Prevention and Control of Influenza during a Pandemic for All Healthcare Settings
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VI. Planning for an Influenza Pandemic – Using the Organizational Risk Assessment to develop the Pandemic Influenza Infection Prevention and Control and Occupational Health Plan
2. Establishing a Pandemic Influenza IPC/OH Plan for the Management of Pandemic Influenza in All Healthcare Organizations
2.1. Developing the Pandemic Influenza IPC/OH Plan
Based on the inter-pandemic ORA, healthcare
organizations should develop a pandemic influenza IPC/OH plan which incorporates IPC and Occupational Hygiene principles and is integrated with the existing IPC and OH programs.
All organizations responsible for existing and temporary
prehospital, acute, non-acute, long-term, ambulatory (including physicians’ offices), home care, healthcare clinics and other community healthcare settings
should have a pandemic influenza IPC/OH plan.
The organization should establish a multi-disciplinary team
to lead the development and implementation of the pandemic
influenza IPC/OH plan.
pandemic influenza IPC/OH planning team should liaise closely with the organization’s pandemic influenza
pandemic influenza IPC/OH plan
should be integrated with existing IPC and OH programs.
The planning team should ensure that the pandemic influenza IPC/OH plan:
- Is reviewed annually, potentially
during the seasonal influenza campaign, and updated according to emerging
knowledge, regulations and legislation.
- Includes measures to identify and
manage respiratory illness affecting HCWs.
- Includes plans for evaluating and
counselling HCWs at risk of severe complications should they acquire influenza.
- Includes recommendations for how
patient accommodation will be handled to reduce transmission.
- Includes policies to deal with patient visitation during the
- Provides a clear screening method to identify patients and visitors
with ILI symptoms upon entry into the healthcare setting.
developing policies to limit visitation (see Section VII.1.7.).
- Consider developing multi-lingual signage for entrances
to healthcare settings, that should provide patients, HCWs, visitors,
contractors, etc., with:
to influenza assessment and admission areas;
- Instructions regarding respiratory hygiene;
- Instructions regarding hand hygiene.
- Includes specific pandemic influenza
education and skills training for HCWs, including how to do Point of Care Risk Assessments
(see Section VI.4.).
- Includes recommendations for the
delivery of a pandemic influenza vaccine (when it becomes available) according
to the Canadian Pandemic Influenza Plan for the Health Sector (CPIP) (see Annex E of the CPIP The Canadian Pandemic Influenza Plan for the Health Sector - Annex E) and provincial/territorial/regional or local pandemic
influenza vaccine distribution initiatives.
- Includes recommendations for the use
and distribution of antiviral medications according to the CPIP Annex on
antivirals (see Annex D of the CPIP The Canadian Pandemic Influenza Plan for the Health Sector - Annex D) and provincial/territorial/regional or local pandemic
influenza antiviral medication distribution initiatives.
2.2. Planning for the Accommodation and Cohorting of Patients/Residents/Clients
Single rooms are preferred for
patients/residents admitted with influenza to acute care facilities, LTC facilities
or other healthcare settings . However, during an influenza
pandemic wave, healthcare organizations may not have sufficient numbers of
single rooms to accommodate all inpatients with ILI symptoms. The use of
temporary healthcare settings and the use of influenza cohorts may provide
options when caring for large numbers of patients with ILI symptoms.
- The IPC/OH plan should provide for appropriate spatial separation
between patients/residents/clients with ILI symptoms or infected with the
pandemic influenza virus (infected sources) and patients/residents without
influenza (susceptible hosts) by predetermining:
- The need for physical barriers (e.g., glass/acrylic
partitions in entrances to assessment centres) to
separate infectious agents/infected sources from susceptible hosts (other
patients, HCWs, visitors, contractors, etc.).
- The location of influenza care/isolation areas and
non-influenza care areas (i.e., these areas should be identified in acute care,
long-term care, and community infirmary settings).
- The location of influenza care areas within specialty units
(e.g., Trauma Intensive Care Units, Coronary Care Units, Maternity Units,
- The location of separate assessment areas for
patients/residents with ILI symptoms and those without influenza symptoms.
- The location of separate admission holding areas for
patients and LTC residents with ILI symptoms and those without influenza
- A process for alternative methods of ambulatory care and
home care delivery to decrease the numbers of vulnerable people potentially
exposed to influenza through time spent waiting for service in the healthcare setting.
- Provision should be made to establish inpatient units to cohort
patients/residents with ILI symptoms separately from non-influenza patients/residents
during a pandemic wave. Criteria should also be developed for closing
inpatient units at the end of the wave. Opening and closing patient/resident units
should be based on the needs and requirements that emerge during the pandemic.
- An active screening process should be established to
separate patients/residents with ILI symptoms from non-influenza patients/residents
as soon as influenza symptoms are identified.
- LTC facilities should identify areas to hold newly admitted
residents for one incubation period.
- LTC facilities should identify a separate area to isolate
residents that develop ILI symptoms.
- Cohorting of non-influenza patients/residents who are at
high risk of severe complications if they were to be infected with influenza
should be considered.
- Any patient/resident admitted from the community to a
non-influenza cohort should be assumed to have been exposed to influenza in the
community (i.e., maintain a high index of suspicion during the incubation
- Patients/residents should be closely monitored (i.e., every
four to six hours) for influenza symptoms for the duration of the incubation
- Non-influenza patients/residents without high risk of
severe influenza complications should be accommodated as per the organization's
routine patient or residential accommodation system (e.g., medical, surgical).
- Assume that all acute care patients and newly admitted LTC residents admitted to a non-influenza cohort have been exposed to influenza in
- Processes should be established to monitor for symptoms of
influenza upon admission and every four to six hours for the duration of the
- Processes should be developed to separate patients/residents
with ILI symptoms from non-influenza patients as soon as symptoms are noted.
- Plans should be developed to cohort confirmed influenza
patients/residents and patients/residents with ILI symptoms including those who
also require specialty care or assessment for other conditions (e.g., Trauma
Intensive Care Units, Coronary Care Units, Maternity Units, Neonatal units).
- A plan to establish and maintain spatial separation of two
metres between influenza and non-influenza patients should be developed.
- Wherever possible plan to use physical barriers to minimize
exposure to other patients, HCWs, visitors, contractors, etc., from patients/residents
with ILI symptoms.
- Patients/residents who are immune to the pandemic influenza
strain (i.e., those who were immunized at least two weeks previously or who
have recovered from the pandemic strain of influenza) may be accommodated in
the area most appropriate to their care needs.
- The influenza vaccine may not be fully efficacious in
providing immunity. Immunized patients/residents should continue to be
assessed for signs of influenza.
2.2.1. Use of Patient Rooms During the Pandemic Period
Single rooms are preferred for
patients with ILI symptoms (seasonal and pandemic influenza).
Note: Ambulatory care settings including physicians’ offices
and other outpatient settings. Processes should be established for waiting
areas to enable the spatial separation of infected sources and susceptible hosts
(e.g., two metres, partitions, immediate placement of patients with ILI symptoms into an examination room).
2.2.2. Planning Airborne Infection Isolation Rooms During a Pandemic Period
Patients/residents with influenza
caused by the pandemic strain do not require airborne infection isolation.
- AGMPs (see Section
V.4.4.4. and Section
VII.1.5.4.) on patients with influenza caused by
the pandemic strain should be performed in a designated airborne infection
isolation room or other rooms with enhanced air exchanges and air exhausted to
the outside, if feasible .
- As the number of airborne infection
isolation rooms is limited in most healthcare settings, these rooms should be
prioritized for patients with known or suspected airborne infections (e.g.,
tuberculosis, measles, varicella and disseminated zoster) or those undergoing
sputum induction or bronchoscopy over patients with ILI symptoms.
- Moving influenza patients/residents to
an airborne infection isolation room for treatment should not be considered if
it compromises the delivery of care.
2.2.3. Temporary Healthcare Settings
limit confusion, whenever possible, the temporary setting's pandemic influenza IPC/OH plan should be
integrated with the parent organization's pandemic
influenza IPC/OH plan.
- The temporary setting's pandemic
influenza IPC/OH plan should be based on published IPC recommendations .
temporary setting's pandemic influenza IPC/OH plan should be integrated
with federal/provincial/territorial/regional pandemic influenza contingency plans.
- Pandemic influenza planning should ensure
that all HCWs working in temporary healthcare settings (e.g., housekeeping and
laundry workers and workers handling waste) are offered appropriate
of reusable medical instruments should not be undertaken in temporary settings.
2.3. Planning for Transfer/Transport of Patients with ILI symptoms Within and Between Healthcare Settings
Prior determination of an organization's patient
transportation/transfer policies during a pandemic period should enable the
application of consistent care policies. Planners should consider the
organization’s patient population, the possibility of HCWs and other staff
shortages, and the impact of transportation/transfer policies and capacities on
the medical care and recovery of patients.
In preparation for an influenza pandemic, the organization
- Plan to limit the movement of patients
with ILI symptoms to moves that are medically necessary.
- For patients that must be moved between departments, units or
organizations, formal communication processes should be established to ensure
that the transporting agency, and the receiving department, unit or facility is
made aware of the patient's ILI symptoms, diagnosis and laboratory results (i.e.,
direct communication with the staff of the receiving department, unit or
- Ensure transfer/transport personnel perform a PCRA (see Appendix D) and put on
appropriate PPE (see Section V.18.104.22.168.) for the transport.
- When transfer/transport is necessary
plans should be in place to teach patients with ILI symptoms (if able) the
- Perform hand hygiene prior to transfer/transport.
- Wear a mask (NOT a respirator) for the duration of transfer/transport
- Practice respiratory hygiene during transport.
2.4. Planning for Visitors: Responsibilities and Restrictions
Prior determination of an organization's visitor policies
during the pandemic period should enable the application of consistent
restrictions. Planners should consider their patient population, the
possibility of HCWs and other personnel shortages, and the impact of
restrictions on care and recovery of patients.
- In preparation for an influenza pandemic, the organization should
plan that asymptomatic visitors may visit asymptomatic patients/residents in
accordance with the organization’s visitation policies.
- Organizations should identify processes for visitors who wish to visit
a patient with ILI symptoms. Visitors should:
- Consider NOT visiting if they are at high risk of complications
should they contract influenza (e.g., immunosuppressed, pregnant).
- Perform hand hygiene on entry to and exit from the patient's
- Consider wearing the same PPE that HCWs are using/wearing if they
will be within two metres of the patient they are visiting.
the visit to one patient only to prevent inadvertent influenza transmission to
- The organization should identify processes to enable the
identification of visitors with ILI symptoms upon entry into a healthcare
- Symptomatic visitors should be prevented from visiting except
under exceptional circumstances (see Section VI.2.4.).
- Consideration should be given to identifying prominent areas at the
entrances of the healthcare setting for all visitors to perform an influenza
self-assessment under the direction of organizational personnel to monitor for
any ILI symptoms (see Appendix A).
- Organizations should identify areas where visitors can perform
hand hygiene upon entering a healthcare setting and on entrance to and exit
from a patient's room.
- Organizations should identify methods to ensure that all visitors
receive respiratory hygiene instructions prior to or immediately upon entry
into the healthcare setting.
- Organizations should plan for further visitor restrictions if an
outbreak or active transmission of pandemic influenza is occurring in the
facility. During a facility influenza outbreak, consideration should be given
- Restricting visitors who have not yet had the pandemic strain of
- Restricting visitors who have not been immunized against the
pandemic strain in the prior two weeks.
- The organization should plan for special exemptions for a visitor
with ILI symptoms (e.g., if the visitor is a close relative of a terminally ill
patient or a parent of a sick/admitted child).
- The organization should ensure that symptomatic visitors do not
have opportunity to expose other patients, HCWs, visitors, contractors, etc.,
to influenza while in the healthcare setting.
- The organization should plan to provide resources (i.e., equipment
and direction) to enable the ill visitor to receive instruction on proper mask
wearing and removal, hand hygiene and respiratory hygiene including:
- Putting on a mask upon entering and wearing the mask for the
duration of the time in the healthcare setting.
- Performing hand hygiene upon entering the healthcare setting and
prior to entering and leaving a patient's room.
- Observing respiratory hygiene throughout the time in the healthcare
- Ill visitors should restrict their visit to a single patient
(terminally ill adult or sick child). Under no condition should they visit
anyone other then the designated patient/resident.
- Children with ILI symptoms, who are relatives of a terminally ill
patient, may visit if the parents or guardians provide strict supervision of
- Parents or guardians should ensure that the sick child/visitor
wear a mask and practice strict hand and respiratory hygiene.
- Under no condition should visiting children with ILI symptoms visit any other area/room/patient in the facility (e.g., cafeterias, common
areas, play areas, etc.).
- Patients who have received ill visitors should be monitored for
one incubation period after the last visit by an ill visitor.
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