Influenza plan of the University Hospital of Ghent being prepared for an emerging pandemic R. Peleman, MD, PhD Chief Medical Officer P. De Waegemaeker, Ma Hospital Infection Control Team Influenza Coordinator

Development of the plan Experience with SARS (Severe Acute Respiratory Syndrome) Literature Communication: Hospital Management HICT HCW from selected wards

Major parts of the plan Case definitions Severity assessment and hospital admission Infection control guidelines

Case definitions: avian flu Possible case Probable case Confirmed case

Possible case a person with High fever (> 38°C) Coughing Feeling ill History of travel within 7 days of symptom onset to a country with documented avian influenza and with close contact to poultry and

Probable case a possible case with Respiratory problems Strongly suggested epidemiological context evaluated by experts (such as visiting a poultry farm with known avian flu) Preleminary labresults that suggest avian influenza, but are not jet confirmed or

Confirmed case a probable case Positive PCR for avian influenza Positive viral culture for avian influenza Significant increase of specific antibodies or

Severity assessment and hospital admission Considerations Number of influenza patients in hospital ? Human transmission is confirmed ?

less than 3 patients

less than 3 patients Emergency Room waiting room normal patient route

less than 3 patients Emergency Room normal patient route waiting room reanimation room pediatric care room

less than 3 patients: first actions alert Chief Medical Officer HICT Community healthcare inspector patient related actions particulate respirator first in line for diagnostic and therapeutic procedures

less than 3 patients: critical patients Admission to indicated intensive care unit Human transmission is not confirmed Unit is not to be evacuated Human transmission is confirmed Unit is to be evacuated

less than 3 patients: critical patients ICU unit 5 isolation room 1 anteroom anteroom isolation room 2

3 or more patients: triage in ER Emergency Room normal patient route waiting room

3 or more patients: triage in ER Emergency Room garage normal patient route triage route decontamination room waiting room

3 or more patients: triage in ER Emergency Room garage normal patient route triage route decontamination room waiting room CAT scan radiology

3 or more patients Intensive care is necessary: Admission to Intensive Care Unit or Burn Unit (ventilated patients) Burn Unit

3 or more patients Intensive care is necessary: Admission to Intensive Care Unit or Burn Unit (ventilated patients) Intensive care is not necessary: Admission in isolated building (psychiatry ward)

3 or more patients selected psychiatry wards ER Burn Unit

Infection Control Guidelines Isolation precautions (incl. PPE) Patient care equipment Patient transport Environmental cleaning and disinfection Waste disposal, laundry, dishes, … Specimen handling

Isolation precautions airborne + droplet + contact precautions (CDC) Single room Keep door closed Negative pressure room if possible

Isolation precautions handhygiene and disposable gloves Personal Protective Equipment particulate respirator (FFP2) for aerosol generating procedures, use FFP3 respirator protective eyeware if splashes are anticipated fluid resistant gown that covers major body parts

Isolation precautions Use closed aspiration system in ventilated patients Cough etiquette for not ventilated patients All HCW and visitors are to be recorded in a log

PPE placement procedure All PPE should be in place before entering the (ante)room No phones or other personal equipment should be taken into the room

PPE removal procedure In the anteroom (if available) Remove gown Remove gloves Disinfect hands Remove eye protection Disinfect hands and eye protection material If no anteroom is available, follow these steps before leaving the room

PPE removal procedure Outside the anteroom Remove respirator Disinfect hands

Patient care equipment Use single use material if available Non-critical patient-care equipment (stetoscope, …) is dedicated to the patient Reprocess through sterilization as much as possible

Patient care equipment Keep diagnostic equipment in quarantine for 6 hours Before re-entering in patient care: disinfect properly

Patient transport The patient is to stay in the room Except for essential purposis If transport is nessecary, patient uses a particulate respirator (if not ventilated)

Environmental cleaning and disinfection Clean and disinfect room and furniture every day Disinfect frequently touched surfaces at least 2 times a day After discharge: keep room in quarantine for at least 6 hours before cleaning Cleaning personnel uses same protection as HCW All cleaning equipment stays in the room or has to be disinfected before use with other patients

dishes and eating utensils linen and laundry use standard precautions dishes and eating utensils use standard precautions waste disposal use standard precautions

specimen handling disinfect recipients before packing and shipping Mark the samples clearly Do not use the pneumatic tube system

Other issues Staff education Antiviral prophylaxis for staff Care of the deceased Patient discharge Recommendations for family members