This document provides general information regarding OSHA's Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers (OSHA Publication 3328) and links to additional resources. Page numbers are given for sections of the longer document that address the question asked.
Many scientists believe that since no pandemic has occurred since 1968, it is only a matter of time before another pandemic occurs. It is difficult to predict when the next influenza pandemic will occur or how severe it will be. Wherever and whenever a pandemic starts, everyone around the world is at risk.
The World Health Organization (WHO) maintains a global surveillance system of circulating influenza strains and a Global Influenza Preparedness Plan. Once a new influenza A virus develops the capacity for efficient and sustained human-to-human transmission in the general population (Phase 6), the WHO declares that an influenza pandemic is in progress (this is known as the "Pandemic Period"). In the event of a pandemic, the U.S. Department of Health and Human Services (HHS)/Centers for Disease Control and Prevention (CDC) will coordinate support and intelligence with U.S. public health departments regarding the pandemic situation in the U.S. and in foreign countries.
Given that the exact transmission pattern or patterns will not be known until after the pandemic influenza virus emerges, transmission-based infection control strategies may have to be modified to include additional selections of engineering controls, personal protective equipment (PPE), administrative controls, and/or safe work practices. The following precautions are advisable until more information is known about the transmission of any future pandemic influenza virus.
The appropriate use of engineering controls and other control efforts will require frequent analysis of pandemic influenza transmission patterns in designated wards, in the facility, and in the community.
If possible, and when practical, use of an airborne infection isolation room may be considered when conducting aerosol-generating procedures. Airborne infection isolation rooms receive numerous air changes per hour and are under negative pressure, so that the direction of the air flow is from the outside adjacent space (e.g., the corridor) into the room. The air in an airborne infection isolation room is preferably exhausted to the outside, but may be recirculated provided that the return air is filtered through a high-efficiency particulate air (HEPA) filter.
Cohorting: If single rooms are not available, patients infected with the same organisms can be cohorted (share rooms). Management of cohort areas should incorporate the following:
Hand Hygiene: To reduce the risk of becoming infected with influenza, healthcare workers working with influenza patients should follow rigorous hand hygiene measures:
Facility Hygiene: To protect healthcare workers, standard practices for handling and reprocessing used patient care equipment, including medical devices, should be followed.
Healthcare workers should use precautions when cleaning the rooms of pandemic influenza patients or of influenza patients who have been discharged or transferred.
Cleaning and Disinfection of Patient-Occupied Rooms:
Cleaning and Disinfection after Patient Discharge or Transfer:
Respiratory Hygiene/Cough Etiquette: Educate persons with respiratory illness and coughing or sneezing to:
For additional information, see Respiratory Hygiene/Cough Etiquette in Healthcare Settings.
Precautions during Specimen Collection and Transport: Healthcare workers who collect or transport clinical specimens should consistently adhere to recommended infection control precautions to minimize their exposure. Potentially infectious specimens should be placed in leakproof specimen bags for transport, labeled or color coded for transport and handled by personnel who are familiar with safe handling practices and spill cleanup procedures. Healthcare workers who collect specimens from pandemic-influenza infected patients should also wear PPE as described for employees performing direct patient care.
Precautions during Patient Transport within Healthcare Facilities: Influenza-infected patients' respiratory secretions are the principle source of infectious material in healthcare settings. Maintaining source control of patient secretions will limit the opportunities for nosocomial (in hospital) transmission.
Staff Education and Training: It is incumbent upon healthcare employers to educate employees about the hazards to which they are exposed and to provide reasonable means by which to abate those hazards.
Personal Protective Equipment (PPE)
Gloves: HHS recommends the use of gloves made of latex, vinyl, nitrile, or other synthetic materials as appropriate, when there is contact with blood and other bodily fluids, including respiratory secretions.
Goggles/Face Shields: The HHS Pandemic Influenza Plan does not recommend the use of goggles or face shields for routine contact with patients with pandemic influenza; however, if sprays or splatters of infectious material are likely, it states that goggles or a face shield should be worn as recommended for standard precautions. If a pandemic influenza patient is coughing, any healthcare worker who needs to be within 6 feet of the infected patient is likely to encounter sprays of infectious material. Eye and face protection should be used in this situation, as well as during the performance of aerosol-generating procedures.
For additional information about eye protection for infection control, see NIOSH's Eye Protection for Infection Control.
Respiratory Protection for Pandemic Influenza: While droplet transmission is likely to be the major route of exposure for pandemic influenza, as is the case with seasonal influenza, it may not be the only route. Given the potential severity of health consequences (illness and death) associated with pandemic influenza, a comprehensive influenza preparedness plan should address airborne transmission to ensure that healthcare workers are protected against all potential routes of exposure.
More information on the elements of a comprehensive respiratory protection program and the use of respirators can be found in the Respiratory Protection Safety and Health Topics Page.
Respirators: A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer's risk of inhaling hazardous gases, vapors, or airborne particles (e.g., dust or droplet nuclei containing infectious agents).
For a more complete discussion of respirator use during an influenza pandemic, see the section titled "Respiratory Protection for Pandemic Influenza" that begins on page 27 of OSHA Publication 3328
Correctly Putting On and Removing PPE: When PPE is necessary for the specific situation, HHS/CDC recommends that personal protective equipment be put on in the following order:
Upon leaving the room, HHS/CDC recommends that PPE be removed in a way to avoid self-contamination, as follows:
Remember to always use hand hygiene after removing PPE. A printable poster on the sequences for putting on and taking off PPE, which can be used for employee training and can be posted outside respiratory isolation rooms is available, see NIOSH's Severe Acute Respiratory Syndrome (SARS): Infection Control.
A vaccine against a specific pandemic influenza strain will likely not be available until after the pandemic begins. But vaccinations against seasonal influenza during the WHO's Interpandemic and Pandemic Alert Period can reduce co-infections and might ameliorate pandemic effects. A monovalent vaccine is expected to start becoming available within four-to-six months after identification of a specific pandemic virus strain.
The HHS Pandemic Influenza Plan recommends that healthcare workers be included on the priority list when the availability of pandemic influenza vaccinations is limited.2
Healthcare employers and employees should work together to develop an institutional safety climate that encourages compliance with recommended infection control practices. Healthcare administrators should emphasize those aspects of infection control already identified as "weak links" in the chain of infectious precautions -- adherence to hand hygiene, consistent and proper use of PPE, and influenza vaccination of healthcare workers.3
A Guide for Individuals and Families, a checklist, and forms for family health information to help guide your planning and preparation are available, see Pandemic Influenza Planning: A Guide for Individuals and Families (PDF).
Visit: One-stop access to U.S.government avian and pandemic flu information, managed by the Department of Health and Human Services.
1 Infection control professionals have traditionally used a range of 3-6 feet to reflect the distance from a patient that potentially infectious particles could travel. Recent reviews of the scientific literature suggest that the data on what constitutes "close contact" is not definitive. For pandemic influenza planning purposes, and in order to be more protective, DOL and HHS experts now recommend that close contact be considered a distance of less than 6 feet.
2 The DHHS/DHS Pandemic Influenza Vaccine Allocation and Targeting Guidance (PDF) was released in August 2008.
3 For guidance on when to stay home and when to return to work, see the Department of Veterans Affairs When to return to Your Workplace or to School (PDF).
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