Working Together to SAVE LIVES Influenza Prevention and

Working Together to SAVE LIVES Influenza Prevention and Control OHS & IPC Joint Educational Session Fall 2019

Objectives • Examine influenza along the Prevention/Outbreak Management continuum • Apply an integrated approach to influenza management for patients/residents and HCW* • Outline current Covenant Health initiatives to prevent and control the impacts of influenza for the 2019 -20 season • Provide resources for prevention and management of influenza outbreaks

Influenza Management PREVENTION CONTROL OUTBREAK MANAGEMENT

Influenza by the Numbers • • • Flu season in Canada starts in November and ends in April. Globally: 250, 000 -500, 000 deaths annually Canada: 10 -20% of the population will be infected; causing an estimated 12, 200 hospitalizations and 3500 deaths annually. (PHAC) 2019 -20 Alberta had 30 deaths due to influenza (lab confirmed). • Total of 1, 391 hospitalizations due to influenza (lab confirmed) • **Provincial target: 80% HCW immunization** In 2019 -20 Covenant Health Flu immunization rate was 69% vs AHS of 67%

Influenza Signs & Symptoms Sudden or Acute onset of a respiratory illness associated with: ü ü ü ü FEVER >38° C COUGH sore throat arthralgias (aching joints) myalgias (aching muscles) prostration (extreme weakness and/or severe exhaustion) § Children under the age of 5 may also have GI symptoms § Fever may not be present in those <5 or >65 yrs. If patient meets above criteria initiate Contact & Droplet Precautions HCW are advised to self-monitor and exclude themselves from work if symptomatic. Note: This ILI definition is a National definition - adapted from PHAC Flu. Watch ILI information. Each Zone should follow the recommendations of their Zone MOH.

Prevention MOST EFFECTIVE STRATEGIES for preventing Influenza and reducing its impacts: • ROUTINE PRATICES including: • • Hand hygiene Respiratory etiquette Environmental cleaning The use of Personal Protective Equipment (PPE) Linen and waste management Patient placement/accommodation INFLUENZA VACCINATION

Health Care Worker (HCW) Immunization “People who are potentially capable of transmitting influenza to those at high risk should receive annual vaccination, regardless of whether the high-risk person has been immunized. ” Immunization of care providers and residents is associated with decreased risk of ILI outbreaks”. From the National Advisory Committee on Immunization (NACI) Statement on Seasonal Influenza Vaccine (2019 -20), p. 28.

Removal of Barriers to HCW Immunization: Collaboration • Making the flu vaccine accessible through: • • Mass Flu Immunization clinics Scheduling Flu clinics to target shift workers Track Clinic Utilization Flu Site Ambassadors to facilitate clinics and tracking clinic utilization • Provide information and dispel the myths associated with flu vaccines. • Promote the concept of “herd immunity” among our HCWs in preventing disease to our patients and colleagues. • Encouraging health care professionals as In. FLUencers to promote vaccination amongst their peers.

2019 -20 Flu Vaccine The strains that will be included in the 20192020 influenza vaccine for the Northern hemisphere are: Quadrivalent vaccine • A/Brisbane/02/2018(H 1 N 1)pdm 09 -like virus • A/Kansas/14/2017(H 3 N 2)-like virus • B/Colorado/06/2017 -like virus • B/Phuket/3073/2013 -like virus *Fluzone and Flulaval Tetra vaccine brands for 2019 -20

Vaccination Myths “I don’t need it – I never get sick” “Influenza vaccine is dangerous to my health” “I got FLU from the vaccine” “The FLU shot is inconvenient; I don’t have time to get it” Relatively new field of study on issue of myths that impact HCW decision to get the flu shot: Bellia et al. (2013). Healthcare worker compliance to seasonal and pandemic influenza vaccination. Influenza and Other Respiratory Viruses 7(Suppl. 2), 97– 104. Mah et al. (2005). Understanding influenza vaccination attitudes at a Canadian cancer centre, AJIC: American Journal of Infection Control.

ILI Patient Screening Tool Note: This tool is NOT part of the permanent chart. • This checklist /tool is designed to help staff identify, record and organize actions on all newly admitted patients and current inpatients. • Prompts user to ensure correct actions are undertaken and serves as a guide to assist staff

Patient Accomodations • Patient(s) with suspected or confirmed ILI should have 2 meters of separation from others • Single room preferred • Post Contact & Droplet Precaution sign • Room door must be closed when performing an aerosol- generating medical procedure (AGMP) • Refer to IPC Guidelines for Cohorting Isolation Patients • If the patient leaves the room they are to perform hand hygiene, wear a clean hospital gown (or clean clothes) and mask. • Patients on precautions should not be leaving the unit except for medically necessary procedures.

Discontinuing Precautions • Must be 5 days from the onset of the acute illness OR they are over the acute illness and have been afebrile for 48 hours. A repeat NP swab for respiratory viral testing is not routinely required. (Physician/NP removes precautions) • Any immunocompromised patient with influenza must remain on contact and droplet precautions until they are asymptomatic or repeat testing for viral respiratory pathogens is negative.

OUTBREAK ROLES & RESPONSIBILITIES

Facility Administration • Supports and encourages annual influenza immunization for patients/residents and staff • Develops an influenza response plan that details how antiviral prophylaxis will be implemented for patients/residents and staff. • Collaborate with Public Health/IPC on outbreak management control strategies. • Notify Senior Management, staff and external stakeholders as appropriate. • Complies with unit/bed restrictions. • Ensure resources are adequate to manage outbreak. • Sends forms to Public Health (as per the AHS Outbreak Management Guidelines) when an admission, discharge or transfer is to occur during the outbreak. • Ensure outbreak control strategies are maintained until outbreak is declared over.

Unit Manager/Designate: IPC Measures • Implement IPC measures immediately • Notify IPC immediately when unusual cluster of illness suspected (Infection Control available weekdays from 8 -4 pm. During STAT holidays or weekends/after hours, contact the manager on call. ) • Post appropriate outbreak signage • Ensure staff aware of ILI case definition and reporting requirements • Cohort staff assignments as much as possible • Anticipates and provides adequate unit resources for outbreak management • Distribute and ensure that the outbreak checklist is reviewed shift to shift • Completes daily line listing and faxes to Public Health

Unit Manager/Designate: OHS Measures 1. Send symptomatic staff home. 2. Ensure that staff are aware of work restrictions, roles and expectations during flu outbreak. 3. Review the “Fit to Work” staff list to identify which staff are fit to work on the outbreak unit and adjust staffing accordingly. 4. Send the list of employee names and contact information to OHS who are not on the fit to work list. Do not send names of employees who are on the fit to work list. 5. Manager provides names and contact information to OHS for any non-employees that have been exposed on the outbreak unit (ie: students and or medical residents etc…). 6. Advise staff who received their flu immunization offsite (ie GP office, AHS, Public Health etc…) to complete the “I Got My Flu Shot” form or a copy of their NCR form to OHS so OHS can update the fit to work list. 7. Work collaboratively with IPC & OHS to disseminate information to HCW, patients/residents, students, other departments and families regarding protocol when a unit is in flu outbreak (ie limit visitors, encourage proper hand hygiene to all visitors and staff, advise visitors and staff to remain home if ill etc…). 8. Ensure staff are up to date on their N 95 Respirator fit test.

OUTBREAK CONTROL STRATEGIES

Steps in Outbreak Management Notification / Communication • Unit Manager / Designate notifies IPC & OHS of suspected and lab confirmed ILI • All stakeholders Access Toolkit on Compassion. Net • IPC notifies and liaises with MOH • MOH issues EI number to IPC, and directs outbreak with measures for patients and staff under authority of Public Health Act • Unit Manager/Designate sends list of exposed staff (not on the fit to work list), from outbreak unit and all HCW visiting unit, to OHS (using spreadsheet template in Manager’s Tool. Kit) • Unit Manager / Designate activates and leads Outbreak Management Team (OMT) • Unit Manager / Designate communicates with OMT staff, visitors, and patients.

Steps in Outbreak Management HCW Fitness to Work (FTW) • • • Unit Manager / Designate sends symptomatic staff home and selfmonitor for symptoms, and report which staff are symptomatic to OHS provides an updated fit to work list to Unit Manager as OHS follows-up with employees not on the fit to work list. OHS contacts “unfit” employees to provide immunization and/or Tamiflu recommendations as per MOH direction. OHS provides info to HCW re: work restrictions and access to Tamiflu. HCW follows recommendations of OHS as per protocol. If the HCW is prescribed Tamiflu, the HCW provides OHS with copy of Tamiflu prescription prior to returning to the outbreak unit to confirm fitness to work. HCW to submit “I got my flu shot” form to OHS if they received their flu immunization off site. OHS advises Unit Manager / Designate with updates on the number of new cases of employees that are reporting ILI symptoms for each day of the outbreak. Managers on the outbreak unit will be asked by OHS to provide the total number of staff on the unit (includes: students, residents and all support staff) and those who are “fit to work” (immunized). This information will be forwarded to Public Health.

OHS Influenza Outbreak Staffing Algorithm (on Compassion. Net)

Steps in Outbreak Management Reporting and Closure MOH assesses performance of outbreak and advises IPC when declared closed. IPC advises Unit Manager / Designate and Outbreak Management Team and holds closure meeting OHS, on direction of MOH, advises staff re: discontinuing Tamiflu. OHS reports on vaccination rates at start of outbreak and number of staff exposed at close (ratio) to Public Health.

Resources – Compassion. Net. ca • IP&C OHS Source Control Documents Influenza Immunization Campaign Comprehensive Point of Care Risk Assessment Immunizer Toolbox ILI Patient Screening Tool Outbreak Management Policy and Protocol-Manager’s Toolkit Collection of NP Throat Swabs Outbreak Management FAQs Other Key Materials Exposure spreadsheet template Influenza Page on Compassionnet http: //compassionnet. ca/Page 188. aspx Let’s put these in as links within the module

Questions?