"The WHO Patient Care Checklist: new influenza A (H1N1) is intended for use by hospital staff treating a patient with a medically suspected or confirmed case of new influenza A (H1N1)," the checklist document states. "This checklist combines two aspects of care: i) clinical management of the individual patient and ii) infection control measures to limit the spread of new influenza A (H1N1)."
Some specific recommendations:
- When the patient arrives at triage, those with flu-like symptoms should be directed to a designated waiting area and given instruction and educational materials regarding respiratory hygiene and cough etiquette (cover mouth and nose with a tissue when coughing or sneezing, discard tissue in a bin with a lid, and then clean hands). Patients who can tolerate it should wear a medical or surgical mask, which should also be worn during patient transport and transfer.
- When the patient is first evaluated, respiratory rate should be recorded for 1 full minute, as well as oxygen saturation when available. Senior care staff should be notified and consulted if respiratory rate is high or oxygen saturation is under 90%. History should document flu-like symptoms, date of onset, travel, exposure to persons with flu-like symptoms, and comorbid conditions, and alternative or additional diagnoses should be considered.
- Specialized diagnostic tests, such as reverse transcriptase polymerase chain reaction, may be indicated. When taking respiratory samples, healthcare personnel should wear a medical or surgical mask, eye protection, and gloves. Specimens should be correctly labeled and sent with biohazard precautions in compliance with local regulations. Suspected cases of H1N1 infection should be reported to the local authorities.
- Before the patient arrives at the isolation room or cohort, restricted entry and infection control signs should be posted. When available, dedicated patient equipment should be provided. Patients in the cohort area should be separated by at least 1 meter (3.3 feet). The local hospital protocol should be implemented for frequent linen and surface cleaning.
- Before a healthcare staff member or visitor enters an isolation room or cohort, they should put on a medical or surgical mask and clean their hands by hand rubbing with an alcohol-based hand rub formulation (preferred unless hands are visibly soiled) or by hand washing with soap and water.
- Before any exposure to a patient with known or suspected H1N1 influenza infection, healthcare staff should don a medical or surgical mask and clean their hands. When there is risk for exposure to body fluids or splashes, eye protection, gown, and gloves should also be worn. Personal or dedicated patient equipment should be cleaned and disinfected. Between patients, staff should change their gloves and clean their hands.
- When aerosol-generating procedures, such as intubation, bronchoscopy, cardiopulmonary resuscitation, or suctioning are being performed, only those staff essential to the procedure should be allowed access. The procedure should be done in an adequately ventilated room. A gown, particulate respirator (if available; eg, EU FFP2, US NIOSH-certified N95), eye protection, and gloves should be worn.
- Before a healthcare staff member or visitor leaves an isolation room or cohort, they should remove their gloves, gown, mask, eye protection, and any other personal protective equipment and discard disposable supplies according to hospital protocol. Hands should be cleaned, and dedicated patient equipment and personal equipment used by the patient should be cleaned and disinfected. Viral-contaminated waste should be disposed of as clinical waste.
- Alternative or additional diagnoses should be considered in patients with known or suspected H1N1 infection.
- Supportive treatment for patients with H1N1 infection should be similar to that for any influenza patient. Supplemental oxygen should be given as needed to maintain oxygen saturation above 90%, as well as to patients with increased respiratory rate if monitoring oxygen saturation is not feasible. For patients younger than 18 years, paracetamol or acetaminophen is recommended as an antipyretic. Patients with evidence of pneumonia or secondary bacterial infection should receive appropriate antibiotics. Use of the antiviral drugs oseltamivir or zanamivir should be considered after weighing contraindications and potential drug interactions.
- Before a patient with a confirmed or suspected case of H1N1 influenza infection is discharged from hospital, the patient and/or caregiver should be educated and given materials regarding respiratory hygiene and cough etiquette and counseled regarding home isolation, infection control, and limiting social contact. Patient contact information should be recorded.
- After discharge, dedicated patient equipment should be discarded or cleaned and disinfected according to the hospital protocol, linen should be changed and laundered without shaking, surfaces should be cleaned according to the hospital per local protocol, and viral-contaminated waste should be disposed of as clinical waste.
"Staff can use this checklist in a variety of ways — ticking the boxes is optional," the WHO document states. "The objective is to ensure that no critical patient care items are missed during or immediately following care. The checklist can be used as part of the patient's clinical record; reproduced as wall posters for hospitals or clinics; or printed up as cards for staff members to carry around with them."
The checklist is currently being assessed and updated to improve usability, and WHO plans to post the updated version on its Web site.
Source : http://www.medscape.com/viewarticle/705527?src=mpnews&spon=34&uac=133298AG
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