H1N1 Influenza A (Swine Flu)

What is H1N1 Influenza A Virus (Swine Flu)? H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. This new virus was first detected in people in April 2009 in the United States. H1N1 Influenza A (swine flu) is transmitted by respiratory secretions This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs in North America.

Can Humans Catch H1N1 Influenza A (swine flu)? It is determined that this new H1N1 Influenza A virus is contagious and is spreading from human to human; however, at this time, it is not known how easily the virus spreads between people.

What are the Signs & Symptoms of H1N1 Influenza A in Humans? The symptoms of this new influenza A H1N1 virus in people are similar to the symptoms of regular human flu and include fever (greater than 100.0º F or 37.8 º C), cough, sore throat, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting.   Also, like seasonal flu, severe illnesses and death has occurred as a result of illness associated with this virus.

How Does H1N1 Influenza A Spread? Human-to-human transmission of H1N1 Influenza A predominantly occurs through direct droplet transmission (Usually within 6-10 feet). This is thought to occur in the same way as seasonal flu, which is mainly person-to-person transmission through coughing or sneezing of infected people. People may become infected by touching something with flu viruses on it and then touching their mouth or nose (moist mucous membranes).

How Long Can an Infected Person Spread this Virus to Others? With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick.  Children, especially younger children, might potentially be contagious for longer periods.

How Can Someone with the H1N1 Influenza A Infect Someone Else? Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches their own eyes, mouth or nose before washing their hands.

What is the Infectious Period? Persons who continue to be ill longer than 7 days after illness onset should be considered potentially contagious until symptoms have resolved. Non-hospitalized ill persons who are a confirmed or suspected case of swine-origin influenza A (H1N1) virus infection are recommended to stay at home (voluntary isolation) for at least the first 7 days after checking with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema.

What Can I do to Keep From Getting the Flu (Influenza)? Wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

Interim Recommendations for Assessment of “Influenza-Like Illness” (ILI) Step 1: EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions while assessing all patients for suspected cases. Step 2: Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following: nasal congestion/rhinorrhea, sore throat, or cough).

Personal Protective Equipment (PPE) EMS Personnel should ensure that they have the necessary personal protective equipment N95 mask, surgical masks, gloves, eye protection, gown, and other standard equipment for droplet precautions Fit-tested disposable N95 respirator and eye protection (e.g., goggles; eye shield), disposable non-sterile gloves, and gown, when coming into close contact with the patient.

Infection Control Interim Recommendations: When removing PPE make every attempt to avoid contact with contaminated areas and wash hands before touching a clean area. All patients with acute febrile respiratory illness should wear a surgical mask or approved respiratory barrier, if tolerated by the patient. = +

Sequence for Removing PPE Gloves Face shield or goggles Gown Mask or respirator

How to Remove Gloves Grasp outside edge near wrist Peel away from hand, turning glove inside-out Hold in opposite gloved hand

How to Remove Gloves (continued) Slide ungloved finger under the wrist of the remaining glove Peel off from inside, creating a bag for both gloves Discard in approved biomedical waste container

Removing Goggles or Face Shield Grasp ear or head pieces with ungloved hands Lift away from face Discard in approved biomedical waste container

Removing Isolation Gown Unfasten ties Peel gown away from neck & shoulder Turn contaminated outside toward the inside Fold or roll into a bundle Discard in approved biomedical waste container

Removing a Mask Untie the bottom, then top, tie Remove from face Discard in approved biomedical waste container

Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard in approved biomedical waste container

Hand Hygiene Perform hand hygiene immediately after removing PPE. Wash hands with soap and water or use an alcohol-based hand rub Ensure that hand hygiene facilities are available at the point needed (sink or alcohol-based hand rub)

Interfacility Transport EMS personnel involved in the interfacility transfer of patients with suspected or confirmed H1N1 Influenza (swine flu) should use standard, droplet and contact precautions for all patient care activities. This should include wearing a fit-tested disposable N95 respirator, wearing disposable non-sterile gloves, eye protection (e.g., goggles, eyeshield), and gown, to prevent conjunctival exposure. If the transported patient can tolerate a facemask (e.g., a surgical mask), its use can help to minimize the spread of infectious droplets in the patient care compartment.  

Interfacility Transport (continued) Encourage good patient compartment vehicle airflow/ ventilation to reduce the concentration of aerosol accumulation when possible. If the transported patient can tolerate a facemask (e.g., a surgical mask), its use can help to minimize the spread of infectious droplets in the patient care compartment.  

Routine cleaning with soap or detergent and water to remove soil and organic matter, followed by the proper use of disinfectants, are the basic components of effective environmental management of influenza. Reducing the number of influenza virus particles on a surface through these steps can reduce the chances of hand transfer of virus. Influenza viruses are susceptible to inactivation by a number of chemical disinfectants readily available from consumer and commercial sources.

Antiviral Treatment for H1N1 Influenza A (Swine Flu) Infections in Humans Antivirals may be used as either a treatment to a confirmed or suspected case of H1N1 Influenza A (swine flu) or as prophylactic treatment to exposed individuals under specified conditions At this time, prehospital treatment of patients with antiviral agents is not being utilized CDC recommends the use of Tamiflu (oseltamivir phosphate) or Relenza (zanamivir) as part of the treatment and/or reduction of severity of infection with swine influenza viruses.

Vaccinations There is no vaccine to protect humans from H1N1 Influenza A (swine flu) at this time. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.

Recommendations for: Vehicle Decontamination Upon completion of patient care (single call), clean all equipment that came in contact with or was within 6 feet of the suspected ILI patient with an approved disinfectant. The equipment may include stretchers, railings, medical equipment control panels, adjacent flooring, walls, ceilings and work surfaces, door handles, radios, keyboards, and/or cell phones. Cleanse all surfaces within 6 feet of the patient or surfaces touched by the patient or caregivers with an approved disinfectant.

Recommendations for: Vehicle Decontamination (Continued) Large spills of bodily fluids (e.g., vomit) should first be managed by removing visible organic matter with absorbent material. Place contaminated reusable patient care devices and equipment in biohazard bags. Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturer’s recommendations. Cleaning should be done with detergent and water and then disinfected using an EPA-registered hospital disinfectant in accordance with the manufacturer's instructions.

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