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Put patients in private rooms, neg pressure for aerosols
CDC interim H1N1 infection control guidelines
As this issue went to press, interim infection control recommendations by the Centers for Disease Control and Prevention for H1N1 influenza A included the following:
• Patient placement and transport
Patients who have a confirmed, probable, or suspected case of novel H1N1 should be placed directly into individual rooms and the door should be kept closed. For procedures that are likely to generate aerosols (e.g., bronchoscopy, elective intubation, suctioning, administering nebulized medications), an airborne infection isolation room (AIIR) with negative-pressure air handling with six to 12 air changes per hour can be used. Air can be exhausted directly outside or be recirculated after filtration by a high-efficiency particulate air (HEPA) filter. Facilities should monitor and document the proper negative-pressure function of AIIRs, including those in operating rooms, intensive care units, emergency departments, and procedure rooms. Facilities should also ensure that plans are in place to communicate information about suspected cases that are transferred to other departments in the facility (e.g., radiology, laboratory) and other facilities. The patient should wear a surgical mask to contain secretions when outside of the patient room and should be encouraged to perform hand hygiene frequently and follow respiratory hygiene/cough etiquette practices.
• Isolation measures
Healthcare personnel entering the room of a patient in isolation should be limited to those performing direct patient care. All healthcare personnel who enter the patient's room should take standard and contact precautions. Eye protection should be used for all patient care activities for patients being evaluated or in isolation for novel H1N1. Maintain adherence to hand hygiene by washing with soap and water or using alcohol-based hand sanitizer immediately after removing gloves and other equipment and after any contact with respiratory secretions. Nonsterile gloves and gowns along with eye protection should be donned when entering a patient's room.
All healthcare personnel who enter the rooms of patients in isolation with confirmed, suspected, or probable novel H1N1 influenza should wear a fit-tested disposable N95 respirator or equivalent (e.g., powered air purifying respirator). Respiratory protection should be donned when entering a patient's room. Note that this recommendation differs from current infection control guidance for seasonal influenza, which recommends that healthcare personnel wear surgical masks for patient care. The rationale for the use of respiratory protection is that a more conservative approach is needed until more is known about the specific transmission characteristics of this new virus.
• Management of visitors
Limit visitors for patients in isolation for novel H1N1 infection to persons who are necessary for the patient's emotional well-being and care. Visitors who have been in contact with the patient before and during hospitalization are a possible source of novel H1N1. Therefore, schedule and control visits to allow for appropriate screening for acute respiratory illness before entering the hospital and appropriate instruction on use of personal protective equipment and other precautions (e.g., hand hygiene, limiting surfaces touched) while in the patient's room. Visitors should be instructed to limit their movement within the facility. Visitors may be offered a gown, gloves, eye protection, and respiratory protection (i.e., N95 respirator) and should be instructed by healthcare personnel on their use before entering the patient's room.
• Duration of precautions
Isolation precautions should be continued for 7 days from symptom onset or until the resolution of symptoms, whichever is longer. Persons with novel H1N1 virus infection should be considered potentially contagious from one day before to 7 days following illness onset. Persons who continue to be ill longer than 7 days after illness onset should be considered potentially contagious until symptoms have resolved. Children, especially younger children, might be contagious for longer periods.
(Editor's note: For the full CDC guidelines, go to: http://www.cdc.gov/h1n1flu/index.htm.)