Standard and Droplet Precautions are considered adequate to control the transmission of influenza in most health care situations. Vaccination of health care staff, carers and vulnerable patients against seasonal and, eventually, pandemic influenza strains is an essential protective strategy.
performance of hand hygiene before and after every patient contact or contact with the patient environment, in accord with the national 5 Moments for Hand Hygiene Standard;
disinfection of the patient environment;
early identification and isolation of patients with suspected or proven influenza;
adoption of a greater minimum distance of patient separation (2 metres) than previously recommended;
use of a surgical mask and eye protection for personal protection on entry to infectious areas or within 2 metres of an infectious patient;
contact tracing for patient and health care staff and restriction of prophylactic antivirals mainly to those at high risk of severe disease;
in high aerosol-risk settings, use of particulate mask, eye protection, impervious long-sleeved gown, and gloves donned in that sequence and removed in reverse sequence, avoiding self-contamination;
exclusion of symptomatic staff from the workplace until criteria for non-infectious status are met;
reserving negative-pressure ventilation rooms (if available) for intensive care patients, especially those receiving non-invasive ventilation;
ensuring that infectious postpartum women wear surgical masks when caring for their newborn infants and practise strict hand hygiene; and implementation of special arrangements for potentially infected newborns who require nursery or intensive care.
- 1. World Health Organization. New influenza A (H1N1) virus: global epidemiological situation, June 2009. http://www.who.int/wer/2009/wer8425/en/index.html (accessed Jul 2009).
- 2. World Health Organization. Assessing the severity of an influenza pandemic. 11 May 2009. http://www.who.int/csr/disease/swineflu/assess/disease_swineflu_assess_20090511/en/index.html (accessed Jul 2009).
- 3. Maines TR, Jayaraman A, Belser JA, et al. Transmission and pathogenesis of swine-origin 2009 A(H1N1) influenza viruses in ferrets and mice. Science 2009; 325: 484-487.
- 4. Munster VJ, de Wit E, van den Brand JM, et al. Pathogenesis and transmission of swine-origin 2009 A(H1N1) influenza virus in ferrets. Science 2009; 325: 481-483.
- 5. Australian Government Department of Health and Ageing. Protect phase. Annex to the Australian Health Management Plan for Pandemic Influenza. Version 2.0, 8 July 2009. http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/resources/$File/AHMPPI-PROTECTannex.pdf (accessed Aug 2009).
- 6. Australian Government Department of Health and Ageing. Interim infection control guidelines for pandemic influenza in healthcare and community settings. Canberra: Commonwealth of Australia, 2006. http://www.health.gov.au/internet/panflu/publishing.nsf/Content/interim-infection-control-guidelines-1 (accessed Aug 2009).
- 7. Wong T, Lee C, Tam W, et al. Cluster of SARS among medical students exposed to single patient, Hong Kong. Emerg Infect Dis 2004; 10: 269-276.
- 8. Xie X, Li Y, Chwang AT, et al. How far droplets can move in indoor environments — revisiting the Wells evaporation-falling curve. Indoor Air 2007; 17: 211-225.
- 9. Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007; 35 (10 Suppl 2): S65-S164.
- 10. Johnson D, Druce J, Birch C, Grayson M. A quantitative assssment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. Clin Infect Dis 2009; 49: 275-277.
- 11. Gralton J, McLaws M. Protecting healthcare workers from pandemic influenza: N95 or surgical masks? Crit Care Med 2009. In press.
- 12. Australian Government Department of Health and Ageing. Australian health management plan for pandemic influenza. Assumption table 6. Canberra: Commonwealth of Australia, 2008: 92. http://www.flupandemic.gov.au/internet/panflu/publishing.nsf/Content/ahmppi-1 (accessed Aug 2009).
- 13. Brouqui P, Puro V, Fusco FM, et al. Infection control in the management of highly pathogenic infectious diseases: consensus of the European Network of Infectious Disease. Lancet Infect Dis 2009; 9: 301-311.
- 14. Brankston G, Gitterman L, Hirji Z, et al. Transmission of influenza A in human beings. Lancet Infect Dis 2007; 7: 257-265.
- 15. Australian Government Department of Health and Ageing. Infection control guidelines for the prevention of transmission of infectious diseases in the health care setting. Canberra: Commonwealth of Australia, 2004. http://www.health.gov.au/internet/main/publishing.nsf/Content/icg-guidelines-index.htm (accessed Aug 2009).
- 16. Australian Government Department of Health and Ageing. The Australian immunisation handbook. 9th ed. Canberra: DoHA, 2008.
- 17. Grayson L, Russo P, Ryan K, et al, editors. Hand Hygiene Australia. 5 moments for hand hygiene. Canberra: Australian Commission on Safety and Quality in Health Care, 2009. http://www.hha.org.au/home/5-moments-for-hand-hygiene.aspx (accessed Aug 2009).
- 18. World Health Organization. Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance on global surveillance. 10 July 2009. http://www.who.int/csr/disease/swineflu/WHO_case_definition_swine_flu_2009_04_29.pdf (accessed Jul 2009).
- 19. Centers for Disease Control and Prevention. Interim guidance for infection control for care of patients with confirmed or suspected novel influenza A (H1N1) virus infection in a healthcare setting. May 13 2009. http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm (accessed Jul 2009).
- 20. Lee N, Chan PK, Hui DS, et al. Viral loads and duration of viral shedding in adult patients hospitalized with influenza. J Infect Dis 2009; 200: 492-500.
- 21. Australian Government Department of Health and Ageing. Safe Use of Personal Protective Equipment (PPE). http://www.flupandemic.gov.au/internet/panflu/publishing.nsf/Content/safeuse-dvd-1 (accessed Aug 2009).
- 22. Novel influenza A (H1N1) virus infections in three pregnant women — United States, April–May 2009. MMWR Morb Mortal Wkly Rep 2009; 58: 497-500.
- 23. Jamieson D, Honein MA, Rasmussen SA, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009; 374: 451-458.
- 24. Communicable Diseases Network Australia. H1N1 influenza 09 infection: ‘Protect Phase’ guidelines for Australian public health units. Version 4.1, 8 July 2009. http://www.public.health.wa.gov.au/cproot/2322/2/CDNA%20H1N1%20Protect%20Phase%20Guidelines%20for%20APHU%20(SoNG)%20version%204_1%208July09%20FINAL.pdf (accessed Aug 2009).
- 25. Society for Healthcare Epidemiology of America. SHEA position statement: interim guidance on infection control precautions for novel swine-origin influenza A H1N1 in healthcare facilities. 10 June 2009. http://www.shea-online.org/Assets/files/policy/061209_H1N1_Statement.pdf (accessed Jul 2009).
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.