CDC Issues Updated Guidance on H1N1 Infection Control for Health Care Facilities/Personnel
The Centers for Disease Control (CDC) has issued updated guidance for infection control measures for limiting the spread of H1N1. This guidance applies to personnel in all health care settings (acute care, ambulatory care, home health, nursing homes), as well as personnel in non-health care settings where health services are delivered, such for school nurses and correctional facility staff. The entire guidance is linked HERE.
The CDC identified that while the H1N1 influenza virus appears to be transmitted the same as seasonal influenza, the precautions for H1N1 are at a higher level given the lack of immunity in the entire population. The CDC recognizes that H1N1 is not transmitted over long distances, such as from one room to another, but that all respiratory and GI secretions, including diarrhea, are to be considered infectious.
The guidance establishes a hierarchy of controls: 1) elimination of potential exposures, 2) engineering controls, 3) administrative controls (patient flow, vaccination), and 4) personal protective equipment.
The guidance is very comprehensive, but answers some difficult questions such as how to manage respiratory protection protocols when supplies of N95s are scarce. This includes prioritization of N95s for personnel, and identifies which procedures require an N95 always be used.
A change to the guidance is that health care personnel who develop a fever and respiratory symptoms must be excluded from work until they are 24 hours without fever, without the use of fever-reducing medicines. The guidance formerly recommended health care workers be excluded for 7 days post-fever, while non health care settings had the 24 hour exclusion. It also provides guidance for reuse or prolonged use of the N95.
Highlights of the guidance include:
- Reaffirmation that the N95 respirator be the minimum level of respiratory protection for personnel in close contact with suspected or confirmed cases of H1N1 (not limited to direct medical care, can be any close contact)
- Offer pandemic and seasonal vaccines free of charge, and require declination forms for personnel who decline vaccine.
- Encouraging non-punitive policies that encourage or require ill personnel to stay home.
- Limiting visitors for patients in isolation for influenza to those necessary for patient's emotional well-being and care, and scheduling and controlling visits to allow for symptoms assessment of visitors and limiting visitor movement throughout facility.
- Information on how to transport infectious patients or those under isolation precautions, such as providing patient with a facemask and attempting to minimize waiting times in cohorted areas.
- Prioritize respirator use - facilities must show that reasonable efforts were made to obtain N95s before prioritization of use is enacted. N95s should always be used during aerosolized procedures with H1N1 cases. Those personnel at low-risk for exposure or complications of H1N1 may be considered for lower respiratory protection. Planning is essential for ensuring that sufficient N95s are on hand for those that will need them.
- During severe shortages, extended use of an N95 may be necessary. An N95 can be used for extended time (i.e. from one patient to another) only if the respirator is not contaminated by fluids, bent or torn, or has been removed or repositioned from the face and has jeopardized the tight seal.
- Hand hygiene and respiratory etiquette/cough protocol should be enforced for everyone in the facility - patients, staff, administration, visitors, contractors, etc.
The guidance is also available in Question and Answer format HERE, and is attached to this message in a Word document.