TO: All SHC Staff and Physicians
FROM: Lucy Tompkins, MD, PhD, Medical Director, Infection Control, SHC
Sasha Madison, MPH, CIC, Manager, Infection Control and Epidemiology Department, SHC.

RE: UPDATED “Novel” Influenza H1N1 (Swine Flu) Protocol

Screening for Novel H1N1 Influenza (Swine Flu):
1. Fever (100 or greater) AND one of the following:
• Cough
• Sore throat
• Runny nose or nasal congestion

2. If patient meets any of the above criteria, place a surgical mask on the patient until placement in isolation (Respiratory/Droplet Isolation).
• If a direct fluorescent antibody (DFA) test is ordered, the patient MUST be placed on Respiratory/Droplet Isolation.
• PCR may be ordered for patients suspected of having influenza who have negative DFA. (To order PCR contact Dr. Pinsky in the Virology Lab by calling (650) 723-8222, pager ID 22822.)

3. Ask patient if they or anyone at home has been ill with upper respiratory symptoms.
4. Notify Infection control dept. (5-1106) when patient with Suspect or Probable H1N1 is admitted

ISOLATION
Since the onset of H1N1 2009, also known as “Novel” H1N1 Influenza 2009 we have tried to keep up with the ongoing debate among numerous regulatory and professional agencies regarding what type of personal protective equipment (PPE) should be worn by our staff to best protect them. Unfortunately, opinion continues to change. We are about to make yet another change in our practice with regard to masks. Although professional infectious disease organizations (including the CDC) continue to believe that H1N1 is spread by droplet route, which requires healthcare workers to wear a surgical mask with faceshield as PPE, CalOSHA has come out this month mandating the use of the N95 for fit-tested health care staff caring for patients with “novel” influenza. Since CalOSHA represents the law and CDC sets “guidelines” Stanford will adhere to the CalOSHA standard and ask that all health care staff wear the N-95 exclusively at this time when caring for suspected or probable H1N1 2009 patients.

RESPIRATORY/DROPLET ISOLATION (green sign) is required for all suspect/probable H1N1 2009 patients.
• Admit to a negative airflow room OR private room with a HEPA filter – keep door closed.
• Staff must wear a N95 fit-tested mask with faceshield OR N95 mask with splash guard or goggles. An N95 may be re-donned for a shift. Place in a paper bag with your name on it. Only good for one patient.
• Order Respiratory Isolation (document in chart if patient on isolation).
• Communicate isolation status to other healthcare workers
• Patient must wear a surgical mask during transport

Isolation may be discontinued upon approval of the Infection Control Dept. (725-1106 or pager 16167)
A negative DFA is not sufficient criteria to discontinue isolation in the inpatient population.

HAND HYGIENE IS REQUIRED BEFORE AND AFTER PATIENT CONTACT.

Employee Illness
Hospital staff with influenza-like-illness (ILI) MUST stay home for 7 days from the onset of symptoms or for 24 hours after resolution of symptoms; whichever is longer.

Housestaff MUST contact their Chief Resident. Chief Resident may contact Occupational Health for screening.
Employee Exposure (Occupational Health Services)
Any Healthcare worker who has prolonged contact (within 6 feet) with a patient with a confirmed or probable case of H1N1 2009 AND WAS NOT wearing appropriate PPE must contact Occupational Health (x35922)

For Infection Control and Prevention questions call 725-1106