Pandemic infection control practices for HCWs

This is the current Centers for Disease Control and Prevention (CDC)/Department of Health and Human Services (HHS) guidance related to personal protective equipment (PPE) for health care workers during an influenza pandemic.

Infection control practices for pandemic influenza are the same as other human influenza viruses and primarily involve the application of standard and droplet precautions during patient care in health care settings. This guidance also applies to health care personnel going into the homes of patients. During a pandemic, conditions that could affect infection control may include shortages of antiviral drugs, decreased efficacy of the vaccine, increased virulence of the influenza strain, shortages of single-patient rooms, and shortages of personal protective equipment. These issues may necessitate changes in the standard recommended infection control practices for influenza. The CDC will provide updated infection control guidance as needed.

PPE for standard and droplet precautions

PPE is used to prevent direct contact with the pandemic influenza virus. PPE that may be used to provide care includes surgical or procedure masks, as recommended for droplet precautions, and gloves and gowns, as recommended for standard precautions. Additional precautions may be indicated during the performance of aerosol-generating procedures.

• PPE for special circumstances

— PPE for aerosol-generating procedures

During procedures that may generate increased small-particle aerosols of respiratory secretions (e.g., endotracheal intubation, nebulizer treatment, bronchoscopy, suctioning), HCWs should wear gloves, gown, face/eye protection, and a N95 respirator or other particulate respirator. Respirators should be used within the context of a respiratory protection program that includes fit-testing, medical clearance, and training. If possible, and when practical, use of an airborne isolation room may be considered when conducting aerosol-generating procedures.

— PPE for managing pandemic influenza with increased transmissibility

The addition of airborne precautions, including respiratory protection (an N95 filtering facepiece respirator or other appropriate particulate respirator), may be considered for strains of influenza exhibiting increased transmissibility, during initial stages of an outbreak of an emerging or new strain of influenza, and as determined by other factors such as vaccination/immune status of personnel and availability of antivirals. As the epidemiologic characteristics of the pandemic virus are more defined, the CDC will provide updated infection control guidance, as needed.

— Precautions for early stages of a pandemic

Early in a pandemic, it may not be clear that a patient with severe respiratory illness has pandemic influenza. Therefore, precautions consistent with all possible etiologies, including a newly emerging infectious agent, should be implemented. This may involve the combined use of airborne and contact precautions, in addition to standard precautions, until a diagnosis is established.