1. 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

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

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

4. Case definitions: avian flu
Possible case
Probable case
Confirmed case

5. 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

6. 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

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

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

10. less than 3 patients

11. less than 3 patients
Emergency Room
waiting room
normal patient route

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

13. 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

14. 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

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

16. 3 or more patients: triage in ER
Emergency Room
normal patient route
waiting room

17. 3 or more patients: triage in ER
Emergency Room
garage
normal patient route
triage route
decontamination room
waiting room

18. 3 or more patients: triage in ER
Emergency Room
garage
normal patient route
triage route
decontamination room
waiting room
CAT scan
radiology

19. 3 or more patients Intensive care is necessary:
Admission to Intensive Care Unit or Burn Unit (ventilated patients)
Burn Unit

20. 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)

21. 3 or more patients
selected psychiatry wards ER
Burn Unit

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

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

24. 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

25. 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

26. 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

27. 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

28. PPE removal procedure Outside the anteroom Remove respirator
Disinfect hands

29. 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

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

31. 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)

32. 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

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

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

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