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CDC rolls out pandemic plan for swine flu patients
Negative-pressure rooms, full isolation measures, N95s
Warning that continuing transmission and more severe disease are likely, the Centers for Disease Control and Prevention has issued infection control guidelines for hospitals admitting patients with an emerging swine flu strain. The guidelines are similar to those devised to combat avian influenza A (H5N1), but it appears swine influenza A (H1N1) may have beaten "bird flu" to the pandemic punch. As this issue went to press, the situation was very much in flux.
Public health officials were confirming numerous cases in an expanding number of states and nations and were expecting more patient deaths and health care worker exposures and infections in the United States. Illness signs and symptoms include fever and respiratory problems (cough, sore throat, and runny nose), headache, muscle aches - and have had vomiting and diarrhea in some cases. The potential for exacerbation of underlying chronic medical conditions or invasive bacterial coinfection with swine influenza virus infection should be considered.The CDC infection control recommendations for patients with confirmed or suspected infection with H1N1 swine flu include:
Patients should be placed in a single-patient room with the door kept closed. If available, an airborne infection isolation room 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. For suctioning, bronchoscopy, or intubation, use a procedure room with negative pressure air handling.
The patient should wear a surgical mask when outside of the patient room, and should be encouraged to wash hands frequently and follow respiratory hygiene practices. Cups and other utensils used by the patient should be washed with soap and water before use by other persons. Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management of swine influenza.
Standard, Droplet, and Contact precautions should be used for all patient care activities, and maintained for seven days after illness onset or until symptoms have resolved. Maintain adherence to hand hygiene by washing with soap and water or using hand sanitizer immediately after removing gloves and other equipment and after any contact with respiratory secretions. Personnel providing care to or collecting clinical specimens from suspected or confirmed cases should wear disposable nonsterile gloves, gowns, and eye protection (e.g., goggles) to prevent conjunctival exposure.
Pending clarification of transmission patterns for this virus, personnel providing direct patient care for suspected or confirmed swine influenza A H1N1 cases should wear a fit-tested disposable N95 respirator when entering the patient room.
(Editor's note: For more on the CDC guidelines, go to: http://www.cdc.gov/swineflu/guidelines_infection_control.htm.)