Infection Control and Respiratory Outbreaks

1
Infection Control and Respiratory Outbreaks

• Bruce Gamage
• Infection Control Consultant
• BC Centre for Disease Control

2
Objectives

• Epidemiology
• Prevention
• Control
• Resources

3
Epidemiology

• Influenza
• 1 in 6 Canadians will get the influenza
• 7,000 will die
• 75-90 of deaths will be in those gt 65 years old
• In BC gt1400 die from the influenza and pneumonia
  every year
• SARS
• 8462 cases worldwide /807 deaths
• 248 cases in Canada/44 deaths

4
Prevention

• Contingency Planning
• Vaccination
• Surveillance
• Antiviral Medication
• Infection Control Precautions
• Droplet
• Contact
• Airborne

5
Contingency planning

• Pre-written orders for administering
  influenza/Pneumococcal vaccine to all
  residents/eligible discharges
• Pre-written orders for empiric use of antivirals
  for suspected/confirmed influenza outbreak
• Ptr-written orders for serum creatinine in the
  event of an influenza outbreak and use of
  amantadine

6
Contingency planning

• NP rooms?
• N95 mask supply?
• Fit testing of priority staff?
• Staff trained in use of PPE?
• Surveillance?

7
Influenza Vaccination

• gt 65 years old
• Chronic health problems
• ? Immunity
• Residents of Long Term Care Facilities
• Health care workers
• Emergency responders
• Independent health practitioners
• Families (including children) and caregivers of
  high-risk people

8
Pneumococcal vaccine

• Elderly and the chronically ill
• Community care facilities residents
• Single dose of the vaccine
• All previously unvaccinated individuals admitted
  to such facilities
• All unvaccinated residents
• All eligible persons discharged
• from acute hospitals
• Can be administered
  with influenza vaccine

9
Surveillance Acute Care

• Algorithm for Respiratory and/or Febrile Illness
  NYD
• Any admission with respiratory illness or fever
• Admit to NP room if available
• Apply droplet/contact precautions
• Airborne precautions?

10
Surveillance LTCF

•   Early recognition of an outbreak and reporting
  to public health
•   Laboratory diagnosis and rapid notification of
  diagnosis
•   Prompt institution of infection control
  measures and the use of antiviral medication
  during an influenza outbreak.

11
Antiviral Medication

• Amantadine is effective in the prevention of
  Influenza A only
• In case of confirmed outbreak
• For residents with ILI symptoms, give amantadine
  only if symptoms started within past 48 hrs, and
  continue amantadine for 5 days
• For residents who have NOT developed ILI
  symptoms, give amantadine for 12 days or, if new
  cases of ILI are occurring, for one week after
  the last case of ILI illness is identified in the
  facility
• administered simultaneously to ALL residents,
  regardless of vaccination status .

12
Antiviral Medication

• Zanamivir (Relenza) and Oseltamivir (Tamiflu)
• Are licensed for the treatment of influenza
• Oseltamivir is approved for prophylaxis
• When started within the first 2 days of illness
  onset they may reduce the duration of influenza
  symptoms.
• 70-90 effective in preventing onset of illness
  in persons exposed to influenza A or B.

13
Infection Control Precautions

• Contact Precautions
• Droplet Precautions
• Airborne Precautions

14
Contact Transmission

• Contact
• Direct contact with body fluids
• Via hands and subsequent contact with mucous
  membranes.
• Precautions
• gowns
• gloves,
• hand hygiene

15
Droplet Transmission

• Droplets
• produced by talking, coughing and sneezing
• are large particles
• fall within a 1-metre range
• Precautions
• gown, gloves, hand hygiene
• goggles and surgical mask
  within 1 metre

16
Airborne Transmission

• Airborne
• particles are much smaller than droplets
• are greatly affected by air currents
• remain in the air for long periods
• produced during aerosolizing procedures as well
  as coughing and sneezing
• Precautions
• require specialized breathing barriers
• such as a respirator

17
Infection Control Precautions

• Isolate or cohort patients
• Use mask, eye protection if entering the room
  (ensure appropriate mask )
• If unsure about mode of transmission then use N95
• Use gowns and gloves if contact with body fluids
  or contaminated surfaces likely
• Emphasize hand hygiene before and after contact
• Use of alcohol-based sanitizers

18
Management of Staff

• Staff with ILI excluded from work for five days
  after the onset of symptoms or until symptoms
  resolve
• If influenza outbreak
• Non-immunized staff
• excluded from working
• until the outbreak is over

19
Management of Staff during an ILI outbreak

• Staff immunized during the outbreak should be
  excluded for 14 days after immunization.
• If the outbreak is due to influenza A staff may
  work if they take amantadine
• Excluded staff should wait one incubation period
  prior to working in a non-outbreak facility, to
  ensure that they are not incubating influenza

20
SARS

• Would present very similar to ILI
• Need to institute droplet/contact precautions for
  any febrile respiratory Illness
• Adequate PPE for SARS ?
• N95 vs. PAPR
• BC/Health Canada Guidelines
• How to avoid another KPL?

21
Resources

• Guidelines for the Management of ILI in BC Health
  Care Facilities BCCDC 2005
• BC Pandemic Influenza Plan (www.bccdc.org)
• Guidelines for Management of SARS in Acute Care
  Settings (www.bccdc.org)
• www.sars.ca