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Transmission Prophylaxis 179

Transmission Prophylaxis

As soon as a case of human H5N1 infection is suspected, precautions need to be taken to minimise nosocomial spread. If the diagnosis is confirmed, possible contacts of the index case must be identified to facilitate early intervention with antiviral therapy, in order to reduce morbidity and mortality and limit further spread of the disease (WHO 2004).

General Infection Control Measures

Infection control measures include the application of standard precautions (Garner 1996) to all patients receiving care in hospitals. If the diagnosis of H5N1 influenza infection is being considered on the basis of clinical features, additional precautions should be implemented until the diagnosis can be ruled out.

Special Infection Control Measures

Influenza virus is transmitted by droplets and fine droplet nuclei (airborne). In addition, transmission by direct and indirect contact is also possible. Although there is currently no evidence that the H5N1 virus is transmitted among humans, the WHO recommends the following precautions (WHO 2004):

Use of high-efficiency masks in addition to droplet and contact precautions.

Patients should be housed in a negative pressure room.

Patients should be isolated to a single room. If a single room is not available, cohort patients separately in designated multi-bed rooms or wards.

Patient beds should be placed more than 1 metre apart and preferably be separated by a physical barrier (e.g. curtain, partition).

To protect healthcare workers (HCWs) and other hospital personnel, the following recommendations have to be followed (WHO 2004):

HCWs should protect themselves with a high efficiency mask (European CE approved respirators or US NIOSH certified N-95), gown, face shield or goggles, and gloves. The use of masks by healthcare workers in pandemic settings has recently been clarified (WHO 2005b). A surgical mask, when consistently used, may also reduce the risk of infection, but not significantly (Loeb 2004).

Limit the number of HCWs who have direct contact with the patient(s); these HCWs should not look after other patients.

The number of other hospital employees (e.g. cleaners, laboratory personnel) with access to the environment of these patients should also be limited.

Designated HCWs should all be properly trained in infection control precautions. Restrict the number of visitors and provide them with appropriate personal protective equipment and instruct them in its use.

Ask HCWs with direct patient contact to monitor their own temperature twice daily and to report any febrile event to hospital authorities. HCWs who have a fever > 38ºC, and who have had direct patient contact, should be treated immediately.