Interim Infection Control Guidance on 2009 H1N1 Influenza for Personnel at Blood and Plasma Collection Facilities

November 12, 2009 4:30 PM ET

This document provides staff and volunteers at blood and plasma collection facilities with 2009 H1N1 influenza infection control recommendations. This information complements the guidance provided in the Centers for Disease Control and Prevention (CDC) Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel Implementation of these recommendations will also help prevent the spread of seasonal flu viruses that circulate along with 2009 H1N1 during the 2009-10 flu season.

Ongoing collection of blood and blood components (including plasma used to make plasma derivatives, such as intravenous immunoglobulin) is essential to support healthcare delivery during the 2009-2010 flu season. This document describes public health measures that may be taken by staff and volunteers at collection facilities to protect their health and the health of blood and plasma donors while helping their communities to maintain adequate supplies of blood and blood products. These measures include compliance with routine infection control and environmental management practices; staying home when ill; and temporary deferral of donors if they are not in good health on the day of donation. These measures will help decrease the spread of both seasonal influenza and 2009 H1N1 influenza. Collection facility personnel should also be aware that additional measures may be recommended at a later time, if the 2009 H1N1 becomes more widespread and/or more clinically severe. These may include social distancing measures that help prevent disease spread. Such measures may be especially important during blood drives, which are likely to continue throughout the 2009-2010 flu season, even if some other public events are cancelled.

At the present time, CDC is working with state and local health departments and other HHS agencies to monitor the 2009 H1N1 pandemic and its potential impact on blood availability and blood safety. CDC and other HHS agencies are also continuing to work with the AABB Interorganizational Task Force on Pandemic Influenza and the Blood Supply to enhance pandemic preparedness at blood collection facilities and transfusion services.

Collection facility personnel should also be aware of:

• Occupational health guidance provided by the Occupational Safety and Health Administration (OSHA), Department of Labor
• OSHA requirements for occupational exposure to blood or other potentially infectious materials, as provided in the OSHA Blood Borne Pathogen Standard.
• Blood donor and blood product management guidance provided by the Food and Drug Administration (FDA).

CDC’s H1N1 Flu website may also be consulted for additional information.

Background Information on 2009 H1N1 Influenza

Transmission. 2009 H1N1 virus is likely to spread in the same way as seasonal flu, from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.

Symptoms. The symptoms of seasonal and 2009 H1N1 flu virus in people can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1, and have respiratory symptoms without a fever. Like seasonal flu, 2009 H1N1 influenza infection in humans can vary in severity from mild to severe.

Recommendations for Staff and Volunteers at Blood/Plasma Centers and Blood Drives

A. Infection control and environmental management practices

Respiratory Hygiene/Cough Etiquette and Isolation Precautions. At all times, collection facility staff and volunteers should adhere to routine infection control procedures, including appropriate Respiratory Hygiene/Cough Etiquette and routine isolation precautions for preventing the transmission of infectious agents.

Routine Hand Hygiene Practices. Phlebotomy staff should wash their hands with soap and water between contacts with different blood donors, and when gloves are used they should change gloves and cleanse their hands between contacts with different blood donors. Good hand hygiene will help prevent person-to-person spread of 2009 H1N1 influenza and other influenza viruses.

Staff and volunteers should also wash hands at other appropriate times, including when hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids. An alcohol-based hand sanitizer may be used as an interim measure when soap and water are not available and hands are not visibly soiled. (See also: CDC. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(RR16):1-45).

With regard to staff safety, the wearing of gloves and hand cleansing are governed by OSHA requirements pertaining to bloodborne pathogens in 29 CFR 1910.1030(c)(3)(ix) and 29 CFR 1910.1030 (d)(iii)–(vi) respectively.

Environmental Management. Environmental surfaces should be cleaned and disinfected in accordance with standard facility protocols after each donor has vacated the station and before setting up for arrival of a new donor at that station.

B. Staying home when ill

To minimize contact between ill staff members and others who work in the facility or donate blood or plasma, CDC recommends that:

• Staff and volunteers should assess themselves each day before leaving for work for symptoms consistent with influenza.
• Staff and volunteers who experience influenza-like symptoms should remain at home and not return to work until at least 24 hours after they are free of fever without the use of fever-reducing medications.

In addition, personnel who develop symptoms of influenza-like illness while at work should:

• Cease collection facility activities, be separated from other staff, notify their supervisor, and go home promptly.
• Be given a surgical mask to wear before they go home (when possible and if they can tolerate it) if they cannot be placed in an area away from others.

C. Deferral of blood and plasma donors

At all times, blood and plasma donors should be temporarily deferred if they are not in good health on the day of donation. Particular attention should be given to any indication of flu symptoms. (See also: AABB Donor History Questionnaire Documents ).

During the 2009-2010 flu season:

• Staff and volunteers at collection facilities should be especially diligent about early recognition of influenza-like illness in prospective donors.
• Optimally, staff and volunteers should educate prospective donors about symptoms of influenza-like illness and encourage them to stay home while they are ill and refrain from donating if they have such symptoms prior to arrival at the donation site.

For example, individuals who seek information or make appointments by phone or through website access should be questioned about symptoms and signs of influenza, and those who respond positively should be asked to wait and reschedule their blood or plasma donation appointment when they are fully recovered. (See FDA’s draft guidance, “Recommendations for the Assessment of Blood Donor Suitability, Blood Product Safety, and Preservation of the Blood Supply in Response to Pandemic (H1N1) 2009 Virus”).

Additional Information

• Additional information on infection control and disease prevention may be found on CDC’s H1N1 Flu webpage. General information related to 2009 H1N1 influenza is also available from state and local health departments.
• Additional information on occupational health and safety issues may be found on the OHSA Pandemic Influenza webpage, which includes:
• Guidance on Preparing Workplaces for an Influenza Pandemic
• How to Protect Yourself in the Workplace
• What Employers Can Do to Protect Workers
• Information on blood donor deferrals and blood product management is provided in FDA’s draft guidance: “Recommendations for the Assessment of Blood Donor Suitability, Blood Product Safety, and Preservation of the Blood Supply in Response to Pandemic (H1N1) 2009 Virus”.
• Additional information that may be of interest to collection facilities may be found on FDA’s 2009 H1N1 Flu Virus (Swine Flu) webpage. Collection facilities may also contact the FDA Office of Blood Research and Review (OBRR) at 301-827-3524 for more information.
• Information for national blood transfusion centers from the World Health Organization (WHO) is provided in: Maintaining a Safe and Adequate Blood Supply in the Event of Pandemic Influenza

Planning for Implementation of Additional Public Health Measures

If 2009 H1N1 becomes more widespread and/or more severe than during spring/summer 2009, public health authorities may ask collection facility personnel to institute social distancing measures to help prevent disease spread.

These may include:

• Adjusting the physical configuration of collection sites and donor appointment schedules to reduce unnecessary physical contact between donors and between donors and staff.
• Conducting active evaluation of staff, volunteers, and prospective donors for influenza-like symptoms as they enter the collection site. Individuals with influenza-like symptoms should be asked to leave the site to reduce the risk of viral transmission.
• In addition, staff or volunteers should continue to assess themselves for influenza-like symptoms each day before leaving for work and should stay home if they are ill.

To be prepared:

• Collection facility personnel should plan and test ways to institute these social distancing measures during blood collection operations.
• These measures will be especially important during blood drives, which are likely to continue throughout the 2009-2010 flu season, even if some other public events are cancelled as a social distancing measure.
• Collection facilities should be reviewing and making plans to implement their facility contingency response and/or pandemic response plans. This should include making plans for addressing potential staffing limitations. See also: CDC Guidance for Businesses and Employers to Plan and Respond to the 2009–2010 Influenza Season.