Current
Swine Flu News
This information is designed to be used by staff as a source of information for themselves, patients and visitors to respond to the challenge of swine flu outbreak. As the national and local situation develops this information will be amended.
The strain of Influenza A (H1N1), also known as swine flu has now spread to more than 100 countries, in the United Kingdom figures are continuing to rise and currently there are over 8,512 cases. All of the signs are that the virus will continue to spread for some time.
Swine Flu – Movement from containment to treatment phase
We are writing to let you know that Andy Burnham, the Secretary of State for Health, has announced that it is time for the health service to move from containment phase of swine flu into a treatment phase. This is because scientists expect to see rapid rises in the number of cases. It has always been known it would be impossible to contain the virus indefinitely but this has provided the time to learn more about this new virus, to build up antiviral and antibiotic stockpiles, and to start to develop a vaccine.
The treatment phase means that:
- Doctors will be able to diagnose Swine Flu on the basis of symptoms rather than waiting for laboratory testing; so swabbing in the community will stop
- Primary Care Trusts will now begin to establish antiviral collection points where necessary, allowing 'flu friends' to collect antiviral drugs as part of the primary care response to this phase. (List in A&E)
- All contact tracing will now cease, and we will stop giving antiviral
drugs to people who may have been exposed to the virus "contacts" (unless they are deemed to be at particularly high-risk of contracting it)
- All those who have contracted the illness will continue to be offered
antiviral treatment. However, it will remain a matter of clinical discretion as to whether to prescribe treatment or not.
The Department of Health will be purchasing sufficient vaccine doses to vaccinate the entire population with the first deliveries arriving in August, and at least 60 million doses are expected by the end of the year. Decisions are yet to be made about who will be prioritised to receive the first doses of the vaccine, but it is anticipated that frontline staff will be considered alongside other high priority groups in order to protect them, their families and their patients.
So what does this mean for Alder Hey NHS Foundation Trust?
Staff
Staff who think they may have swine flu should follow the normal sickness procedure and advise your Line Manager. If you have flu symptoms, please stay at home.
You will be advised by your GP/ Occupational health when you should return to work. If you do not have flu then follow the normal sickness guidelines for coming back to work.
You are only infectious when you have flu symptoms, so you should come to work as normal even if you have been in contact with someone with Swine Flu. Speak to your Line Manager if you are uncertain about your own circumstances.
Staff who would like further information about the Department of Health guidance can visit www.dh.gov.uk/swineflutreatmentphase
General public
If people think they have Swine Flu, they should first
1. People should check their symptoms either
Online at www.nhs.uk
NHS Direct (0845 46 47)
Swine Flu information line on 0800 1 513 513.
2. If they are still concerned, they should then call their GP, who can provide a diagnosis over the phone.
If swine flu is diagnosed then they will be given a voucher to pick to antiviral treatment, this may be a local pharmacy or a community centre, (not all pharmacies will have stocks of antiviral treatment)
3. They Should NOT attend A&E departments.
In the future, as cases rise further, we will move to a system where cases are diagnosed and dealt with by the National Pandemic Flu Service. This will take the pressure off GPs by allowing people to be diagnosed and given their antiviral vouchers either online or via a central call centre.
The UK has now moved from containment phase to treatment phase, this means that GP's will no longer be testing patients for this strain of flu but will be offering antiviral treatment on clinical assessment.
What treatment will they be given?
The treatment for influenza is to alleviate the symptoms and may shorten the
duration time of illness, they will not stop the illness altogether.
Only those who have symptoms will be given antiviral treatment after
assessment by their GP.
Do we treat any patients who attend A&E?
Any patient who attends A&E with suspected swine flu or who are contacts of
a case of swine flu should be directed to contact their GP or NHS Direct.
We are only to treat patients who require admission.
What do I do if I think I have Swine Flu?
If you have a high temperature and have two or more of these symptoms
Ø Pyrexia >38
Ø Aches and Pain (particularly joints)
Ø Sore Throat
Ø Runny Nose
Ø Headache
Ø Vomiting/diarrhoea
Ø Cough
You may have swine flu.
Staff
If you develop symptoms at home:-
1. DO NOT come into work.
2. Follow the usual sickness reporting procedure
3. Ensure you tell your line manager that you have symptoms of flu.
4. Follow guidance for patients to get your antiviral treatment if needed.
If you develop symptoms at work;-
1. Inform line manager immediately
2. Line manager to send directly home.
3. Call your GP/swine flu number from home
Staff who are contacts of someone with swine flu but have no symptoms should work as normal.
Frequently asked questions regarding swine flu on the wards
INFECTION CONTROL
1) Who needs to be isolated?
Any patient with a clinical diagnosis of swine flu regardless of any swab result
2) Do children who have been in contact with a case of swine flu need to be isolated?
If they have no flu-like symptoms, they can be nursed on an open ward. If symptoms of flu develop, they should have a medical assessment and be moved into isolation. (Refer to flu algorithm for diagnostic criteria)
3) How long do patients with swine flu need to be isolated?
Until at least 7 days from the beginning of their illness.
After day 7, patients who are asymptomatic, can be moved out of isolation. Immuno-compromised children may need to be isolated for longer.
Antiviral treatment
4) Who should be given antiviral treatment?
All patients who meet the clinical criteria for a diagnosis of swine flu.
In a < 3 months-old child, please discuss with microbiologist prior to starting antiviral treatment
5) Who should be given antiviral prophylaxis?
People belonging to a "high risk group" who had a significant contact with a known swine flu case
Prophylaxis of children below 1 year of age should be very carefully considered.
6) What are the high risk groups?
Some people are considered to be at greater risk of becoming more seriously ill from swine flu than others. These high risk groups are:
People with - Chronic lung disease
- Chronic heart disease
- Chronic kidney disease
- Chronic liver disease
- Chronic neurological disease
- Immunosuppression
- Diabetes mellitus
Patients who had drug treatment for their asthma within the past 3 years
Pregnant women
Children under 5 years old
People aged 65 years and older
7. When will vaccination be available?
Vaccine is expected in August.
Plans are in place to offer vaccination to all front line staff and high risk vulnerable patients.
INFECTION CONTROL ADVICE
General Advice
1. Patients should be nursed in isolation cubicle.
2. Staff attending to patient should wear apron and mask according to chart below and ensure good hand hygiene practices.
3. Patients who need to attend another department in the Trust should wear a surgical mask whilst being transported.
4. If there is a risk of splashes to the eyes then eye protection should be worn.
5. Staff who are in one of the high risk category as shown above should not be asked to look after definite positive patients, or those who fit the criteria i.e. 2 or more of the symptoms, Staff who are in one of these high risk categories are asked to ensure that occupational health know their status, if required during the pandemic redeployment may be needed.
Aerosol generating procedures.
When undertaking aerosol generating procedures staff should don apron, gloves eye protection and FFP mask as shown on chart below
What face mask should I wear?
For confirmed or suspected cases admitted to a clinical area – i.e. everyone with flu like symptoms:
Patient isolation in cubicle
Good hand hygiene is essential!
o Note :
§ Other than direct clinical care of the patient, a contact is defined as having been within a metre of the patient for greater than 1 hour
§ If asymptomatic you are not infectious
· No mask
o Staff not giving direct medical care
o Domestics cleaning cubicles (aprons and gloves)
o Visitors (if symptomatic should NOT visit, if asymptomatic they are not infectious and do not require face mask)
· Surgical face mask (+ gloves and yellow apron)
o Staff giving direct medical or nursing care
· FFP3 mask (+gown, gloves and eye protection.
Only need to be worn when performing Aerosol Generating Procedures:
(Intubation, manual ventilation and suctioning
Cardiopulmonary Resuscitation (CPR)
Bronchoscopy
Nebulisation if it is necessary to stay with the child)
PICU/HDU;
Non-invasive positive pressure ventilation, High frequency oscillating ventilation, bi-level positive airway pressure (BIPAP).
NB: - Nasopharyngeal aspiration (NPA) is not classed as aerosol generating procedure and surgical face mask and gloves should give sufficient protection.
Environment
The patient area should be cleaned at least daily and kept free from dust.
Equipment which is not going to be used should be removed from the area.
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