Instructions from our Chief, Infectious Diseases

I work at a large city hospital. These are our latest instructions:

To all,

Most of you are aware that as of April 27, 2009, there have been 40 confirmed cases of swine influenza A (H1N1) reported in the US; 7 cases in California, 2 cases in Kansas, 1 case in Ohio, 2 cases in Texas, and 28 cases in New York City. Updates on swine flu are available at the CDC website:

http://www.cdc.gov/swineflu/

Although there have been no cases reported in Arizona, because we are a border state, we need to monitor, especially, our emergency, urgent care, and outpatient settings.

Please be advised that any patients with acute febrile respiratory illness, especially, those who recently visited Mexico, the states and the city listed above need to follow cough etiquette such as covering their noses and mouths with a tissue when they cough or sneeze and washing their hands often with soap and water, or rubbing them with alcohol-based hand cleaners.
Also, please ask them to wear a surgical mask outside of the patient room.
Standard, Droplet and Contact Precautions should be used for all patient care activities and hand hygiene with soap and water, or hand sanitizer should be strictly adhered immediately after removing gloves and other equipment and after any contact with respiratory secretions.
Personnel providing care to or collecting clinical specimens from suspected or confirmed cases should wear disposable non-sterile gloves, gowns, and eye protection (e.g., goggles) to prevent conjunctival exposure.

CDC also made interim recommendations as follows:

- Personnel engaged in aerosol generating activities (e.g., collecting of clinical specimens, endotracheal intubation, nebulizer treatment, bronchoscopy, and resuscitation involving emergency intubation or cardiac pulmonary resuscitation) for suspected or confirmed swine flu cases should wear a fit-tested disposable N95 mask.
- Pending clarification of transmission patterns for this virus, personnel providing direct patient care for suspected or confirmed swine flu cases should wear a fit-tested disposable N95 mask when entering the patient room.

Although it is not known whether the sensitivity of rapid tests for human influenza A (H1N1) will be equivalent for swine influenza A (H1N1), please make every effort to obtain nasopharyngeal specimens from suspected cases for further investigation.

As for the treatment, only if influenza A is confirmed, use dual therapy with both oseltamivir (or zanamivir) and rimantadine (or amantadine) due to delay in confirmation of swine flu by CDC.

Prophylaxis with oseltamivir or zanamivir can be used only if there is an exposure to a confirmed case.

At this point there is no cause for alarm. This notice is just intended to ensure that we are prepared for the worst case scenario. If you have any questions regarding this issue, please contact infection control personnel or me. We will provide further updates. Thank you.

Yasuhiro Nakatani, M.D.
Chief, Infectious Diseases
Chair, Infection Control Committee