Saturday, May 9, 2009

Health And Safety - H1N1 Flu Watch - May 6/09


H1N1 INFLUENZA UPDATE
As of May 6, there are 49 lab-confirmed cases of H1N1 influenza in Ontario. Travel to Mexico or contact with a person who has H1N1 and who traveled to Mexico remains the most frequent source of the illness. Because laboratory testing capacity has been increased, cases of H1N1 are now being confirmed faster. New guidance has been released for the management of influenza-like-illness (ILI) in Long Term Care facilities. Unfortunately, the health and safety/infection prevention and control guidance for workers is not as protective as OPSEU believes it should be. OPSEU takes the position that the precautionary principle, which states that action to reduce risk need not await scientific certainty, should be applied as we establish protective measures against this new virus. The three main weaknesses in the document are as follows:
1. There is no recommendation that persons entering a LTC facility be screened by a person (active screening) for ILI before entering the home. The guidance note advises that signs be posted reminding people not to enter if they have ILI symptoms. This is known as passive screening or self-screening. Self-screening may not be effective if people are determined to enter despite having ILI symptoms or if they do not understand the questions on the sign. Advice: OPSEU takes the position that active screening of people entering the facility is more protective of worker health and safety.
2. Healthcare workers are advised to wear an N95 respirator when directly caring for a resident with ILI symptoms who has had contact with a person with a confirmed case of H1N1 flu. OPSEU does not believe that this advice is protective enough. If a visitor with ILI enters the facility, they may not know if they have H1N1. If the visitor later is diagnosed with a confirmed case of H1N1, this information may not be communicated to the LTC facility and workers may not be protected adequately. Advice: OPSEU believes it would be prudent for healthcare workers to wear an N95 respirator when in direct contact with residents with ILI who have been in contact with a person with confirmed or possible H1N1 influenza.
3. Healthcare workers are advised to wear a surgical mask to care for residents with ILI and a fit-tested N95 respirator during aerosol-generating procedures such as tracheal or oral suctioning. This is confusing advice and does not reflect the application of the precautionary principle. It is reasonable to advise the use of an N95 respirator during aerosol-generating procedures. However, requiring workers to wear a surgical mask when caring for residents with ILI in some circumstances and to wear an N95 respirator when caring for residents with ILI who have had contact with a confirmed case of H1N1 will confuse workers and may not be protective enough. Advice: OPSEU believes it would be prudent for healthcare workers to wear an N95 respirator when in direct contact with residents with ILI who have been in contact with a person with confirmed or possible H1N1 influenza.
4. OPSEU continues to advise its members on Joint Health and Safety Committees, and Health and Safety Representatives, to meet to review and update their pandemic influenza plans. In particular, JHSCs in LTC facilities should meet to review this new guidance and to determine what precautions to implement.
Please continue to watch the OPSEU website and the links below for updates on H1N1 Influenza (Human Swine Flu).
New Guidance for Influenza-like Illness (ILI) Management in Long-Term Care
Guidance for Clinical Care of Patients: Ambulatory Settings – provides important infection prevention and health and safety information
Ministry of Health and Long Term Care H1N1 Flu Virus (Human Swine Flu) site has regular updates and links to other useful sites
Ontario’s Agency for Health Protection and Promotion provides regularly updated information on H1N1 Flu (Human Swine Flu)
OPSEU’s “A Healthcare Workers Guide to Pandemic Influenza”