The Centers for Disease Control and Prevention has issued interim recommendations for initial infection control in healthcare settings for confirmed, probable or cases under investigation of avian influenza A (H7N9) virus infection.
The new strain of influenza has been confined to China, where it is known to have infected 33 people and killed nine, and has not proven to be able to transmit from person to person. But the CDC wants United States healthcare facilities to be ready if cases begin to emerge domestically.
The interim recommendations are based on the latest available information and the following considerations: the lack of a safe and effective vaccine, a suspected high rate of morbidity and mortality among infected patients, unknown potential for person-to-person transmission, and an absence of confirmed or probable H7N9 cases in the U.S.
“This interim guidance recommends a higher level of infection control measures than for seasonal influenza,” the CDC wrote. Among the key differences are “recommendations for contact and airborne precautions for patients with confirmed, probable or cases under investigation of H7N9 virus infection, which includes a higher level of personal protective equipment for healthcare personnel, including eye protection (i.e. required) and the expanded use of respirators (i.e. for all patient-care activities).”
Regarding the monitoring and management of ill and exposed healthcare personnel, the CDC said facilities should consider dedicating personnel to the care of H7N9 cases to minimize the risk of transmission and exposure to other patients and staff.
For asymptomatic personnel who have had an unprotected exposure to a patient with confirmed or suspected H7N9 infection, facilities should consider excluding the staff member from work for 10 days to monitor for signs and symptoms of H7N9 illness. If necessary to ensure adequate staffing, the asymptomatic provider could continue work if placed on prophylactic influenza anti-viral medications while wearing a facemask for source control for 10 days after exposure.
Facilities should “implement sick-leave policies for [healthcare personnel]that are non-punitive, flexible and consistent with public health guidance,” the CDC wrote.
All healthcare personnel who enter the room of a patient with confirmed or suspected H7N9 infection should adhere to recommended protocols regarding hand hygiene, gloves, gowns, respiratory protection and eye protection.
Confirmed or suspected H7N9 patients should be placed in an airborne infection isolation room or, if one is not available, should wear a facemask and be isolated in an examination room with the door closed.
Aerosol-generating procedures for H7N9 patients should be limited whenever possible. Such procedures may include bronchoscopy, sputum induction, elective intubation and extubation and autopsies, among other types.
The full set of recommendations is available at www.cdc.gov/flu/avianflu/h7n9-infection-control.htm?s_cid=seasonalflu-govd-003.