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Guidelines for Swine Influenza A (H1N1)
***This is a temporary document with the best information available at this time. Expect additional updates as the situation progresses.
As of May 6, 2009 CDC has confirmed 642 human cases of Swine Influenza A (H1N1) in the U.S. Investigations and surveillance are ongoing. Due to the concern that human-to-human transmission is occurring, the State of Florida DOH has asked providers for assistance to enhance influenza surveillance in Florida.
- They are requesting that specimens are collected and submitted to the Bureau of Laboratories for testing as indicated in the attached “Guidance Document.” The CDC site has the most up-to-date information available: http://www.cdc.gov/swineflu/.
- No cases have been confirmed in Florida, however there is concern that this outbreak could spread, so clinical faculty and staff are encouraged to pay close attention to infection prevention/control practices in all of our healthcare facilities and to practice healthy habits to help stop the spread of influenza.
The State Lab has asked us to submit “high priority” specimens only at this time due to space and capacity limitations.
Please submit nasopharyngeal culture swabs to the State Lab for any patient that meets the case definition for an Influenza-Like Illness (ILI), AND if they:
1) Have had Swine exposure and/or travel to affected areas in San Diego County or Imperial County, California, Quadalupe County, Texas or Mexico.
2) Have been in contact with ill persons or persons from the above areas in the 7 days prior to their illness onset.
3) Are part of influenza or ILI outbreaks or clusters either outpatient or inpatient
Definition of ILI: Fever >37.8°C (100°F) oral or equivalent AND a cough and/or sore throat (in the absence of a known cause other than influenza).
- Specimen should be collected within 3 days of onset of illness and no later than 5 days after onset of symptoms
- Once collected, specimens must be refrigerated at all times, including during transport and shipped no later than 48 hours post collection.
Quest lab will supply the Nasopharyngeal VCM kits that are required for collecting specimens. Specimens must be refrigerated at all time including during transport.
Contact Medical Health Administration (974-3163 or 974-4403) for assistance with timely transport to the State Bureau of Laboratories. We can also be reached by pager at (216-0153).
Spread of this Swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through the coughing or sneezing of people infected with influenza. It can also be spread by touching something with flu viruses on it and then touching your mouth or nose.
The most common Signs/Symptoms for the Swine Influenza A are similar to the Signs/Symptoms for Seasonal Influenza and include:
- Fever > 100°F oral or equivalent AND a cough and/or sore throat (in the absence of a known cause other than influenza)
- Runny or stuffy nose
- Sore muscles/body aches
- Lack of Appetite
- Some people with swine flu also reported nausea, vomiting and diarrhea
The Swine Influenza A Virus is sensitive to the antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) but resistant to amantadine and rimantadine.
Due to the concern that human-to-human transmission is occurring, the CDC recommends implementation of the following measures in the healthcare setting:
- Frequent hand hygiene (washing hands and use of alcohol hand gel) for all staff and patients
- Respiratory hygiene and cough etiquette. Appropriately cover the mouth and nose with a tissue or fabric (sleeve) when coughing and/or sneezing, followed by hand hygiene.
- Visual reminders to wash hands and cover your cough. “Cover your Cough” posters from the CDC in English and Spanish will be placed at all entrances to the USF Medical Clinics and at the patient check-in desks along with disposable tissues and hand gel.
- Staff members should offer a surgical mask to all patients who present for an appointment with the following symptoms:
- Fever over 100°F AND a cough and/or sore throat
The disposable surgical masks will be kept at the information desks and at each patient check-in desk
Attempt to have patients reporting Influenza-like Illness (ILI) taken directly back to the exam room. If this is not possible, encourage these patients to sit separately from others in the waiting room with > 5 feet separation if possible.
- Staff members who are directly caring for patients with fever and cough should also wear a disposable surgical mask
- Staff members who collect nasopharyngeal specimens or give nebulizer treatments to suspected influenza cases should wear a mask, disposable, non-sterile gloves, gowns, and eye protection (goggles) to prevent conjunctival exposure
- “High touch” surfaces should be disinfected frequently by wiping down with disposable germicidal wipes (Sani-Cloth; Cavicide). High touch surfaces include:
Exam table tops; door knobs; light switches; sink faucet handles; computer keyboards; telephone receivers; nursing work stations etc. Exam room surfaces should be wiped down after each patient with Influenza-like Illnesses (ILI)
- Staff sick with ILI should not come to work. They should report their symptoms to their supervisor and primary healthcare provider.
Please feel free to contact us directly for any questions, concerns, etc.
Linda R. Lennerth, RN, MSN
Associate Director, Medical Health Administration
Infection Prevention & Control
Employee/Student Health & Wellness
USF HEALTH - MDC 19
College of Medicine / Department of Internal Medicine
Division of Infectious Disease & International Medicine
Office: (813) 974-3163
Fax: (813) 974-3415