Margaret Jennings (B.App.Sc.), 33 Stanley Avenue, Eltham, Victoria 3095
Tel/Fax: (03) 9439 2436 Mobile: 0404 088 754 Email: firstname.lastname@example.org
INFECTION CONTROL NEWSLETTER 5 - June 7th 2009 Your knowledge checklist for novel H1N1 (swine flu) - how are you travelling? This information checks your understanding & piggy backs onto DHS advice (www. health.vic.gov.au) 1. Do you know why it is important to slow the spread of this current novel strain?
Answer - we need to reduce the gap between this epidemic and arrival of the vaccine which is at least 2 months away. Slowing it down by improved hygiene and infection control will assist to buy us time. Should it develop resistance to tamiflu (which flu classically does) in this time then there is only symptomatic treatment. At this point it is mild but a second wave classically occurs which is usually more serious.
2. Do you know why it is not desirable to take tamiflu unless sick or have had close contact?
Answer - resistance to tamiflu is likely, nausea occurs in approximately 30% and it is a finite resource best kept for those who need it. There has been no resistance to relenza reported. Tamiflu can be given as a liquid while relenza acts directly on infected or susceptible cells and is inhaled.
3. Do you know when to use a surgical mask and when to use a P2 mask and other PPE?
Answer - only use P2 mask when a suspect patient does not wear a mask, when you are taking swab s (all staff in a room where aerosol generating procedures are performed wear a P2 mask) or where any staff are within a metre of suspects not wearing masks. Otherwise use surgical mask and for normal seasonal flu. Don't forget that masks are only a part of PPE - you need gloves, safety glasses and gown & frequent hand hygiene
4. Do you and reception staff have a list of questions re symptoms to ask patients or carers calling so you can direct the next stage to reduce burden on GPs?
Suggest - include symptoms, state of health, who is caring for patient and access to food, medicine etc. Have criteria for when you decide to either direct them to hospital, see them in their car at practice / inside or home.
5. Do you know what you need to set up basic infection control in your practice?
Suggest - place alcohol hand gel pump pack, box of tissues and either labelled box of masks or sign for pts to ask for mask on bench out of child reach and just to side of reception counter. Obviously offer suspect / symptomatic pt a mask as soon as you realise the situation. Attach to the wall nearby a labelled bin lined with bag for tissues and used masks (theoretically clinical waste). Use signs for coughing etiquette. Do not consider transmission via air condtioning. After treating a suspect, there is no time limit for room to remain empty but it does take some time for viral laden particles to settle if pt has been spluttering etc. Be realistic about isolation.
6. Do you know why it is important not to have two dominant circulating strains of Flu in the community?What about staff and others having the current seasonal flu vaccine?
Answer - any genetic reassortment of such strains may result in a more virulent and resistant virus - we do not need this. It is ideal to have as many immunised in the community as possible including staff and healthy young people this year unless contraindicated. It may not protect for swine flu but is does prime the immune response. Avian flu is still circulating so the possibility of a more virulent reassortment with this is possible.
7. Do you know why people over 55 may not get it or get it severely?
Answer - Asian pandemic flu circulated in 1957 and was graded as a moderate flu. Many have antibodies to it and while it was a different strain, there are some shared antigens.
DHS is the control agency and there is only one response - Victoria now in modified sustain phase
Margaret Jennings (www.marjenes.com.au) Microbiologist and Infection Control Educator/Consultant to Office Based Practice
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