2. What is Swine Flu? The Swine Flu outbreak which began in Mexico is a type “A” virus called H1N1. Although it likely originated in pigs, it contains human, avian and pig DNA. It has successfully crossed the species barriers and human-to-human transmission has been confirmed by The World Health Organization. All flu’s, whether seasonal, avian (like the much reported H5N1) or swine are respiratory infections. All are transmitted in exactly the same ways and prevented in exactly the same ways.

3. All flu’s are transmitted in one of two ways: DIRECTLY, in the air flow created by sneezes, coughs, breathing or talking. These droplets can be projected up to two metres before falling to the nearest surface, where they can remain alive for up to 72 hours. INDIRECTLY, by touching an object or surface contaminated by live virus droplets, then touching your mouth, eyes or nose.

4. How To Prevent The Spread of Swine Flu All flu’s are prevented in the same ways: Heightened hand hygiene, with soap and water or waterless sanitizer. Social distancing – keep at least one metre away from potentially infected people Disinfecting hard surfaces Barrier protection using masks, gloves and eye protection

5. All human pandemic flu’s to date have been incubated in the bird or/and swine population, hence the name “avian or swine flu”. Experts say a pandemic flu is overdue. They agree it’s not “if” but “when” it will arrive. A vaccine will take months to develop and production can only begin after the first wave of pandemic has hit. Antivirals such as Tamiflu ® may or may not work effectively and may or may not be available everywhere.

6. This training guide focuses on what you CAN DO to protect yourself and your fellow workers against flu. Training in the tried-and-true infection control techniques can yield big results – lower absenteeism now and greatly improved pandemic readiness.

7. All information contained in this guide is drawn from authoritative sources such as The World Health Organization, Centers for Disease Control and various government websites.

8. SOCIAL DISTANCING A medical mask should be worn within at least 1 metre of other people, to catch droplets carried in the airflow created by normal breathing (two metres for coughs and sneezes). Experts are divided on whether masks should be worn at all times in potentially infected environments but, apart from filtering particles from the air we breathe, masks also protect the nose and mouth from our own fingers, which may carry live viruses from surfaces we’ve touched. (Try not touching your nose or mouth for even five minutes.) Eye shields used in conjunction with masks extend protection. Infection Control Basics

9. Hand-shaking - a good habit to shake  A hand-shake greeting is deeply ingrained and can be highly dangerous. If you must shake hands, be sure to disinfect with soap and water or waterless hand wash before touching mouth, nose or eyes. Viruses can survive up to 72 hours on hard surfaces  Wipe all your hard surfaces including telephone and keyboard with a Polycide ® antimicrobial non-alcohol wipe at the start of your day 1. 1 With repeated use alcohol wipes are harmful to electrical components such as keyboards and certain plastics. Infection Control Basics HANDS AND HARD SURFACES CAUSE CROSS-INFECTIONS

10. Human hands have opposable thumbs, allowing us to grasp and manipulate objects around us. This is a powerful gift with a significant downside – our busy hands pick up germs and viruses and promptly deliver them to mouths, noses and eyes, causing contamination. It’s not just you, hidden camera experiments prove everybody does it! That’s why frequent handwashing and disinfection are the #1 healthy habits. Hand Washing & Disinfection The #1 way to reduce cross-contamination WHO Guidelines on Hand Hygiene in Health Care (advanced draft) / Modified according to ENl 500

11. When soap and water are available, wash hands thoroughly: Hand Washing & Disinfection The #1 way to reduce cross-contamination Cont’d 1.Wet hands with water. 2.Apply enough soap to cover all surfaces. 3.Rub hands palm to palm, right palm over left with interlaced fingers and vice versa. 4.Use palms to rub back of other hand. 5.Rinse under fingernails. WHO Guidelines on Hand Hygiene in Health Care (advanced draft) / Modified according to ENl 500

12. Hand Washing & Disinfection The #1 way to reduce cross-contamination Cont’d 6.Rotational rubbing of left thumb clasped in right palm and vice versa. 7.Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa. 8.Rinse hands thoroughly with water. 9.Dry thoroughly with a single use towel. Use towel to turn off faucet/tap. Duration of the entire procedure: 40-60 sec. WHO Guidelines on Hand Hygiene in Health Care (advanced draft) / Modified according to ENl 500

13. Hand Washing & Disinfection The #1 way to reduce cross-contamination Cont’d Alcohol-based hand wash has been tested and approved as an alternative to soap and water. A quantity should be carried at all times for use when contamination is suspected. When using alcohol hand scrubs : 1.Pre ‐ wash with soap and water when hands are visibly soiled because alcohols are not good cleaners. 2.Be sure the hands remain wetted for 15 seconds or the quantity is too little. Caution: Alcohol-based hand wash is flammable. Do not expose wet hands or product to fire or flames.

14. Hand Hygiene Technique with Alcohol-Based Formulation: Hand Washing & Disinfection The #1 way to reduce cross-contamination Cont’d 1.Put enough of the product in a cupped hand to cover all surfaces. 2.Use same technique as used with soap and water. Duration of the entire procedure: 20-30 sec...once dry, your hands are safe. WHO Guidelines on Hand Hygiene in Health Care (advanced draft) / Modified according to ENl 500 Caution: Alcohol-based hand wash is flammable. Do not expose wet hands or product to fire or flames.

15. Duration of the entire procedure: 20-30 sec...once dry, your hands are safe. Hand Washing & Disinfection The #1 way to reduce cross-contamination Cont’d Hand Hygiene Technique with Alcohol-Based Formulation Cont’d WHO Guidelines on Hand Hygiene in Health Care (advanced draft) / Modified according to ENl 500 3.Ensure that the alcohol based product is brought into contact with all hand and nail surfaces. Caution: Alcohol-based hand wash is flammable. Do not expose wet hands or product to fire or flames. Although moisturizers are added to alcohol-based hand sanitizers, frequent use can cause drying of the skin. Go-Kit offers a medically approved non-alcohol formulation. It’s user-friendly and ideal for frequent / repeated use.

16. Gloves and masks become loaded with live virus during use in contaminated environments. Learn how to maximize protection during use by practicing proper donning techniques and how to protect yourself against infection by using safe removal and proper disposal techniques.

17. Knowing how to put on and take off protective masks, gloves and eyewear (called “donning” and “doffing”) is just as important as having them available for use. There is a “right” way to do it and literally hundreds of wrong ways. There is also a correct order in which to don and doff the equipment, and ten ways to get it wrong. Why is this important? It’s the difference between protecting yourself and infecting yourself. Literally the difference between life and death for you and all those you may go on to infect, and all those they may go on to infect, and all those...

18. The two most common categories of masks are:  Ear-loop (Surgical) Mask Primary purpose – protects others from you You’ve seen them on TV medical dramas, worn by doctors and nurses hovering over patients during surgery. Worn to protect the patient from the direct flow of breath, which might carry infectious microbes, they fit loosely, allowing gaps for easy breathing.

19. Ear-loop (Surgical) Mask Cont’d Designed primarily for individuals who feel sick or believe they may be infected, they should be worn when such a person comes within at least a metre of others. Avian Flu is believed to be transmitted by droplets breathed, coughed or sneezed into the air, as opposed to other threats which are “aerosolized” (such as Legionnaire’s Disease) in which tiny particles stay in the air for long periods and can be carried through ventilation ducts.

20. Ear-loop (Surgical) Mask Cont’d Because Avian Flu is droplet-borne rather than aerosolized, earloop masks supply some measure of protection to people who are well, but find themselves in a potentially contaminated environment, although an N95 respirator-mask is far preferable. Masks and Respirator-Masks

21. N95 Respirator-Mask Primary purpose – protects you from others The N95 respirator-mask seals closely around the nose, cheeks and chin, offering a filtration efficiency of 95% or greater, catching very tiny airborne particles. Although it can fit a wide range of adult face sizes, its ability to seal around the face, hence its effectiveness, is greatly reduced by men’s facial hair.

22. Worn to protect against direct exposure to airborne particles carried in an infected person’s breath, coughs or sneezes. They also reduce the likelihood of indirect contamination caused by touching the eyes with contaminated fingers. Remove glasses with clean, disinfected hands after removing gloves.

23. Donning - Before donning any protective equipment wash your hands and face thoroughly. If you don’t have access to soap and warm water then use a sanitizer wipe followed by waterless hand wash.

24. Ear Loop Mask  Mask must be fitted snugly over nose, mouth and under chin.  Grasp flat mask with soft metal band at the top (fig1) and pull the mask open (fig 2).  Grasp the mask by the ear loops (one per hand) metal band on top. Hook loops behind ears.  Position the mask as shown above, pinching the soft metal band over nose bridge between thumb and forefinger while pulling bottom of mask under chin.

25.  N95 Respirator - Mask Donning Protective Equipment 1. Wash your hands. Grasp nose piece at top of mask with one hand. Slide finger of other hand behind chin piece. 2. Open mask by pulling down and out on chin piece until mask is fully open. IT IS IMPORTANT THAT MASK IS FULLY OPEN.

26.  N95 Respirator – Mask Cont’d Donning Protective Equipment 3. Place chin in pocket created. Stretch bands over back of head, positioning bottom band behind neck below ears and top band near crown of head. 4. Conform nosepiece to nose and face contours making sure Magic Arch® Is fully extended away from nose and mouth.

27.  N95 Respirator – Mask Cont’d Donning Protective Equipment 5. Holding mask at nose piece, place one finger inside the mask on the bendable aluminum chin piece, pull down gently so that mask is snug against face. 6. Pinch any excess material together under chin and fold over or twist.

28.  N95 Respirator – Mask Cont’d Donning Protective Equipment 7. Face Fit Check: To check fit, place both hands along edges of the respirator and exhale. If air escapes around your nose, adjust the nose piece. If air leaks at the respirator edges, unfold or untwist the chin piece, repeat Steps 5 and 6. 8. N95 Respirator correctly fit to face.

29. Glove Removal (CDC guidelines) Carefully follow this doffing sequence  Remove Gloves before removing mask - respirator 1. Outside of gloves are contaminated! 2. Grasp outside of glove with opposite gloved hand; peel off. 3. Hold removed glove in gloved hand. 4. Slide fingers of ungloved hand under remaining glove at wrist. 5. Peel glove off over first glove. 6. Discard gloves in appropriate receptacle. 7. Wash hands.

30. Protective Eyewear Removal: 1. Remove your gloves first. 2. With clean hands remove the glasses/goggles without touching your face or your head. 3. Discard eyewear in appropriate receptacle. Alternatively, wash the glasses/goggles and hands again in warm soapy water carefully, rinse and dry with soft paper towel. Place clean, dry glasses/goggles back in their protective plastic bag as a reminder that your glasses/goggles have been cleaned and are ready to wear next time.

31. Respirator-Mask Removal: (CDC guidelines) 1. Remove your gloves and protective eyewear first. 2. Wash hands. 3. Front of mask is contaminated - DO NOT TOUCH! 4. Grasp bottom, then top elastics (back of head) and remove. 5. Discard in appropriate receptacle. 6. Wash hands and face thoroughly.

32. Q. What is the difference between an epidemic and a Pandemic? A. When a localized epidemic becomes widespread, even global, and affects a large proportion of the population, it is called a pandemic. Q. Have pandemics happened before? A. Pandemics have occurred throughout history, including four in the 19 th century and six in the 20 th century. The most severe recent pandemics were the Spanish Flu (H1N1) in 1918/19 which killed an estimated 50 million people, (particularly young, healthy adults), the Asian Flu (H2N2) in 1957/58 which killed 1 million (particularly infants and elderly) and the Hong Kong Flu of 1967/8/9 (H3N2) which caused up to 4 million deaths (especially infants and elderly). It has been forty years since the last pandemic, leading epidemiologists to say we are overdue for another pandemic.

33. Q. Why is there such concern over a flu that kills birds? A. Flu viruses are species-specific, but if someone with human seasonal flu contracts Avian Flu through close contact with infected fowl, H5N1 may mutate into a virus that can cross the species barrier (antigenic shift), becoming highly infectious and highly pathogenic to humans, resulting in a deadly pandemic. Q. Won’t my flu shot protect me? A. No. Vaccines produced for seasonal flu will not protect against pandemic flu. At best the current flu vaccine may help to lessen some of the symptoms by producing antibodies, but this will depend on what last year’s flu strains were like. (Health Canada determines which strains of flu to protect you against, based on last year’s flus).

34. Q. I have a prescription for Tamiflu (antiviral). Won’t that help? A. Maybe. Experts disagree on how long a course of treatment is necessary. And antivirals have a finite shelf life, so the earliest produced are now expiring, unused. Also, using antivirals creates resistant strains, potentially making stockpiled product ineffective. Speak to your physician if you have further questions. Q. Are pandemics spread like seasonal flu’s? A. Yes. Like the seasonal influenza many people experience every year, pandemic influenza will probably spread by infected people coughing or sneezing or by touching an infected surface. Unlike seasonal influenza, people will have little immunity to the virus that causes a pandemic.

35. Q. How can I protect myself from infection? A. There are several steps that can be taken to help fight the flu. The most effective is to wash your hands frequently. We pick up viruses from hard surfaces we touch, then touch our nose or mouth, and infect ourselves. Wiping down hard surfaces with a disinfectant wipe can also reduce the chances of transmission. During an outbreak, avoid close contact with others (shaking hands, kissing, etc.) Respiratory etiquette (covering your mouth and/or nose when you sneeze or cough) should also be observed.

36.  GO-KIT is the originator and market leader in pre-kitted, medically-approved sets of proven precautions.  All kits come complete with comprehensive instructions for safe, effective use. The right tools to cut the chain of infection at work.  Easily distributed Pandemic Preparedness Paks allow businesses to carry on confidently. HOSPITAL-GRADE INFECTION CONTROL SYSTEMS

37.  Portable kits for purse or pocket  HEALTHY HOME A re-sealable repository of infection control products for the home and home-office.

38. GO-KIT IS A KNOWLEDGE-BASED PARTNERSHIP www.stevens.ca 175 years of medical / surgical supplywww.stevens.ca www.pharmax.cawww.pharmax.ca Creating infection-control solutions for healthcare

39. For Families  Be sure to have a store of dry foods, and bottled water in case of store shortages.  Keep some spare cash on hand, in case the banks restrict access or the internet crashes.  Have some extra gas on hand, in case there is a shortage of fuel, or a restriction of supply.  With kids home from school (which will close), have lots of activities ready, to entertain them.  Consider having extra medications available, as seeing your doctor when an outbreak is upon us, will be a difficult task.

40. Key Websites  www.safecanada.ca/link_e.asp?category=10&topic=170 www.safecanada.ca/link_e.asp?category=10&topic=170  www.hc-sc.gc.ca/ed-ud/prepar/flu-pandem/index-eng.php www.hc-sc.gc.ca/ed-ud/prepar/flu-pandem/index-eng.php  www.who.int/csr/disease/influenza/pandemic/en/ www.who.int/csr/disease/influenza/pandemic/en/  www.cidrap.umn.edu/cidrap/content/influenza/avianflu/index.html www.cidrap.umn.edu/cidrap/content/influenza/avianflu/index.html  www.cdc.gov/flu/avian/index.htm www.cdc.gov/flu/avian/index.htm  www.pandemicbusinesstoolkit.ca/preparenow www.pandemicbusinesstoolkit.ca/preparenow  www.pandemicflu.gov/ www.pandemicflu.gov/  www.hhs.gov/pandemicflu/plan/ www.hhs.gov/pandemicflu/plan/

41.  The Flu Pandemic and You – Vincent Lam & Dr. Colin Lee  Bird Flu A Virus of Our Own Hatching – Dr. Michael Greger  The Hot Zone – Richard Preston Go-Kit, Tamaflu, OneStep, Polycide, are the respective trademarks of Go-Kit LLC, Hoffmann-La Roche, Belvedere International Inc., Pharmax Limited