H1N1 Influenza AH1N1 Influenza A(Swine Flu)(Swine Flu)

What is H1N1 Influenza A Virus (Swine Flu)?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 This virus was originally referred to as “swine flu” because laboratory testing “swine flu” because laboratory testing showed that many of the genes in this showed that many of the genes in this new virus were very similar to influenza new virus were very similar to influenza viruses that normally occur in pigs in viruses that normally occur in pigs in North America.North America.

Can Humans Catch Can Humans Catch H1N1 Influenza A (swine flu)? 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.

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

How Does How Does H1N1 Influenza A Spread? pread?

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).

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

With seasonal flu, studies have With seasonal flu, studies have shown that people may be shown that people may be contagious from one day before contagious from one day before they develop symptoms to up to 7 they develop symptoms to up to 7 days after they get sick.  days after they get sick. 

Children, especially younger Children, especially younger children, might potentially be children, might potentially be contagious for longer periods. contagious for longer periods.

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

Droplets from a cough or sneeze of Droplets from a cough or sneeze of an infected person move through the an infected person move through the air. air.

Germs can be spread when a person Germs can be spread when a person touches respiratory droplets from touches respiratory droplets from another person on a surface like a another person on a surface like a desk and then touches their own desk and then touches their own eyes, mouth or nose before washing eyes, mouth or nose before washing their hands. their hands.

What is the Infectious Period?What is the Infectious Period?

Persons who continue to be ill longer than 7 Persons who continue to be ill longer than 7 days after illness onset should be considered days after illness onset should be considered potentially contagious until symptoms have potentially contagious until symptoms have resolved. resolved.

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

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

Wash your hands. Wash your hands. Try to stay in good general health. Try to stay in good general health. Get plenty of sleep, be physically Get plenty of sleep, be physically

active, manage your stress, drink active, manage your stress, drink plenty of fluids, and eat nutritious food. plenty of fluids, and eat nutritious food.

Try not touch surfaces that may be Try not touch surfaces that may be contaminated with the flu virus. contaminated with the flu virus.

Avoid close contact with people who Avoid close contact with people who are sick. are sick.

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

Step 1:Step 1: EMS personnel should stay more EMS personnel should stay more than 6 feet away from patients and than 6 feet away from patients and bystanders with symptoms and exercise bystanders with symptoms and exercise appropriate routine respiratory droplet appropriate routine respiratory droplet precautions while assessing all patients precautions while assessing all patients for suspected cases.for suspected cases.

Step 2:Step 2: Assess all patients for symptoms Assess all patients for symptoms of acute febrile respiratory illness (fever of acute febrile respiratory illness (fever plus one or more of the following: nasal plus one or more of the following: nasal congestion/rhinorrhea, sore throat, or congestion/rhinorrhea, sore throat, or cough). cough).

Personal Protective Personal Protective Equipment (PPE)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.

Infection ControlInfection ControlInterim Recommendations:Interim Recommendations:

When removing PPE make every attempt to When removing PPE make every attempt to avoid contact with contaminated areas and avoid contact with contaminated areas and wash hands before touching a clean area.wash hands before touching a clean area.

All patients with acute febrile respiratory All patients with acute febrile respiratory illness should wear a surgical mask or illness should wear a surgical mask or approved respiratory barrier, if tolerated by approved respiratory barrier, if tolerated by the patient. the patient.

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Sequence for Removing Sequence for Removing PPEPPE

GlovesGloves Face shield or gogglesFace shield or goggles GownGown Mask or respiratorMask or respirator

How to Remove GlovesHow to Remove Gloves

Grasp outside edge near wristGrasp outside edge near wrist Peel away from hand, turning glove Peel away from hand, turning glove

inside-outinside-out Hold in opposite gloved handHold in opposite gloved hand

How to Remove GlovesHow to Remove Gloves(continued)(continued)

Slide ungloved finger under the wrist of Slide ungloved finger under the wrist of the remaining glovethe remaining glove

Peel off from inside, creating a bag for Peel off from inside, creating a bag for both glovesboth gloves

Discard in approved biomedical waste Discard in approved biomedical waste containercontainer

Removing Goggles or Face Removing Goggles or Face ShieldShield

Grasp ear or head pieces with Grasp ear or head pieces with ungloved handsungloved hands

Lift away from faceLift away from face Discard in approved biomedical waste Discard in approved biomedical waste

containercontainer

Removing Isolation GownRemoving Isolation Gown Unfasten tiesUnfasten ties Peel gown away Peel gown away

from neck & from neck & shouldershoulder

Turn contaminated Turn contaminated outside toward the outside toward the insideinside

Fold or roll into a Fold or roll into a bundlebundle

Discard in approved Discard in approved biomedical waste biomedical waste containercontainer

Removing a MaskRemoving a Mask

Untie the bottom, then top, tieUntie the bottom, then top, tie Remove from faceRemove from face Discard in approved biomedical waste Discard in approved biomedical waste

containercontainer

Removing a Particulate Removing a Particulate RespiratorRespirator

Lift the bottom Lift the bottom elastic over your elastic over your head firsthead first

Then lift off the Then lift off the top elastictop elastic

Discard in Discard in approved approved biomedical waste biomedical waste containercontainer

Hand HygieneHand 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)

Interfacility Transport Interfacility Transport EMS personnel involved in the interfacility transfer EMS personnel involved in the interfacility transfer

of patients with suspected or confirmed H1N1 of patients with suspected or confirmed H1N1 Influenza (swine flu) should use standard, droplet Influenza (swine flu) should use standard, droplet and contact precautions for all patient care and contact precautions for all patient care activities. activities.

This should include wearing a fit-tested disposable This should include wearing a fit-tested disposable N95 respirator, wearing disposable non-sterile N95 respirator, wearing disposable non-sterile gloves, eye protection (e.g., goggles, eyeshield), and gloves, eye protection (e.g., goggles, eyeshield), and gown, to prevent conjunctival exposure. gown, to prevent conjunctival exposure.

If the transported patient can tolerate a facemask If the transported patient can tolerate a facemask (e.g., a surgical mask), its use can help to minimize (e.g., a surgical mask), its use can help to minimize the spread of infectious droplets in the patient care the spread of infectious droplets in the patient care compartment.  compartment.  

Interfacility TransportInterfacility Transport(continued)(continued)

Encourage good patient compartment vehicle Encourage good patient compartment vehicle airflow/ ventilation to reduce the concentration airflow/ ventilation to reduce the concentration of aerosol accumulation when possible. of aerosol accumulation when possible.

If the transported patient can tolerate a If the transported patient can tolerate a facemask (e.g., a surgical mask), its use can facemask (e.g., a surgical mask), its use can help to minimize the spread of infectious help to minimize the spread of infectious droplets in the patient care compartment.  droplets in the patient care compartment.  

Encourage good patient compartment vehicle Encourage good patient compartment vehicle airflow/ ventilation to reduce the concentration airflow/ ventilation to reduce the concentration of aerosol accumulation when possible. of aerosol accumulation when possible.

Routine cleaning with soap or Routine cleaning with soap or detergent and water to remove soil and detergent and water to remove soil and organic matter, followed by the proper organic matter, followed by the proper use of disinfectants, are the basic use of disinfectants, are the basic components of effective environmental components of effective environmental management of influenza. management of influenza.

Reducing the number of influenza virus Reducing the number of influenza virus particles on a surface through these particles on a surface through these steps can reduce the chances of hand steps can reduce the chances of hand transfer of virus. transfer of virus.

Influenza viruses are susceptible to Influenza viruses are susceptible to inactivation by a number of chemical inactivation by a number of chemical disinfectants readily available from disinfectants readily available from consumer and commercial sources. consumer and commercial sources.

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

in Humansin 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.

VaccinationsVaccinations

There is no vaccine to protect humans There is no vaccine to protect humans from H1N1 Influenza A (swine flu) at this from H1N1 Influenza A (swine flu) at this time.time.

The seasonal influenza vaccine will likely The seasonal influenza vaccine will likely help provide partial protection against help provide partial protection against swine H3N2, but not swine H1N1 viruses.swine H3N2, but not swine H1N1 viruses.

Recommendations for: Recommendations for: Vehicle DecontaminationVehicle Decontamination

Upon completion of patient care (single call), clean Upon completion of patient care (single call), clean all equipment that came in contact with or was all equipment that came in contact with or was within 6 feet of the suspected ILI patient with an within 6 feet of the suspected ILI patient with an approved disinfectant.approved disinfectant.

The equipment may include stretchers, The equipment may include stretchers, railings, medical equipment control panels, railings, medical equipment control panels, adjacent flooring, walls, ceilings and work adjacent flooring, walls, ceilings and work surfaces, door handles, radios, keyboards, surfaces, door handles, radios, keyboards, and/or cell phones.and/or cell phones.

Cleanse all surfaces within 6 feet of the patient or Cleanse all surfaces within 6 feet of the patient or surfaces touched by the patient or caregivers with surfaces touched by the patient or caregivers with an approved disinfectant.an approved disinfectant.

Recommendations for:Recommendations for:Vehicle Decontamination Vehicle Decontamination

(Continued)(Continued) Large spills of bodily fluids (e.g., vomit) Large spills of bodily fluids (e.g., vomit)

should first be managed by removing visible should first be managed by removing visible organic matter with absorbent material.organic matter with absorbent material.

Place contaminated reusable patient care Place contaminated reusable patient care devices and equipment in biohazard bags.devices and equipment in biohazard bags.

Clean and disinfect non-patient-care areas of Clean and disinfect non-patient-care areas of the vehicle according to the vehicle the vehicle according to the vehicle manufacturer’s recommendations.manufacturer’s recommendations.

Cleaning should be done with detergent and Cleaning should be done with detergent and water and then disinfected using an EPA-water and then disinfected using an EPA-registered hospital disinfectant in accordance registered hospital disinfectant in accordance with the manufacturer's instructions.with the manufacturer's instructions.

Thank youThank you