Introduction
1. 'Most experts believe that it is not a question of whether there will be another severe influenza pandemic, but when.' (Scottish Executive 2005, Explaining pandemic flu:
A guide from the Chief Medical Officer, http://www.scotland.gov.uk/Resource/Doc/924/0040580.pdf
2. Everyone will be involved in the fight against pandemic influenza in terms of managing the impact it will have on society and preventing the further spread of infection. It is impossible to predict the precise characteristics, spread and impact of a new influenza virus strain. From the time it begins in the country of origin, it may take as little as two to four weeks to reach the UK. A pandemic may occur in one or a series of 'waves', weeks or months apart. It will present a major national and international economic and social challenge.
Current position
3. This leaflet is aimed at staff working in community care to inform them how they can protect themselves, their staff, their families and the people they work with in the course of their daily work.
4. This leaflet is available online (a limited supply of hard copies will be made available for staff training) and sits alongside: Planning for pandemic influenza in community care: an operational and strategic framework, which contains guidance and suggestions on how care services can plan for and respond to pandemic influenza.
5. Planners should be aware that the information available on pandemic influenza changes over time as our understanding of the disease develops. Guidance is therefore continually being updated. It is important that planners ensure they work to the latest information, including any guidance referred to within this document.
6. This leaflet is for Scotland only. Parallel leaflets will be issued by the Department of Health in England, the Welsh Assembly Government and the Department of Health, Social Services and Public Safety in Northern Ireland.
More information on pandemic influenza is available at: www.scotland.gov.uk/topics/Health/health/avianinfluenza/pandemicflu
Guidelines for community care staff
7. Everyone will be involved in the fight against pandemic influenza in terms of managing the impact it will have on society and preventing the further spread of infection.
8. This leaflet explains how staff and volunteers can protect themselves, their staff, their families and the people they work with in the course of their daily work.
What is pandemic influenza?
9. Influenza is a familiar infection in the UK, especially during the winter months. The illness, caused by an influenza virus, can be mild or severe and can at times lead to death.
10. Generally, some groups of people are more susceptible than others, especially older people, people with certain health conditions, people who are immunosuppressed and those living in long-stay residential care facilities. This is why it is recommended that the influenza vaccination is given to these groups of people every year.
11. Pandemic influenza is different from ordinary influenza (which usually occurs during the winter months) because it occurs when a new influenza virus emerges into the human population and spreads from person to person worldwide. This means that a pandemic influenza can occur at any time of the year.
12. As it is a new virus, few, if any people will have a natural or acquired immunity to a pandemic virus. Therefore, healthy adults - as well as older people, young children and people with existing medical conditions - could be affected.
13. The lack of immunity in the UK population will result in more people becoming seriously ill and more deaths.
14. The circumstances exist now for a new virus to emerge and spread worldwide. Planners should be aware of the fact that avian viruses present in birds have the potential to infect humans as part of a new influenza pandemic.
Symptoms of influenza
Most significant symptoms
- Cough or shortness of breath
- Malaise (general bodily discomfort/feeling of unease)
Other symptoms
Infectious period (how long you are infectious to others)
15. It is likely that the symptoms of pandemic influenza will be the same as those for ordinary influenza, but they will probably be more severe and more likely to cause serious complications.
16. People are most infectious soon after they develop the symptoms, though they can continue to shed (excreting or casting off the virus through their secretions) virus for usually up to 5 days after the onset of symptoms (this extends to 7 days in children).
17. It is sometimes stated that patients are infectious shortly before they develop symptoms: however, the evidence for this is limited. Spread from a person before they develop symptoms has rarely been recorded, though experimental studies have shown that some people start shedding low doses of virus in the 24 hours before symptoms occur. Some people can be infected without showing symptoms and, as they may shed the virus, be able to pass on the infection.
How is pandemic influenza caught and spread to others?
18. Pandemic influenza is spread from person to person by close contact. Here are some examples of how this infection can spread:
- Infected individuals can pass the virus to others through large droplets when coughing, sneezing and even talking within a close distance (usually three feet, roughly one metre, or less).
- The virus can be passed on by direct contact with an infected individual. Shaking or holding hands with an infected individual, followed by touching your own mouth, eyes or nose without first washing your hands with soap and water, will allow the virus to spread to you.
- The influenza virus can spread when environmental and inanimate objects such as door handles, light switches and handles on public transport become contaminated with the virus. Once again, if you touch these objects and then touch your mouth, eyes or nose without first washing your hands, your chances of catching the virus increase.
- In some circumstances, the virus can be passed on in fine airborne droplets or on dust particles. This is not considered to be a major route of transmission.
Protecting yourself and others from pandemic influenza and other infections at work
General issues
19. There are some general things you can do to protect yourself and others from pandemic influenza and other infections at work:
Hand Hygiene
Hand hygiene is the single most important practice to reduce the transmission of infectious agents and is an essential element of standard infection control precautions. During outbreaks of pandemic influenza strict adherence to hand hygiene recommendations should be enforced as follows:
- Washing your hands frequently, as well as using soap and warm water or alcohol hand rub throughout the day before and after contact with a symptomatic client.
- Hands must always be washed after coughing, sneezing, contact with tissues or contaminated environment.
- An alcohol hand rub can be used instead of soap and warm water if access to a sink is restricted.
- Hand towelettes containing a soap/detergent solution can also be used at these times if it is all that is available.
- Hand hygiene should be performed even if disposable gloves have been worn for any contact as described above.
- Avoid touching your eyes, nose or mouth with contaminated hands (gloved or ungloved)
Coughing/Sneezing
Patients as well as staff, and visitors, should be encouraged to minimise potential influenza transmission through good hygiene measures as follows
- Cover your nose and mouth when sneezing and coughing and use disposable single-use tissues for wiping or blowing your nose. Dispose of used tissues in the nearest waste bin.
- Washing your hands after coughing, sneezing, using tissues, or contact with respiratory secretions and contaminated objects will reduce the risk of spreading influenza to others.
Environment
- Ensure patient/client's immediate environment is clean and not contaminated with respiratory secretions
- Regularly clean frequently touched surfaces, including door handles, television remote controls, keys, etc using warm water and detergent or normal cleaning product
- Ensure that you are aware of your employer's infection-control procedures and that you are following them correctly
- Do not bring your children or other members of your family into the workplace
Laundry
- laundry that may be contaminated, for example clients' clothing and bedding, should be washed in the usual way, as per local policy.
Crockery/Utensils
- Crockery/Utensils should be washed in the normal way with hot soapy water (or in a dishwasher).
Personal protective equipment
20. During an influenza pandemic, you may be required to have close contact with a client with respiratory symptoms. Where this is the case, the use of face masks can be considered to protect healthcare workers or others at particular risk, who may be at occupational risk from close or frequent contact with symptomatic people. Those people who are symptomatic should wear a disposable face mask to avoid contaminating others.
- Fluid-repellent surgical masks can reduce the risk of influenza transmission to staff.
- Gloves prevent excessive contamination of your hands. This contamination can be from contact either with the client or with the immediate environment. Gloves are not a substitute for hand washing.
- Consideration should be given to asking clients who are coughing to wear a fluid-repellent surgical mask whilst care is being provided, if they can tolerate one. If not, they should use disposable single-use tissues to cover their mouth when coughing.
21. In addition to these measures you may wish to consider using other protective equipment.
22. If close contact with an influenza-infected patient is considered inevitable or highly likely, health workers or others should adopt sensible barrier precautions in addition to face masks. Disposable protective equipment, such as aprons and gloves, provide a physical barrier and help avoid spreading contamination. Although the ocular route is not regarded as a major route of transmission for normal human influenza viruses, it is nevertheless biologically plausible and eye protection (preferably disposable) may be necessary when carrying out aerosol-generating procedures or if risk assessment indicates that this is necessary.
Further guidance for employers is available at: www.hse.gov.uk/biosafety/diseases/pandemic.pdf
23. The use of personal protective equipment is also important when handling waste, such as tissues or gloves that are contaminated with respiratory secretions, and laundry (eg aprons). Laundry that may be contaminated, for example clients clothing and bedding, should be washed at as hot a temperature as possible.
24. During routine work, where close contact is not required, do not spend unnecessary time in close proximity to clients (ie within three feet/one metre).
25. The general wearing of face masks in public places by those who do not have influenza symptoms will not be recommended and the Government will not supply facemasks for that purpose.
How you can protect your family at home
26. When the pandemic virus is circulating in the UK, there is little that can be done to avoid contact with it during your normal daily activities and during general contact with other members of the public. Sensible precautions, such as covering your nose and mouth, can reduce, but not eliminate, the risk of catching or spreading the virus.
27. To avoid contacting the influenza virus at work from people who have influenza symptoms, you can reduce the risks by using gloves, masks and strict infection-control measures.
28. Before you leave work, follow these simple, general rules:
- Always wash your hands with soap and warm water and again soon after you arrive home, especially if you are using public transport.
- Whilst the appropriate use of personal protective equipment will protect clothes from contamination, during the pandemic you may wish to consider avoiding travelling to and from work in any work clothes. These work clothes can be washed in a domestic washing machine separately from other items. Store and transport them in a plastic bag.
What you should do if you have symptoms or are ill
29. If you feel ill at work, report it immediately to your manager or occupational health department. Do not simply carry on working.
30. If you develop symptoms whilst off duty:
- stay at home - do not go to work
- seek advice from the national flu line
Your organisation may work differently during the pandemic
31. During an influenza pandemic, your business may work in a different way from how it works now. You may be required to work differently in order to manage the number of affected clients and prevent the spread of infection. There may be staff shortages due to illness in employees and their families. Your employer may take the decision to send you home if you are unwell, so they can limit the spread of the virus amongst remaining staff, it is an employer's responsibility to consider this option.
Returning to work
32. You may be asked to be flexible and take on additional or new responsibilities to help cover staff shortages. If you have recovered from pandemic influenza, your line manager may make it a priority for you to work with ill or symptomatic clients. This is because you may have built up immunity to the pandemic and might not be at such a risk of infection as those people who have not contracted the pandemic. This will help protect your colleagues and reduce the spread of infection. Important note: If staff have already had flu they must continue to use any personal protective equipment when returning to work.
Being prepared - knowing what to do
33. You can be prepared by knowing what to do and by becoming familiar with your organisation's pandemic plans.
- Remember the signs and symptoms of influenza.
- If you are ill at home, do not go to work.
- If you become ill on duty, do not carry on working.
- Above all else, you must observe strict personal hygiene.
The Scottish Government
Primary and Community Care Directorate
October 2007