8° C] plus one or more of the following: rhinorrhea or nasal congestion; sore throat; cough).

If the patient is presenting in a community without novel H1N1 transmission, these infection control recommendations should apply to those patients with febrile respiratory illness AND:

  • close contact with a person who is a confirmed, probable, or suspected case of novel H1N1 virus infection, within the past 7 days

    OR

  • travel to a community either within the United States or internationally where there are one or more confirmed novel H1N1 cases within 7 days
    As the situation evolves, the ability to use epidemiologic links to identify potentially infectious patients may be lost and these recommendations may need to be applied to all patients with febrile respiratory illness. This situation will be monitored, and these guidelines will be updated as needed by the CDC.

STAYING SAFE NO MATTER WHERE YOU ARE
The CDC has some important reminders for us to stay safe no matter where we are:

  • Keep housekeeping surfaces and countertops clean of visible soil by cleaning with detergents and water or proprietary cleaners, followed by rinsing with water. Repeated application of disinfectants to table and desktop surfaces is unnecessary. Frequent use of room air deodorizers to disinfect the air is not recommended.
  • Follow label instructions carefully when using disinfectants and cleaners, noting any hazard advisories and indications for using personal protective items (such as household gloves). Do not mix disinfectants and cleaners unless the labels indicate it is safe to do so. Combining certain products (such as chlorine bleach and ammonia cleaners) can be harmful, resulting in serious injury or death.
  • Clean and disinfect bathroom surfaces on a regular basis using EPA-registered detergent/disinfectants. Alternatively, clean surfaces first with detergent and water and then disinfect with an EPA-registered disinfectant in accordance with manufacturer instructions. (Note: Disinfectant products available in grocery stores or hardware stores are all EPA-registered.)
  • If EPA-registered disinfectants are not available, use a dilute solution (1:100 volume/volume, approximately 600 parts per million [ppm]) of household chlorine bleach (sodium hypochlorite) to disinfect bathroom surfaces. To prepare this solution, add 1/4 cup of bleach to a gallon of clean water, or 1 tablespoon of bleach to a quart of clean water. Apply to a cleaned surface, preferably with a cloth moistened with the bleach solution, and allow the surface to remain wet for minimally 3 – 5 minutes (2).
  • Clean and disinfect commonly touched surfaces in the home with a detergent/disinfectant in accordance with label instructions (e.g., microwaves, refrigerator door handles, door handles). Wipe frequently touched electronic items (e.g., remote controls, hand-held gaming devices) with hand-sanitizer cloths.
  • Carry hand-sanitizer cloths in cars to use on hands and surfaces in cars.

References
1. Bean B, Moore BM, Sterner F, Peterson LR, Gerding DN, Balfour HH Jr. Survival of influenza viruses on environmental surfaces. J Infect Dis 1982; 146: 47-51.

2. Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care facilities: Recommendations of CDC and the Healthcare Infection Control Advisory Committee (HICPAC). MMWR 2003; 52 (No. RR-10): 1-48. (See also the full text version of this guideline at
http://www.cdc.gov/ncidod/dhqp/gl_environinfection.html ).

3. World Health Organization. Avian influenza, including influenza A (H5N1), in humans: WHO interim infection control guideline for health care facilities (amended 24 April 2006). Accessed 13 September 2006 at:
http://www.who.int/csr/disease/avian_influenza/guidelines/infectioncontrol1/en/index.html

For more information and ideas on how to keep your facility safe go to: http://www.cdc.gov.

Quick Rinse - News From Around The World

Commercial Laundry Cited by OSHA

ELM GROVE, W. Va. — Uwanta Linen Supply, a commercial laundry, was recently cited for 21 health and safety violations by the Occupational Safety and Health Administration (OSHA). The laundry faces $62,400 in penalties for the violations. Eighteen of the the 21 violations are considered serious by OSHA. The serious violations include failing to properly guard floor holes and failing to provide hepatitis B vaccines to workers who are potentially exposed to blood borne pathogens.