pandemic influenza

safer, fairer and more productive workplaces

Pandemic influenza

• Patricia Coward • Principal Adviser (Occupational Health)• Occupational Health Unit• (07) 3247 9400• [email protected]


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


Seasonal influenza

• Occurs each winter in Australia • New strain each winter

• It is reasonably predictable because it is similar to previous influenza strains


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


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


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


Previous pandemics1918

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%


Avian influenza

• Disease of birds caused by an avian (bird) influenza virus• Usually infects aquatic birds • Can also infect domestic birds and some

animals


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 19th June 2008• 385 confirmed cases• 243 confirmed deaths


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


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


Pandemic alert level

• The world is on pandemic alert level 3


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


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


Pandemic planning

• Social distancing within the community• Inadequate supplies• Significant absenteeism for a prolonged

period


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


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



• 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



• 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


Infection control for pandemic influenza

http://www.health.sa.gov.au/infectioncontrol/


Hand hygiene

• Regularly wash hands with soap and water or apply alcohol-based hand rub


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


Cleaning programs

• Regular cleaning of • Shared surfaces• Surfaces that are frequently touched

• Cleaning agents• Water and detergent• Alcohol-based disinfectant


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


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


Social distancing

• Promote spatial separation at the office • Arrange work stations >1 metre apart

• Transparent screens at face-to-face customer service areas


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


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


Work restrictions

• Restrict workplace entry• Display notices at workplace entry points

advising people not to enter if they have influenza symptoms


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


Managing sickness at work

• If a person develops pandemic influenza symptoms at work• Separate the person from other workers • First aid or family room



• 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



• 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


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


Stockpiling

• “The decision made now not to stockpile means that you have made the decision not to protect your workers during a pandemic”


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



• Medical offices and clinics pandemic influenza planning checklist http://www.pandemicflu.gov/plan/healthcare/medical.html

• Stockpile medical consumables, including hand hygiene products, PPE and antivirals



• 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



• 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”



• Fit check• User seal check performed each time

the respirator is donned

• Respirator ready• Clean shaven



• 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


Campus health services• Commonwealth Department of Health & Ageing

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.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

pandemic influenza

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