www.HH.NET.nz 2009 Pandemic Planning Novel A (H1N1)

Reference: Ministry of Health Website / Pandemic Planning H1 N1 1 | F i v e

Service: ________________________________ Contact Person: ___________________________

Contact Number: ______________________ Email address: _____________________________

Preventing Entry & Cross infection: [Spread by coughing / sneezing & to a lesser degree

touching where droplets may have landed]

� Susceptible residents & staff have had flu vaccine [per MOH advice]. Tamiflu for ALL probable cases!

� Hand gel at point of entry & ask ALL visitors about symptoms. Less handshaking & hugging is wise.

� Posters displayed. May be downloaded from www.moh.govt.nz

� Good ventilation & safe social distance where possible.

� Quarantine residents & exclude staff exposed to the infection outside of the Rest Home

� Hard line on ANY sick staff at work – send them home [this includes RN’s, other visiting health

professionals and managers]

� ROBUST INFECTION CONTROL: Person responsible for checking hand wash equipment well stocked

EVERYWHERE every shift. Person responsible for environmental cleaning on each shift: wiping areas

of frequent hand contact & visibly dirty / soiled areas [virus stays alive for 1 – 2 days].

� Training of staff & residents in cough & sneeze etiquette & use of tissues / safe disposal / use of PPE.

☼ Recognising Symptoms: � All staff aware of the symptoms of H1N1 [these are VERY similar to seasonal flu]

- Fever [a temperature greater than 38 degrees Celcius]

- Cough

Seek help: Worsening symptoms Temperature above 38 degrees C Difficulty breathing Coughing up green or bloody sputum Cyanosis [blue skin around lips / finger

tips] Severe ear pain Fits or uncontrollable shaking

- Sore throat

- Runny or stuffy nose

- Body aches

- Headache

- Chills

- Fatigue

- Diarrhea & vomiting in some people

Worst symptoms last about five days.

Coughing can last up to three weeks.

Most people will recover well.

Incubation period = 1 – 3 days

Infectious timeframe = 1 day before symptoms for up to five days [children may be infectious longer i.e. 7 –

21 days dependant upon age].

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www.HH.NET.nz 2009 Pandemic Planning Novel A (H1N1)

Reference: Ministry of Health Website / Pandemic Planning H1 N1 2 | F i v e

☼ Diagnosis: (i) history of fever, chills and sweating or clinically documented fever ≥38°C, plus (ii) cough or sore throat].

Low threshold for testing for our susceptible residents = those with clinical symptoms.

This Pandemic Planning has been endorsed by the Rest Home / Residential Services GP & appropriate management of sick residents has been agreed.

We understand that in the case of cluster infections, only a small sample may need testing.

- Realise elderly, and those with low immunity, may not show distinct flu like symptoms.

Our GP has advised who can take swabs, as they need to be double bagged & sent rapidly.

This is: ___________________________________ Diagnosis is by nose or throat swabs: Best in 1st 3 days but may be taken up to five days. Susceptible People in our care = ALL � Elderly [all Rest Home residents are considered more susceptible]

� Immune-compromised

� Asthmatics, Emphysema or Chronic Obstructive Airways Disease

� Other co-morbiities common to the elderly in residential care

Pandemic Information

Pandemic = spread Globally

= crosses all boarders.

Avion Flu = high fatality [stamp it out]

H1N1 “Swine” = Reduce transmission

= Contain outbreaks

= Most recover

☼ Seeking Help & Notification � Helpline posted:

H1 N1 Help Line: 0800 611 116

Press 1: for advice

Press 2: to report

� Attending GP will report confirmed cases on our behalf: Outbreak is over = no new

cases 8 days from onset of symptoms of last affected resident. Staff home recovery.

Categories of Diagnosis:

1. Confirmed Case: by laboratory testing of throat or nasal swabs.

2. Probable Case: flu like illness & link to confirmed case.

3. Close contact: to either of the groups above.

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www.HH.NET.nz 2009 Pandemic Planning Novel A (H1N1)

Reference: Ministry of Health Website / Pandemic Planning H1 N1 3 | F i v e

Managing Sick Staff Managing Sick Residents

[ILI] Symptoms History of fever, chills and sweating or clinically documented fever ≥ 38°C, plus (ii) cough or sore throat]. Action:

Staff should call in sick if they are unwell and NOT COME TO WORK

If staff become sick at work they should be sent home IMMEDIATELY

Sick Rest Home staff may receive free

antiviral drugs from the national stockpile. This can be accessed through their own GP.

Staff must stay off work for at least 72

hours after they have started antivirals.

If they are not taking antivirals, they need to stay at home until symptoms have largely gone (normally around 4-7 days).

A mask should be considered on

return to work if the staff member has a persistent cough or coryzal symptoms.

[ILI] Symptoms History of fever, chills and sweating or clinically documented fever ≥ 38°C, plus (ii) cough or sore throat]. Action:

Urgent medical assessment, with a view to antiviral treatment.

The ill person should be isolated from residents and visitors for at least 72 hours when on antiviral treatment or, if not treated, until well.

Ensure that staff use masks and

hand gel when caring for the ill person.

If the person is unable to take

antiviral drugs, they will need to stay in isolation until the symptoms have largely disappeared (usually 3-7 days).

☼ Guide to Managing Sick People

� Infection Report Form for each person = accurate Log of Infections

� Prevention of dehydration [managing nausea, vomiting & diarrhea]

� Management of fever [linked to dehydration]

� Use of Tamiflu within 48 hours of onset [may lesson symptoms & disease duration]

- Have an arrangement with supplying pharmacy for all residents should they get sick.

- Have an arrangement with supplying pharmacy for all symptomatic care workers nursing the

sick.

� Managing secondary infections [use of antibiotics as agreed with doctors]

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www HH.NET.nz 2009 Pandemic Planning Novel A (H1N1)

Reference: Ministry of Health Website / Pandemic Planning H1 N1 4 | F i v e

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☼ Guide to Adequate Staffing � We know which staff will be prepared to work extra hours to help nurse sick people if needed

� We have identified pregnant staff members who will be excluded from nursing sick people

� We have a list of staff who have had the H1H1 flu and now recovered

� We have additional staff that we can call upon if needed

� We will need to access casual staff and have an agreement with an agency

� Volunteers & family members have been identified who would be capable of helping should we

have a large number of residents sick at the same time & depleted staff numbers

☼ Guide to Staff Training � All staff are given training so that they understand H1 N1 as per guidelines on MOH Website

� Know to wear masks and use hand gel when caring for people with flu like illness.

� Staff likely to nurse those who are sick have had a refresher recently on standard precautions /

airborne precautions / social distancing versus caring for the ill / appropriate PPE to wear / safe use

of gowns / how to put on & dispose of surgical masks. Resource: www.moh.govt.nz

� We have someone sufficiently skilled managing our Infection Control Program

� Or, we can access someone who will advise us.

� Staff realize that they are likely to contract the H1 N1 and recover as for any seasonal flu unless they

are in one of the susceptible groups.

� Staff realize that ALL of our residents are susceptible and the best way to care for them is by

preventing them from coming in contact with the H1 N1

� Staff are aware of the signs of severe illness & dehydration and can call for help 24 / 7

� Staff have become familiar with the Short Term Care Planning likely to be needed to successfully

care for sick people in our Home.

☼ Guide to Hydration supplies

□ Fluid for sick people Enalyte[or similar hydrating fluid on standby if cannot hold food down]

enough for several sick people over a long weekend on supply at all times

□ Food for sick people Rice cook & strain the juice. Cook fresh green vegetables & strain the juice. Combine vegetable juice water and starch from cooked rice water to nourish sick people.

□ Fluid Balance Charts available

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www HH.NET.nz 2009 Pandemic Planning Novel A (H1N1)

Reference: Ministry of Health Website / Pandemic Planning H1 N1 5 | F i v e

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☼ Guide to Resident Care Equipment: Note: It’s a good idea to purchase bulk of one colour linen [e.g. bright yellow] to be used only by sick people:

- flagged infectious by colour. - boosts regular supplies - ensures enough linen left for well residents

□ Outbreak towels when towels start to go tatty retire to the outbreak box flannels [more the better / can use disposable] handtowels [very useful double as flannel or towel]

□ Zinc and Castor Oil – Essential to control risk of excoriated skin [sore bottoms]

- Chemist should make up 12 small pots very cheaply [one each affected person]

□ Soothing Baby Wipes (one for each toilet and one in each sick person’s room)

□ Protect sofas and cushions before they are soiled

□ Lots of big plastic bags for linen – especially if you decide to send it off site to launder [Launder in the usual manner / hot tumble dry desirable].

□ Linen Skips: plastic lids / pedal operated and leak proof.

☼ Guide to Isolation Supplies:

□ Laminated Work Instructions for staff: Airborne Precautions. □ Laminated Signage for each door – entrances and sick residents bed rooms

□ Long-sleeved gowns (mark inside and outside with marker pen) Much cheaper in bulk ordered in advance. Can be very expensive if needing same day delivery.

□ Plastic stick-on hooks for back of doors [coat hangers work in an emergency] if using non disposable

□ Hand gel – 2 litre bulk supply: smaller pumps for every sick person’s room

□ Gloves (at least one months supply at hand at all times)

□ Surgical [water repellent] and N 95 masks / Ebos full face visors

☼ Guide to Cleaning Supplies: [H1 N1 virus may live on surfaces for up to 7 days] Frequency increased during outbreak – colour coding for Isolation areas.

□ Heavy duty gloves right size for cleaners / dedicated cleaners / increased cleaner hours in outbreak

□ Plenty of gloves for care staff / spare mop heads / cleaning cloths that may be discarded after use

□ Good supply disposable clothes / old linen [retire tatty linen to the outbreak kit]

□ Good supplies household cleaners – especially bleach [like janola] effective against the virus

□ Tuffy wipes such as from from EBOS or Janola ISO supplies.

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2009 Pandemic Planning Novel A (H1N1) Personal Protective Equipment Guideline

Reference: Ministry of Health Website / Pandemic Planning H1 N1 1 | O n e

Good

Handwashing

Social

Distance

[One metre]

Cough /

Sneeze

Etiquette

Good

Ventilation

Masks Gloves Gowns

Apron

Eye

Protection

Risk Level

LOW

Risk Level

MEDIUM

SURGICAL MASK

Risk Level

MED - HIGH

SURGICAL MASK

Risk Level

HIGHER

N 95 or P2 MASK

FULL EYE PROTECTION MASK

This chart was copied from resources on the NZ MOH Website: www.moh.govt.nz

Bugs Control Resource Policy & Pictures Infection Control\correct use of gowns: www.healthcareproviders.org.nz

Remember: Gown first / mask next fit snug / eye protection if needed / gloves. http://www.moh.govt.nz/moh.nsf/indexmh/pandemicinfluenza-resources-videoandaudio#infectioncontrol for instructional video

Adequate supplies of masks should be purchased well in advance of needing them. They are available through your usual medical suppliers /

at Mitre 10 or other similar distributors [used by carpenters / painters] and at some $2 shops.

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www.HH.NET.nz Swine Flu H1 N1 Pandemic Planning Notice to Visitors

Reference: Ministry of Health Website / Pandemic Planning H1 N1

♥ Caring for our Vulnerable Residents PLEASE VISITORS & STAFF: if you have these symptoms, or have been in contact with anyone that has, then please STAY AWAY from our susceptible residents:

Feeling hot [even a mild fever ]

Sore Throat

Cough

Muscle & joint pain / aching body

Headache

Chills

Feeling more tired than you should

Vomitting or diarrhoea

♥ We will welcome you when you are well again.

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www.HH.NET.nz Swine Flu H1 N1 Pandemic Planning Notice to Visitors

Reference: Ministry of Health Website / Pandemic Planning H1 N1

BEWARE! We have flu like illness here! WE WANT TO PREVENT SPREAD: if you want to avoid / or if you have had the following flu like signs recently:

Feeling hot [even a mild fever ]

Sore Throat

Cough

Muscle & joint pain / aching body

Headache

Chills

Feeling more tired than you should

Vomitting or diarrhoea

PLEASE DO NOT ENTER / BEST TO STAY AWAY! People who feel they need to visit:

Please go to your chosen visitor without social call to others Wash your hands well using soap & water first And, again after the visit Ring us on this number if unsure: _____________________

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1 | F o u r

N1 H1 Short Term Care Plan

Name: _________________________________ [preferred name]____________________

Date: ________________ NHI Number: _________________ High Falls Risk

Update existing Falls Prevention: - Sensor mat may be needed - May need one on one care - RN to review & tell all staff

Y or N

Problem H1 N1 Flu Like Illness

Aim Solution Review & Date: Is it working?

Dehydration:

From high temperature Feeling ill & not taking fluids Possible diarrhea

Will be well hydrated Signs of dehydration: - concentrated urine - little urine output - sunken eyes - dry mouth & lips - thick secretions - cracked lips - thirsty

Frequent fluids [every hour] Offer a little at a time [1 – 2 hourly] What resident prefers

Cool juice Tea Jelly Ice block Soup

Help to drink [juice bottles / straws]

Monitor with Fluid Balance Chart: - ALL fluids in & out recorded

On ALL shifts [tally each 24 hours] Report where output is MORE than input & report poor output < 30 ml / hr

Fever Above 38 degrees Hot to touch Flushed

Normal = 37 degrees Feeling Unwell = 38 degrees Report at once = above 38 degrees Needs Cooling down = 39 degree

Temperature under 38 degrees Celsius Fever will be monitored and reduced as much as possible

REPORT to RN if over 38 degrees

Paracetamol: Panadol tablets or elixir as charted Record all panadol given

Tepid Sponge:

Cool sponge / flannel to reduce fever & help comfort Fan to cool Minimal bed cloths Do not over cool & make shiver

Record: Take temperature 4hrly / 2 hrly / ……. Strict Fluid Balance Chart

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2 | F o u r

N1 H1 Short Term Care Plan

Name: _________________________________ [preferred name]____________________

Date: ________________ NHI Number: _________________ High Falls Risk

Update existing Falls Prevention: - Sensor mat may be needed - May need one on one care - RN to review & tell all staff

Problem H1 N1 Flu Like Illness

Aim Solution Review & Date: Is it working?

Diarrhea: Loose bowel motions Stomach pains

Please keep as accurate fluid balance chart as possible Runny liquid diarrhea should be reported as Bristol Stool Chart [7]

Monitor & Rehydrate Minimise:

Dehydration Skin excoriation Distress & Mess

Medications: As charted Record all medications given

Comfort:

Assist to toilet as needed May need to use incontinence product “nappies” Sponge clean with very light pressure on skin

Protect Skin: Use zinc & castor oil [large pot per resident] Apply each change Report redness of skin / any excoriation

Head ache & Aching Body: Where family want to support and care for sick residents this must be agreed with the RN or Manager due to Infection Control. Sick people feel much more support when reassured, especially by loved ones / people they trust in a pleasant environment

Minimise:

Malaise Pain Distress

Medications: Panadol as charted ………………….. ……………………………………………. Record all medications given

Comfort:

Minimise fever Report pain control effectiveness Plenty of fluids available Frequent bathing as needed Pleasant environment As much support as possible

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3 | F o u r

N1 H1 Short Term Care Plan

Name: _________________________________ [preferred name]____________________

Date: ________________ NHI Number: _________________ High Falls Risk

Update existing Falls Prevention: - Sensor mat may be needed - May need one on one care - RN to review & tell all staff

Problem H1 N1 Flu Like Illness

Aim Solution Review & Date: Is it working?

Difficulty Breathing: Where family want to support and care for sick residents this must be agreed with the RN or Manager due to Infection Control. Signs of distress:

Blue around lips Blue finger tips Cannot speak Wheeze Straining muscles in neck to

breathe

1. Support

2. Report to RN at once if in respiratory distress:

Supportive Nursing Care:

Comfortable position Semi recumbent in bed Arms supported All effort kept to minimum Cool fan & open window for air

movement Keep cares to a minimum as these

increase oxygen demand Promote rest Medications as prescribed

Appropriate Medication:

May reduce severity May shorten duration illness May reduce infectious period

Store in fridge or at room temp

Tamiflu within 24 hours of symptoms:

..................... Time & date started

……………………….. Stop date [5 days].

Tamiflu dosage for 40 kg and over:

5 ml orally twice daily [12 mg/ml ] liquid

1 x 75mg capsule morning and evening

Note: Prophylaxis = 10 day course

Airborne Precautions: Put on:

1. Gown First 2. Mask next snug fit 3. Gloves last

Remove in reverse order

Contain & prevent spread:

Resident to staff Resident to

resident Staff to resident

Isolated in own room Own dedicated bathroom Same area as other sick people Use dedicated staff for sick people Use those who may have had Tamiflu

& recovered Use family members but keep away

from ANY other resident Good environmental cleaning

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4 | F o u r

N1 H1 Short Term Care Plan

Name: _________________________________ [preferred name]____________________

Date: ________________ NHI Number: _________________ High Falls Risk

Update existing Falls Prevention: - Sensor mat may be needed - May need one on one care - RN to review & tell all staff

Problem H1 N1 Flu Like Illness

Aim Solution Review & Date: Is it working?

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