Pandemic influenza
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Transcript of Pandemic influenza
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Pandemic influenza
• Patricia Coward • Principal Adviser (Occupational Health)• Occupational Health Unit• (07) 3247 9400• [email protected]
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Session overview
• What is the difference between seasonal influenza, pandemic influenza and avian influenza (bird flu)?
• Infection control practices to protect staff and students in the event of pandemic influenza
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Seasonal influenza
• Occurs each winter in Australia • New strain each winter
• It is reasonably predictable because it is similar to previous influenza strains
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Seasonal influenza
• Some groups are at greater risk from seasonal influenza• Persons 65 years of age and over• Aboriginal and Torres Strait Islander persons
aged 50 years and over• Chronic disease • Immunosuppression • Residents of long-term care establishments• Pregnant women
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Pandemic influenza
• Pandemic influenza is a severe form of influenza that infects many people around the world at the same time
• Occurs when a new strain of influenza virus emerges to which no-one has immunity
• Can occur at any time of the year and lasts longer than seasonal influenza
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Pandemic influenza
• Causes more severe illness and death • All people may be at risk, not just the
usual ‘at-risk’ groups• The only predictable thing about
pandemic influenza is its unpredictability
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Previous pandemics1918
Spanish flu
20-40 million deaths
CFR 2-3%
1957
Asian flu
1-4 million deaths
CFR <0.2%
1968
Hong Kong flu
1-4 million deaths
CFR <0.2%
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Avian influenza
• Disease of birds caused by an avian (bird) influenza virus• Usually infects aquatic birds • Can also infect domestic birds and some
animals
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Avian influenza
• Historically, human infection with avian influenza viruses has been rare and mild
• Human infection with the H5N1 strain of avian influenza is rare but it can cause serious human infection with a high death rate • > 60%
• WHO 19th June 2008• 385 confirmed cases• 243 confirmed deaths
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Avian influenza
• Children and young adults are most at risk from H5N1• 90% of cases are < 40 years of age• 52% of cases are < 20 years of age
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Avian influenza
• H5N1 is circulating in wild and domestic bird flocks in many parts of Asia, Africa and Europe
• H5N1 has pandemic potential• There is concern that H5N1 could mutate to
cause the next human influenza pandemic
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Pandemic alert level
• The world is on pandemic alert level 3
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Pandemic planning
• Tertiary education facilities are at significant risk for pandemic influenza
• Colleges and universities pandemic influenza checklist• http://www.pandemicflu.gov/plan/school/
collegeschecklist.html
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Assumptions
• A pandemic is likely to be widespread throughout Queensland
• May last up to 12 months• May be 2 or more pandemic waves each
lasting about 8 weeks • Healthcare system will be overloaded
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Pandemic planning
• Social distancing within the community• Inadequate supplies• Significant absenteeism for a prolonged
period
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Protecting staff and students
• Vaccination• May not be available at the start of a pandemic
• Antiviral medications• Availability will be restricted
• Infection control• Critical control for protecting staff and students• Based on influenza’s modes of transmission
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How is influenza spread?
• Contact transmission• Occurs when you have contact with an
infected person or a contaminated surface
• Transfer influenza virus to your eyes, nose and mouth via your hands
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How is influenza spread?
• Droplet transmission• Occurs when an infected person releases
droplets containing influenza virus when they cough, sneeze or talk
• The droplets land on your eyes, mouth and nose if you are within about 1 metre distance of the person
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How is influenza spread?
• Airborne transmission• Occurs when you inhale aerosols of influenza
virus• Risk for healthcare workers who perform
aerosol generating procedures• No evidence that influenza is spread through
air-conditioning systems
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Infection control for pandemic influenza
http://www.health.sa.gov.au/infectioncontrol/
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Hand hygiene
• Regularly wash hands with soap and water or apply alcohol-based hand rub
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Respiratory hygiene and cough etiquette
• Cough or sneeze into a disposable tissue • If no tissue available, cough or sneeze into
sleeve• Perform hand hygiene after coughing and
sneezing
X
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Cleaning programs
• Regular cleaning of • Shared surfaces• Surfaces that are frequently touched
• Cleaning agents• Water and detergent• Alcohol-based disinfectant
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Social distancing
• Restrict non-essential face-to-face contact• Conduct business by alternative ways that
minimise face-to-face contact• Ensure supporting communications
systems• Staff and students able to work from home
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Social distancing
• Where essential face-to-face contact is required• Sit > 1 metre apart• Hold the meeting outdoors if practicable
• Stagger start, finish and break times so that fewer people are using workplace facilities and public transport at the same time
• Postpone work recreational activities
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Social distancing
• Promote spatial separation at the office • Arrange work stations >1 metre apart
• Transparent screens at face-to-face customer service areas
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Personal protective equipment
• Disposable gloves for tasks that involve contact with potentially contaminated surfaces• Vinyl, nitrile or powder-free latex gloves• Perform hand hygiene after glove removal
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PPE
• Surgical masks for • Staff who develop influenza illness at
work• Contain their coughs and sneezes
• Staff who have face-to-face contact with others
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Work restrictions
• Restrict workplace entry• Display notices at workplace entry points
advising people not to enter if they have influenza symptoms
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Work restrictions
• Exclude sick family members from the workplace • Exclude infected children from family rooms
• Exclude staff who are contacts of infected people• Should be in quarantine for 7 days from the
time that their contact became ill
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Managing sickness at work
• If a person develops pandemic influenza symptoms at work• Separate the person from other workers • First aid or family room
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Managing sickness at work
• Provide the person with • Surgical mask and tissues • Alcohol-based hand gel to sanitise their hands
and prevent contamination of their work surfaces
• Influenza kit for managing sick workers• Surgical masks, alcohol-based hand gel,
tissues, disinfectant, disposable gloves, garbage bags
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Managing sickness at work
• Send the person home promptly• Most contagious at the onset of symptoms
• Clean and disinfect the sick person’s workstation once they have left
• Identify recent close work contacts and advise them of the situation • May require isolation
• Train first aid personnel
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Vaccination
• Maintain annual seasonal influenza vaccination• Seasonal influenza strains may continue to
circulate during a pandemic
• Encourage vaccination once a pandemic influenza vaccine becomes available
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Stockpiling
• “The decision made now not to stockpile means that you have made the decision not to protect your workers during a pandemic”
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Campus health services
• May be the first to see cases of suspected pandemic influenza
• May have to provide care to sick students and staff if hospitals, GPs and community influenza clinics are overwhelmed• International students• Students residing in student housing
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Campus health services
• Medical offices and clinics pandemic influenza planning checklist http://www.pandemicflu.gov/plan/healthcare/medical.html
• Stockpile medical consumables, including hand hygiene products, PPE and antivirals
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Campus health services
• Triage system to identify and separate persons presenting with influenza symptoms from others• Single room with ventilation that is not
recirculated to other rooms within the facility• Shaded outdoor area
• Provide infected persons with a surgical mask to contain coughs and sneezes
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Campus health services
• P2 respirators for healthcare workers, clinic administrative staff and others• Respirator fit test• AS 1715:1994 Selection, use and maintenance
of respiratory protective devices• “In order for the designed performance to be
achieved by a respirator, it is essential the respirator be properly fitted to the individual to whom it is assigned”
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Campus health services
• Fit check• User seal check performed each time
the respirator is donned
• Respirator ready• Clean shaven
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Campus health services
• Clinic security• Infection control training • Staff fatigue and work overload• Clinic staff who may be at high risk from
acquiring pandemic influenza• Pregnant staff
• Monitor clinic staff for influenza illness
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Campus health services• Commonwealth Department of Health & Ageing
www.health.gov.au • Interim Infection Control Guidelines for
Pandemic Influenza in Healthcare and Community Settings
• Prepared and protected DVD• Queensland Health www.health.qld.gov.au
• Pandemic Influenza – Infection Control for Healthcare Workers DVD
• Available from the Communicable Diseases branch of Queensland Health (07) 3234 1155
• Royal Australian College of General Practitioners