1. safer, fairer and more productive workplaces Pandemic influenza Patricia Coward Principal Adviser (Occupational Health) Occupational Health Unit (07) 3247 9400 Patricia.Coward@qld.gov.au

2. safer, fairer and more productive workplaces Session overview What is the difference between seasonal influenza, pandemic influenza and avian influenza (bird flu)? Infection control practices to protect staff and students in the event of pandemic influenza

3. safer, fairer and more productive workplaces Seasonal influenza Occurs each winter in Australia New strain each winter It is reasonably predictable because it is similar to previous influenza strains

4. safer, fairer and more productive workplaces Seasonal influenza Some groups are at greater risk from seasonal influenza Persons 65 years of age and over Aboriginal and Torres Strait Islander persons aged 50 years and over Chronic disease Immunosuppression Residents of long-term care establishments Pregnant women

5. safer, fairer and more productive workplaces Pandemic influenza Pandemic influenza is a severe form of influenza that infects many people around the world at the same time Occurs when a new strain of influenza virus emerges to which no-one has immunity Can occur at any time of the year and lasts longer than seasonal influenza

6. safer, fairer and more productive workplaces Pandemic influenza Causes more severe illness and death All people may be at risk, not just the usual ‘at-risk’ groups The only predictable thing about pandemic influenza is its unpredictability

7. safer, fairer and more productive workplaces Previous pandemics 1918 Spanish flu 20-40 million deaths CFR 2-3% 1957 Asian flu 1-4 million deaths CFR <0.2% 1968 Hong Kong flu 1-4 million deaths CFR <0.2%

8. safer, fairer and more productive workplaces Avian influenza Disease of birds caused by an avian (bird) influenza virus Usually infects aquatic birds Can also infect domestic birds and some animals

9. safer, fairer and more productive workplaces Avian influenza Historically, human infection with avian influenza viruses has been rare and mild Human infection with the H5N1 strain of avian influenza is rare but it can cause serious human infection with a high death rate > 60% WHO 19 th June 2008 385 confirmed cases 243 confirmed deaths

10. safer, fairer and more productive workplaces Avian influenza Children and young adults are most at risk from H5N1 90% of cases are < 40 years of age 52% of cases are < 20 years of age

11. safer, fairer and more productive workplaces Avian influenza H5N1 is circulating in wild and domestic bird flocks in many parts of Asia, Africa and Europe H5N1 has pandemic potential There is concern that H5N1 could mutate to cause the next human influenza pandemic

12. safer, fairer and more productive workplaces Pandemic alert level The world is on pandemic alert level 3

13. safer, fairer and more productive workplaces Pandemic planning Tertiary education facilities are at significant risk for pandemic influenza Colleges and universities pandemic influenza checklist http://www.pandemicflu.gov/plan/school/ collegeschecklist.html http://www.pandemicflu.gov/plan/school/ collegeschecklist.html

14. safer, fairer and more productive workplaces Assumptions A pandemic is likely to be widespread throughout Queensland May last up to 12 months May be 2 or more pandemic waves each lasting about 8 weeks Healthcare system will be overloaded

15. safer, fairer and more productive workplaces Pandemic planning Social distancing within the community Inadequate supplies Significant absenteeism for a prolonged period

16. safer, fairer and more productive workplaces Protecting staff and students Vaccination May not be available at the start of a pandemic Antiviral medications Availability will be restricted Infection control Critical control for protecting staff and students Based on influenza’s modes of transmission

17. safer, fairer and more productive workplaces How is influenza spread? Contact transmission Occurs when you have contact with an infected person or a contaminated surface Transfer influenza virus to your eyes, nose and mouth via your hands

18. safer, fairer and more productive workplaces How is influenza spread? Droplet transmission Occurs when an infected person releases droplets containing influenza virus when they cough, sneeze or talk The droplets land on your eyes, mouth and nose if you are within about 1 metre distance of the person

19. safer, fairer and more productive workplaces How is influenza spread? Airborne transmission Occurs when you inhale aerosols of influenza virus Risk for healthcare workers who perform aerosol generating procedures No evidence that influenza is spread through air-conditioning systems

20. safer, fairer and more productive workplaces Infection control for pandemic influenza http://www.health.sa.gov.au/infectioncontrol/

21. safer, fairer and more productive workplaces Hand hygiene Regularly wash hands with soap and water or apply alcohol-based hand rub

22. safer, fairer and more productive workplaces Respiratory hygiene and cough etiquette Cough or sneeze into a disposable tissue If no tissue available, cough or sneeze into sleeve Perform hand hygiene after coughing and sneezing X

23. safer, fairer and more productive workplaces Cleaning programs Regular cleaning of Shared surfaces Surfaces that are frequently touched Cleaning agents Water and detergent Alcohol-based disinfectant

24. safer, fairer and more productive workplaces Social distancing Restrict non-essential face-to-face contact Conduct business by alternative ways that minimise face-to-face contact Ensure supporting communications systems Staff and students able to work from home

25. safer, fairer and more productive workplaces Social distancing Where essential face-to-face contact is required Sit > 1 metre apart Hold the meeting outdoors if practicable Stagger start, finish and break times so that fewer people are using workplace facilities and public transport at the same time Postpone work recreational activities

26. safer, fairer and more productive workplaces Social distancing Promote spatial separation at the office Arrange work stations >1 metre apart Transparent screens at face-to-face customer service areas

27. safer, fairer and more productive workplaces Personal protective equipment Disposable gloves for tasks that involve contact with potentially contaminated surfaces Vinyl, nitrile or powder-free latex gloves Perform hand hygiene after glove removal

28. safer, fairer and more productive workplaces PPE Surgical masks for Staff who develop influenza illness at work Contain their coughs and sneezes Staff who have face-to-face contact with others

29. safer, fairer and more productive workplaces

30. Work restrictions Restrict workplace entry Display notices at workplace entry points advising people not to enter if they have influenza symptoms

31. safer, fairer and more productive workplaces Work restrictions Exclude sick family members from the workplace Exclude infected children from family rooms Exclude staff who are contacts of infected people Should be in quarantine for 7 days from the time that their contact became ill

32. safer, fairer and more productive workplaces Managing sickness at work If a person develops pandemic influenza symptoms at work Separate the person from other workers First aid or family room

33. safer, fairer and more productive workplaces Managing sickness at work Provide the person with Surgical mask and tissues Alcohol-based hand gel to sanitise their hands and prevent contamination of their work surfaces Influenza kit for managing sick workers Surgical masks, alcohol-based hand gel, tissues, disinfectant, disposable gloves, garbage bags

34. safer, fairer and more productive workplaces Managing sickness at work Send the person home promptly Most contagious at the onset of symptoms Clean and disinfect the sick person’s workstation once they have left Identify recent close work contacts and advise them of the situation May require isolation Train first aid personnel

35. safer, fairer and more productive workplaces Vaccination Maintain annual seasonal influenza vaccination Seasonal influenza strains may continue to circulate during a pandemic Encourage vaccination once a pandemic influenza vaccine becomes available

36. safer, fairer and more productive workplaces Stockpiling “The decision made now not to stockpile means that you have made the decision not to protect your workers during a pandemic”

37. safer, fairer and more productive workplaces Campus health services May be the first to see cases of suspected pandemic influenza May have to provide care to sick students and staff if hospitals, GPs and community influenza clinics are overwhelmed International students Students residing in student housing

38. safer, fairer and more productive workplaces Campus health services Medical offices and clinics pandemic influenza planning checklist http://www.pandemicflu.gov/plan/healthcar e/medical.html http://www.pandemicflu.gov/plan/healthcar e/medical.html Stockpile medical consumables, including hand hygiene products, PPE and antivirals

39. safer, fairer and more productive workplaces Campus health services Triage system to identify and separate persons presenting with influenza symptoms from others Single room with ventilation that is not recirculated to other rooms within the facility Shaded outdoor area Provide infected persons with a surgical mask to contain coughs and sneezes

40. safer, fairer and more productive workplaces Campus health services P2 respirators for healthcare workers, clinic administrative staff and others Respirator fit test AS 1715:1994 Selection, use and maintenance of respiratory protective devices “In order for the designed performance to be achieved by a respirator, it is essential the respirator be properly fitted to the individual to whom it is assigned”

41. safer, fairer and more productive workplaces Campus health services Fit check User seal check performed each time the respirator is donned Respirator ready Clean shaven

42. safer, fairer and more productive workplaces Campus health services Clinic security Infection control training Staff fatigue and work overload Clinic staff who may be at high risk from acquiring pandemic influenza Pregnant staff Monitor clinic staff for influenza illness

43. safer, fairer and more productive workplaces Campus health services Commonwealth Department of Health & Ageing www.health.gov.au www.health.gov.au Interim Infection Control Guidelines for Pandemic Influenza in Healthcare and Community Settings Prepared and protected DVD Queensland Health www.health.qld.gov.auwww.health.qld.gov.au Pandemic Influenza – Infection Control for Healthcare Workers DVD Available from the Communicable Diseases branch of Queensland Health (07) 3234 1155 Royal Australian College of General Practitioners