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

3. Planning for the Identification and Management of HCWs with ILI Symptoms

During the pandemic period, it is likely that most cases of influenza will be caused by the pandemic strain. When HCWs are in the community, (e.g., at home, at school, shopping) they will have the same risk of acquiring influenza as the general population.

Note: The pandemic influenza planning recommendations in this section have corresponding action recommendations in Section VII.1.9.

1. Processes should be established for HCWs to perform a daily self assessment for influenza (see Appendix A) to determine their influenza status and thus their ability to work with susceptible hosts (patients, other HCWs, visitors, etc.).
2. Processes should be established to accommodate potential staffing shortages (e.g., a number of HCWs, and/or the HCW’s family members may acquire influenza while in the community).
   • In situations of severe personnel shortages, consider establishing criteria for allowing HCWs that have mild influenza to come to work, if they feel well enough. These HCWs should only work with patients with ILI symptoms. See Section V.6.2.2.
   • Criteria should be established to evaluate and counsel self identified HCWs at high risk of influenza complications. See Section V.6.2.2.
3. Policies and procedures should be established to identify, track and manage organizational clusters of ill HCWs including processes, case definitions, surveillance methodology, and outbreak response directives. Report the cluster to public health authorities, as required.
4. For planning purposes, HCWs who have recovered from laboratory confirmed influenza acquired during the pandemic may be considered immune to the pandemic influenza strain.
5. For planning purposes, two weeks after vaccination, HCWs who have been immunized against the pandemic influenza strain may be considered immune for purposes of work placement. For more recommendations regarding pandemic influenza vaccine, please refer to Annex D of the CPIP⁽⁵⁾ The Canadian Pandemic Influenza Plan for the Health Sector - Annex D and the National Advisory Committee on Immunization Canadian Immunization Guide Seventh Edition - 2006^(17;18).
   • Vaccinated individuals should continue to do daily self-assessment for influenza. Please refer to the Influenza Assessment Tool in Appendix A.
   • Vaccinated individuals should continue to use appropriate PPE to protect against new strains of influenza and other respiratory agents.
6. For more information and recommendations for antiviral use during an influenza pandemic, please refer to Annex E of the CPIP The Canadian Pandemic Influenza Plan for the Health Sector - Annex E⁽⁵⁾.

4. Planning and Providing Pandemic Influenza Education and Skills Training for HCWs in All Healthcare Organizations

During the inter-pandemic period, all healthcare organizations, including agencies that supply contract personnel to healthcare settings, should provide appropriate education and skills training for all HCWs regarding prevention and control of pandemic influenza in health care.

1. Education and skills training related to seasonal influenza and pandemic influenza should be provided to HCWs on all shifts, in all departments.
   • Building on an organization's seasonal influenza campaign may be an appropriate time to provide pandemic influenza education and skills training.
   • The education and skills training on pandemic influenza should be appropriate to the audience.
   • A variety of education methods may be employed, e.g., postings in elevators and at entrances, brochures, newsletters, websites, mini-education sessions during shift change, use of role plays or other scenarios, etc.
2. Pandemic influenza education and skills training, given in the inter-pandemic period, should include:
   • A detailed review of the organization's pandemic influenza IPC/OH plan, including how it can be accessed.
   • An explanation of how the organization plans to communicate their evolving plans to HCWs.
   • An explanation of the organizations’ ORA (see Appendix C) and how personnel should apply the relevant changes in the ORA to their practice.
   • A discussion of processes for HCWs, at high risk of complications due to influenza, to self-identify and seek guidance from the OH clinician (e.g., early antiviral treatment, immunization).
   • An explanation of why and how to perform the daily Influenza Self Assessment to identify ILI symptoms and/or determine whether symptoms are compatible with influenza (see Appendix A).
   • An explanation of how full application of RPAP measures plus Pandemic Influenza Precautions should minimize or prevent the transmission of all infections, including pandemic influenza, in all healthcare settings. This should include an explanation of the importance of:
     • The use of Pandemic Influenza Precautions (see Section V.6.2.6.) for all patients with ILI symptoms.
     • The appropriate use of PPE (see Appendix D) for caring for patients with ILI symptoms.
     • Strict adherence to hand hygiene practices as a key strategy in preventing transmission of the pandemic influenza virus in healthcare settings^(10;11).
     • The impact of respiratory hygiene in minimizing influenza transmission.
   • Procedures for accessing immunization for the pandemic strain when vaccine becomes available, as per the Annex D of the CPIP The Canadian Pandemic Influenza Plan for the Health Sector - Annex D.
   • Procedures for access and use of various antiviral medications for the purpose of treatment and outbreak response during a pandemic, as per Annex E of the CPIP The Canadian Pandemic Influenza Plan for the Health Sector - Annex E.
   • A review of plans for temporary pandemic influenza assessment centres and temporary influenza hospitals (see Section VI.2.2.3.).
   • A discussion of appropriate use of PPE based on PCRAs; including any PPE prioritization strategies.
   • Training to perform efficient and accurate PCRAs (see Appendix D) before every patient contact during the pandemic period.

In addition, all HCWs should have the following education and skills training in order to perform effective PCRAs and proficiently and safely care for patients while protecting themselves. Consideration should be given to including the following elements in training materials:

• Information on novel influenza strains that may lead to an influenza pandemic.
• The expected clinical presentation of the pandemic strain including the clinical presentation in very young children and the frail elderly with influenza and other upper respiratory tract infections.
• A discussion of the risk posed by the pandemic influenza strain and possible complications for high-risk groups (see Section V.4.2.2.b.).
• A review of the organization's pandemic influenza ORA findings and any corrective action taken.
• Provision of skills training on performing PCRAs during an influenza pandemic (see Appendix D).
• Provision of skills training on how to integrate and apply knowledge acquired from specific PCRAs with knowledge of the organization's ORA (see Appendix C) (e.g., available engineering controls and administrative policies and procedures to prevent and control pandemic influenza transmission in the healthcare setting).

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