With more than 100 deaths from swine flu in Mexico, and suspected cases in New Zealand, Israel, France, and Canada, the World Health Organization (WHO) has declared an international public health emergency and called for increased surveillance worldwide.

The Infection Prevention and Control Department (IPC) has been following the swine influenza situation very closely. It has been in contact with local and state health officials and is reviewing CDC/TDSHS/DCHHS updates as they become available. Methodist Health System has had a travel inquiry as part of the admission screening process for some years and this includes travel to Mexico. Since last week our emergency departments, hospitalists, and other medical staff members have been instructed to screen any patients presenting with influenza-like illness (ILI) or acute respiratory illness (ARI) for influenza and place in appropriate isolation precautions. Education in the Emergency Departments has placed staff on heightened awareness and the medical staff has been alerted. IPC is also monitoring inventories of lab supplies and medications.

Physicians on the Methodist Health System medical staff, nursing staff, and all clinical areas should enhance surveillance for swine flu in patients presenting with flu-like illness. Unless there is evidence to the contrary, swine flu should be highly suspected in persons with influenza-like illness. Symptoms of swine flu are similar to those of regular or seasonal flu and include fever, cough, fatigue, and muscle aches. Some with swine flu also have reported runny nose, sore throat, headache, nausea, vomiting, and diarrhea. Employees are urged to practice standard precautions for all patient contacts and perform frequent hand hygiene and proper respiratory etiquette.

Evaluation criteria for swine flu in persons with Influenza-Like Illness/Acute Respiratory Illness:

1. All patients with influenza-like illness (ILI: fever >100° F and cough and/or sore throat)

2. All patients with acute respiratory illness (ARI: recent onset of at least two of the following: rhinorrhea or nasal congestion, sore throat, cough (with or without fever or chills) and

• a history of recent travel to Mexico (within 7 days) or

• contact with a person who has been diagnosed with Influenza A. Patients with ILI/ARI who meet the above criteria for a probable/highly suspected case of swine flu:

• Immediately provide a surgical mask to the patient and place in a single room, keeping the door closed except when needed to enter or leave the room. Encourage patient and family members to use alcohol hand sanitizer frequently.

• Place patient in Droplet and Contact precautions for 7 days after illness onset or until symptoms have resolved (whichever is longer).

o Personnel entering the patient room should wear N95 respirators and goggles.

o Perform suctioning, bronchoscopy, or intubation in an airborne isolation room.

o Patients with ILI/ARI with a positive influenza A screen or with confirmed swine flu should be placed in an airborne isolation room. Inform Infection Prevention Department of patients hospitalized with ILI/ARI.

• Obtain a nasopharyngeal aspirate for rapid flu testing.

• Antiviral treatment for suspected or confirmed case of swine flu H1N1 infection should include inhaled zanamivir (or oral oseltamivir). Employees with ILI/ARI symptoms who meet the above criteria or who have had contact with friends/family members with ILI/ARI symptoms per above criteria:

• Stay home to avoid close contact with others at work. Call in per departmental policy and include information about your symptoms. Infection Prevention and Control will need to be notified daily of call-in per IPC policy.

• Contact your physician to determine need for antiviral chemoprophylaxis (pre-exposure or post-exposure) as recommended by CDC for close contacts of a confirmed or suspected case of swine flu. Exposed employees should be monitored daily for fever (temp ≥100.4 ºF) and/or any respiratory symptoms up to 7 days following the last known exposure to a confirmed case of swine flu.

• Call Employee Health/Nursing Supervisors to obtain clearance prior to return to work.

• Health care workers caring for patients with confirmed or highly suspected swine flu will be provided chemoprophylaxis by Employee Health in consultation with the Hospital Epidemiologist.

For more info please visit: http://www.cdc.gov/h1n1flu/