H1N1 Influenza A (Swine Flu)

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H1N1 Influenza A(Swine Flu)
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What is H1N1 Influenza A Virus (Swine Flu)?

• H1N1 (referred to as swine flu early on) is a
  new influenza virus causing illness in people.
• This new virus was first detected in people in
  April 2009 in the United States.
• H1N1 Influenza A (swine flu) is transmitted by
  respiratory secretions
• This virus was originally referred to as swine
  flu because laboratory testing showed that many
  of the genes in this new virus were very similar
  to influenza viruses that normally occur in pigs
  in North America.

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Can Humans Catch H1N1 Influenza A (swine flu)?

• It is determined that this new H1N1 Influenza A
  virus is contagious and is spreading from human
  to human however, at this time, it is not known
  how easily the virus spreads between people.

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What are the Signs Symptoms of H1N1 Influenza A
in Humans?

• The symptoms of this new influenza A H1N1 virus
  in people are similar to the symptoms of regular
  human flu and include fever (greater than 100.0º
  F or 37.8 º C), cough, sore throat, body aches,
  headache, chills and fatigue.
• A significant number of people who have been
  infected with this virus also have reported
  diarrhea and vomiting.  
• Also, like seasonal flu, severe illnesses and
  death has occurred as a result of illness
  associated with this virus.

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How Does H1N1 Influenza A Spread?

• Human-to-human transmission of H1N1 Influenza A
  predominantly occurs through direct droplet
  transmission (Usually within 6-10 feet).
• This is thought to occur in the same way as
  seasonal flu, which is mainly person-to-person
  transmission through coughing or sneezing of
  infected people.
• People may become infected by touching something
  with flu viruses on it and then touching their
  mouth or nose (moist mucous membranes).

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How Long Can an Infected Person Spread this Virus
to Others?

• With seasonal flu, studies have shown that people
  may be contagious from one day before they
  develop symptoms to up to 7 days after they get
  sick. 
• Children, especially younger children, might
  potentially be contagious for longer periods.

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How Can Someone with the H1N1 Influenza A Infect
Someone Else?

• Droplets from a cough or sneeze of an infected
  person move through the air.
• Germs can be spread when a person touches
  respiratory droplets from another person on a
  surface like a desk and then touches their own
  eyes, mouth or nose before washing their hands.

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What is the Infectious Period?

• Persons who continue to be ill longer than 7 days
  after illness onset should be considered
  potentially contagious until symptoms have
  resolved.
• Non-hospitalized ill persons who are a confirmed
  or suspected case of swine-origin influenza A
  (H1N1) virus infection are recommended to stay at
  home (voluntary isolation) for at least the first
  7 days after checking with their health care
  provider about any special care they might need
  if they are pregnant or have a health condition
  such as diabetes, heart disease, asthma, or
  emphysema.

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What Can I do to Keep From Getting the Flu
(Influenza)?

• Wash your hands.
• Try to stay in good general health.
• Get plenty of sleep, be physically active, manage
  your stress, drink plenty of fluids, and eat
  nutritious food.
• Try not touch surfaces that may be contaminated
  with the flu virus.
• Avoid close contact with people who are sick.

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Interim Recommendations for Assessment of
Influenza-Like Illness (ILI)

• Step 1 EMS personnel should stay more than 6
  feet away from patients and bystanders with
  symptoms and exercise appropriate routine
  respiratory droplet precautions while assessing
  all patients for suspected cases.
• Step 2 Assess all patients for symptoms of acute
  febrile respiratory illness (fever plus one or
  more of the following nasal congestion/rhinorrhea
  , sore throat, or cough).

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Personal Protective Equipment (PPE)

• EMS Personnel should ensure that they have the
  necessary personal protective equipment
• N95 mask, surgical masks, gloves, eye protection,
  gown, and other standard equipment for droplet
  precautions
• Fit-tested disposable N95 respirator and eye
  protection (e.g., goggles eye shield),
  disposable non-sterile gloves, and gown, when
  coming into close contact with the patient.

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Infection ControlInterim Recommendations

• When removing PPE make every attempt to avoid
  contact with contaminated areas and wash hands
  before touching a clean area.
• All patients with acute febrile respiratory
  illness should wear a surgical mask or approved
  respiratory barrier, if tolerated by the patient.

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Sequence for Removing PPE

• Gloves
• Face shield or goggles
• Gown
• Mask or respirator

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How to Remove Gloves

• Grasp outside edge near wrist
• Peel away from hand, turning glove inside-out
• Hold in opposite gloved hand

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How to Remove Gloves(continued)

• Slide ungloved finger under the wrist of the
  remaining glove
• Peel off from inside, creating a bag for both
  gloves
• Discard in approved biomedical waste container

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Removing Goggles or Face Shield

• Grasp ear or head pieces with ungloved hands
• Lift away from face
• Discard in approved biomedical waste container

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Removing Isolation Gown

• Unfasten ties
• Peel gown away from neck shoulder
• Turn contaminated outside toward the inside
• Fold or roll into a bundle
• Discard in approved biomedical waste container

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Removing a Mask

• Untie the bottom, then top, tie
• Remove from face
• Discard in approved biomedical waste container

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Removing a Particulate Respirator

• Lift the bottom elastic over your head first
• Then lift off the top elastic
• Discard in approved biomedical waste container

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Hand Hygiene

• Perform hand hygiene immediately after removing
  PPE.
• Wash hands with soap and water or use an
  alcohol-based hand rub
• Ensure that hand hygiene facilities are available
  at the point needed (sink or alcohol-based hand
  rub)

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Interfacility Transport

• EMS personnel involved in the interfacility
  transfer of patients with suspected or confirmed
  H1N1 Influenza (swine flu) should use standard,
  droplet and contact precautions for all patient
  care activities.
• This should include wearing a fit-tested
  disposable N95 respirator, wearing disposable
  non-sterile gloves, eye protection (e.g.,
  goggles, eyeshield), and gown, to prevent
  conjunctival exposure.
• If the transported patient can tolerate a
  facemask (e.g., a surgical mask), its use can
  help to minimize the spread of infectious
  droplets in the patient care compartment.  

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Interfacility Transport(continued)

• Encourage good patient compartment vehicle
  airflow/ ventilation to reduce the concentration
  of aerosol accumulation when possible.
• If the transported patient can tolerate a
  facemask (e.g., a surgical mask), its use can
  help to minimize the spread of infectious
  droplets in the patient care compartment.  
• Encourage good patient compartment vehicle
  airflow/ ventilation to reduce the concentration
  of aerosol accumulation when possible.

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• Routine cleaning with soap or detergent and water
  to remove soil and organic matter, followed by
  the proper use of disinfectants, are the basic
  components of effective environmental management
  of influenza.
• Reducing the number of influenza virus particles
  on a surface through these steps can reduce the
  chances of hand transfer of virus.
• Influenza viruses are susceptible to inactivation
  by a number of chemical disinfectants readily
  available from consumer and commercial sources.

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Antiviral Treatment for H1N1 Influenza A (Swine
Flu) Infections in Humans

• Antivirals may be used as either a treatment to a
  confirmed or suspected case of H1N1 Influenza A
  (swine flu) or as prophylactic treatment to
  exposed individuals under specified conditions
• At this time, prehospital treatment of patients
  with antiviral agents is not being utilized
• CDC recommends the use of Tamiflu (oseltamivir
  phosphate) or Relenza (zanamivir) as part of the
  treatment and/or reduction of severity of
  infection with swine influenza viruses.

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Vaccinations

• There is no vaccine to protect humans from H1N1
  Influenza A (swine flu) at this time.
• The seasonal influenza vaccine will likely help
  provide partial protection against swine H3N2,
  but not swine H1N1 viruses.

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Recommendations for Vehicle Decontamination

• Upon completion of patient care (single call),
  clean all equipment that came in contact with or
  was within 6 feet of the suspected ILI patient
  with an approved disinfectant.
• The equipment may include stretchers, railings,
  medical equipment control panels, adjacent
  flooring, walls, ceilings and work surfaces, door
  handles, radios, keyboards, and/or cell phones.
• Cleanse all surfaces within 6 feet of the patient
  or surfaces touched by the patient or caregivers
  with an approved disinfectant.

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Recommendations forVehicle Decontamination
(Continued)

• Large spills of bodily fluids (e.g., vomit)
  should first be managed by removing visible
  organic matter with absorbent material.
• Place contaminated reusable patient care devices
  and equipment in biohazard bags.
• Clean and disinfect non-patient-care areas of the
  vehicle according to the vehicle manufacturers
  recommendations.
• Cleaning should be done with detergent and water
  and then disinfected using an EPA-registered
  hospital disinfectant in accordance with the
  manufacturer's instructions.

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• Thank you