CONTROL MEASURES IN HEALTHCARE SETTINGS

1. Most exposures to influenza occur in hospitals or other healthcare setting from influenza infected patients. Influenza-infected heathcare workers (HCW), patients and visitors can spread infection within and outside healthcare facilities. Transmission risks are primarily from unprotected
exposures to unrecognized cases in inpatient and outpatient settings.

2. It can also occur through large respiratory droplets and close contact with infected patients. Also, exposure during aerosol – generating procedures may increase exposure risks. Strict adherence to appropriate infection control practices, including the use of personal protective equipment (PPE), helps prevent transmission.

3. Please refer to Appendices 1 and 2 for infection control guidelines and the framework for the use of PPE, respectively.The Interim Cleaning Guidelines for Healthcare Facilities are the same as those prescribed for SARS and are at Appendix 3. Hence, measures established for SARS will be used during the
influenza pandemic. These include the following:

a. An effective infection control program at healthcare settings
which requires:
(1) Early identification of persons infected or suspected to be
infected with influenza.
(2) Early isolation of persons infected or suspected to be
infected with influenza.
(3) Early implementation of preventive measures to limit the
transmission of disease.

b. Key elements of an influenza infection control program are
(1) Triage of patients at Emergency Departments (EDs),
specialist clinics and before direct admission into wards to
separate febrile and potentially infectious patients from other
patients.
(2) Use of PPE in higher risk areas including EDs, triage
areas, isolation wards, Intensive Care Units (ICUs).
(3) Isolation of febrile and potentially infectious patients until
the cause of infection has been established or the patient is
afebrile.
(4) Tracking of fever clusters in healthcare institutions.
(5) Developing capability to generate list of contacts in event
of an influenza incident.

c. Other key control measures for influenza are:
(1) Audit of healthcare facilities by Ministry of Health (MOH)
for infection control and isolation procedures.
(2) Zoning of restructured hospitals with specific nursing
homes (NHs) so that the hospitals can refer patients to specific
NHs, and NHs can only refer back to the ‘parent’ hospital should
the resident require hospital care. This minimizes the risk of the
pandemic virus from being transferred across restructured
hospitals by undiagnosed influenza patients with co-morbidities.
(3) Restriction of inter-hospital movement of healthcare
workers.
(4) Monitoring of the health status of healthcare workers.
Healthcare workers who present with fever and symptoms
suggestive of influenza need to be identified and isolated.
Febrile staff (oral temperature more than or equal to 38 degrees
Celcius) should not be allowed to work and referred to staff clinic
for assessment.
(5) Implementation of visitor policy in healthcare facilities to
limit the number of visitors for each patient or to institute novisitor
policy.
(6) Record information of all visitors1, including date and time
of visit, name of visitor, IC number, telephone number and the
location/ward he/she is visiting for contact tracing purpose. The
temperatures of all visitors should be checked. Anyone with a
fever should not be allowed into the facility.

Visitors should also
declare the following:
(a) Do you have a fever of more than or equal to 38oC
or and/ other symptoms such as cough, malaise, chills,
headache, myalgia, etc?
(b) Have you been in contact or near anyone who is
now suspected to have or has influenza?
(c) Have you been to any influenza affected countries
in the last 14 days?

Visitors should be advised to go for assessment if they have
symptoms suggestive of influenza, contact and/ or travel history.

• Guidelines on the Use of PPE (Appendix 1)
  Framework for Use of PPE in Hospital, Primary Healthcare Settings and Residential Step-down Facilities during Influenza Pandemic (Appendix 2)
  Cleaning Guidelines for Healthcare Facilities (Appendix 3)
  
• Framework for Use of PPE in Hospital, Primary Healthcare Settings and Residential Step-down Facilities during Influenza Pandemic (Appendix 2)
• Cleaning Guidelines for Healthcare Facilities (Appendix 3)