Swine Influenza
Is a highly contagious respiratory disease of pigs caused by one of several type A influenza viruses. Swine viruses are most commonly the H1N1 subtype. Pigs can also be infected with avian influenza viruses and human seasonal viruses as well as swine influenza viruses.
Symptoms
Range from typical 'flu'-like symptoms i.e.
- fever or history of fever
- cough
- sore throat
- muscle aches
- rhinorrhoea
- vomiting/diarrhoea
OR
- Other severe/life threatening illnesses such as pneumonia and acute respiratory distress.
AND
- Recent travel to an area where there are confirmed cases
- Contact with a person who has a confirmed case of swine influenza
- Contact with an animal with confirmed or suspected swine influenza
Symptomatic patients presenting to the CUH ED
- A high filtration face-mask N95 or FFP2/3(3M mask) is placed onto the patient
- This face-mask must be fitted correctly to ensure that the nose and mouth are covered
- Staff to wear high filtration single use face mask, disposable single –use goggles and disposable single use gown.
- Patients should be placed into a designated area
- Patients in acute respiratory distress transfer to ED Resusc room
- Patients who present via ambulance – keep in ambulance for direct transfer to soft tissue clinic area or transfer to eye room
- Patients presenting via ED reception – transfer to soft tissue clinic.
- Patient assessed by Medical Registrar on call
- Wearing PPE obtain a nasopharyngeal swab. Contact Microbiology to advise them ext 22503/4/0/20120 (or OOH - consultant)
- If admission warranted, admit to a negative pressure room in 5B
Common cold v influenza
Symptoms |
SWINE FLU |
COLD |
Onset |
Suddenly |
Slowly |
Fever |
High (39°) |
Rare |
Headache |
Prominent |
Rare |
General aches and pain |
Usual, often severe |
Mild |
Fatigue, weakness |
Can be prolonged (weeks) |
Quite mild |
Extreme exhaustion |
Early and prominent |
Never |
Stuffy nose |
Sometimes |
Common |
Sneezing |
Sometimes |
Usual |
Sore throat |
Sometimes |
Common |
Chest discomfort, cough |
Common, can be severe |
Mild to moderate, hacking cough |
Diarrhoea, vomiting |
Common |
Not associated |
The symptoms of influenza come on rapidly and are typically accompanied by muscle aches and a fever. The common cold has a more insidious onset and is associated with a runny nose, sneezing, and blocked nasal passages.
Swine flu is that diarrhoea and vomiting have been quite prominent symptoms among cases.
Infectious period
1 day before to 7 days after onset of illness
Precautions
Contact and droplet precautions
Frequent hand hygiene
Information from CUH Infection control bulletin 25, April 2009 and HPSC Jan 2011
Order for Putting On & Removing Protective Equipment (PPE)
When PPE is necessary for the specific situation, HHS/CDC recommends that personal protective equipment be put on in the following order:
- Gown.
- Respirator (or mask, when appropriate).
- Face shield or goggles.
- Gloves.
- Upon leaving the room, HHS/CDC recommends that PPE be removed in a way to avoid self-contamination, as follows:
- Gloves.
- Face shield or goggles.
- Gown.
- Respirator or mask.
Dispose of any PPE and all other waste as clinical waste- immediately into a yellow bag – secure and remove promptly form the area. Remember to always use hand hygiene after removing PPE.
Donning & Fit Checking for Kimberley–Clark *PFR95* N95 Respirators & Masks
The following are relevant extracts from the Kimberley Clark Instruction Booklet
Proper donning of a PFR95* N95 Particulate Filter Respirator and Surgical Mask may feel a little awkward at first, but it will become easier with repeated applications.
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- Separate the edges of the respirator to fully open it.
- Slightly bend the nose wire to form a gentle curve.
- Hold the respirator upside down to expose the two headbands.
- Using your index fingers and thumbs, separate the two headbands.
- While holding the headbands with your index fingers and thumbs, cup the respirator under your chin.
- Pull the headbands up over your head.
- Release the lower headband from your thumbs and position it at the base of your neck.
- Position the remaining headband on the crown of your head.
- Conform the nose-piece across the bridge of your nose by firmly pressing down with your fingers.
- Continue to adjust the respirator and secure the edges until you feel you have achieved a good facial fit. Now, perform a Fit Check.
Directions for Fit Checking:
To ensure PFR95* N95 Particulate Filter Respirators and Surgical Masks are providing the intended level of protection, they MUST be ´Fit Checked´ each and every time they are worn.
- To Fit Check a respirator, the wearer should forcefully inhale and exhale several times.
- The respirator should collapse slightly upon inhaling and expand upon exhaling.
- The wearer should not feel any air leaking between his/her face and the respirator.
- This is the sign of a good facial fit and a successful Fit Check.
- If the respirator does not collapse and expand OR if air is leaking out between the wearer´s face and the respirator, then this is NOT a good facial fit.
- The wearer should adjust the respirator until the leakage is corrected and he/she is able to successfully Fit Check the respirator.
Tips for Achieving a Good Fit:
- Use a mirror while adjusting the respirator.
- Ask someone to look for hair or earrings that might be caught in the seal.
- Make sure the headbands are positioned properly. It is especially important that the top headband is on the crown of your head, as it is designed to hold the bottom of the respirator snug against your chin.
Note:
It is important to stress to the wearer that
- The respirator must be Fit Checked each and every time it is donned, and
- He/she should not proceed with activities until a successful Fit Check has been completed.
Note:
Fit Checking is not a substitute for Fit Testing but Fit Testing is not to date carried out in the hospital or in very few hospitals in the country (still controversial)
H1N1 specimen screening MUH
House Screening Test
- Routine transport swab (Blue cap).
- Swab both left and right nasal passages using the one swab (blue cap).
- Nasal aspirates may also be tested.
PCR
Testing by PCR-this test will only be performed in the Reference laboratory in Dublin and s not available in Cork.
- Use two Remel Transport containers (Red capped).
- One for nasal and one for throat.
- For each site (Nasal and throat) use both stainless steel and plastic applicator swabs provided.
- Place swabs in tube containing transport media and break off tops, close and sent to Lab.
Transport all specimens to the lab immediately
Links
- Interim emergency Out of Hours Public Health Medical Advisory Service 087 6486414
- 'Flu page on Health Protection Surveillance Centre (HPSC)