1. Basic infection control recommendations for all health-care facilities Standard and Droplet Precautions should be used when caring for a patient with an acute, febrile, respiratory illness.
2. Respiratory hygiene/cough etiquette Health-care workers, patients and family members should cover their mouth and nose with a
3 Interim WHO guidance for the surveillance of human infection with swine influenza A (H1N1) virus. WHO, 2009. Available at: http://www.who.int/csr/disease/swineflu/WHO_case_definition_swine_flu_2009_04_29.pdf
4 Mothers and newborn infants should be kept together unless absolutely necessary. The benefits of not separating a mother and her newborn baby and of breastfeeding outweigh the potential risks.
5 Laboratory Biosafety Manual - Third Edition. WHO, 2004. Available at: http://www.who.int/csr/resources/publications/biosafety/WHO_CDS_CSR_LYO_2004_11/en/index.html.
disposable tissue when coughing, then discard the tissue in a receptacle and perform hand hygiene afterwards.
6.Triage, early recognition and reporting of pandemic (H1N1) infection Consider assessing pandemic (H1N1) 2009 virus infection in patients with acute, febrile, respiratory illness in places where community-level spread is occurring or in patients who have been in an affected region within one week prior to symptom onset and who have been exposed to pandemic (H1N1) 2009 by an infected patient.13
7. Placement of suspected and confirmed pandemic (H1N1) 2009 infected patients Place patients with the same diagnosis in wards keeping at least 1 metre distance between beds.14 All persons entering the isolation area should adhere to Standard and Droplet Precautions. For health services targeting healthy populations, such as pregnant women, children attending immunization services or regular check-ups, measures must be taken to avoid exposing healthy people to suspected or confirmed cases.
8. Additional measures to reduce pandemic (H1N1) 2009 virus transmission associated with health care Limit the number of health-care workers/family members/visitors exposed to the pandemic (H1N1) 2009 patient. Implement rooming-in policies to keep mothers and babies together.
9. Specimen transport/handling within health-care facilities Follow applicable transport regulations and requirements and use Standard Precautions for specimen transport to the laboratory. Health-care facility laboratories should follow good biosafety practices.15
10. Family member/visitor recommendations Family members/visitors should be limited to those essential for patient support and should use the same IC precautions as health-care workers.
11. Patient transport within health-care facilities Suspected or confirmed pandemic (H1N1) 2009 patients should wear a medical mask or cover their cough and practice appropriate hand hygiene while being transported within health-care facilities.
12. Pre-hospital care (e.g. transportation to hospital). When transporting patients to hospital, IC precautions are similar to those practiced during hospital care for all involved in the care of suspected pandemic (H1N1) 2009 patients.
13. Occupational health Monitor health of health-care workers exposed to pandemic (H1N1) 2009 patients. Health-care workers with symptoms should stay at home. Vulnerable groups at high risk for complications of pandemic (H1N1) 2009 infection should carefully follow recommended infection-control measures. In addition, alternatives such as reassignment to other duties should be considered. Antiviral prophylaxis should follow local policy.
14. Waste disposal Standard Precautions should be used when handling and disposing of sharps and contaminated items.
15. Dishes/eating utensils Wash using routine procedures with water and detergent. Use non-sterile rubber gloves.
16. Linen and laundry Wash with routine procedures, water and usual detergent; avoid shaking linen/laundry during handling before washing. Wear non-sterile rubber gloves.
17. Environmental cleaning Ensure that appropriate and regular cleaning is performed with water and usual detergent on soiled and/or frequently touched surfaces (e.g. door handles).
18. Patient care equipment Ensure cleaning and disinfection of reusable equipment between patients. ²
19. Duration of pandemic (H1N1) 2009 infection control precautions Until further information becomes available, IC precautions should be practiced for seven days from the onset of symptoms. For prolonged illness with complications (i.e. pneumonia), control measures should be used during the duration of acute illness. Children may shed the virus longer than adults, and personal hygiene and separation from immunologically naive family members is recommended for at least one week after the resolution of fever.
20. Patient discharge If the pandemic (H1N1) 2009 patient is still infectious upon hospital discharge (i.e. discharged within the period of IC precautions: see 16 above), instruct family members on appropriate IC precautions in the home.
21. Prioritization of PPE when supplies are limited Medical masks and hand hygiene supplies should be prioritized for the care of all pandemic (H1N1) 2009 patients.
22. Health-care facility (HCF) engineering controls The HCF spaces should be well ventilated. Aerosol-generating procedures should be performed in adequately-ventilated rooms (>12 air changes per hour).
23. Mortuary care Mortuary staff and the burial team should apply Standard Precautions, i.e. perform proper hand hygiene and use appropriate PPE according to the risk of exposure to body fluids (e.g. gown, gloves, and facial protection if there is a risk of splashes from patient's body fluids/secretions onto staff member's body and face).
24. Health-care facility managerial activities Development of procedures to ensure proper implementation of administrative controls, environmental controls and use of PPE, including adequate staffing and supplies, training of staff, education of patients and visitors and a strategy for risk communication.
25. Health care in the community Limit contact with the person with influenza-like symptoms as much as possible. If close contact is unavoidable, use the best available protection against respiratory droplets and perform hand hygiene.
