Summary of Recommendations for Care of Patients with Confirmed or Suspected 2009 H1N1 in Healthcare Settings

The following recommendations are considered to be the minimum isolation precautions recommended for the evaluation and care of patients with confirmed or suspected 2009 H1N1 influenza infection.

Facilities should perform organization-wide as well individual employee-level occupational risks assessments, and consider the current activity of flu in the surrounding community, the number of persons ill with influenza like illness who require medical evaluation, and evidence within their own institution of transmission of virus to patients or healthcare personnel when determining on an institution specific basis how they should implement or expand these precautions.

• Utilize a hierarchy of controls including administrative work-practice, engineering controls, and personal protective equipment including a program of respiratory hygiene and cough etiquette, disease-recognition protocols, surveillance practices, availability of anti-viral agents and vaccine, patient placement, and air handling.
• Place H1N1 patients in a private room. If a private room is not available, consider cohorting patients with suspected 2009 H1N1 influenza infection together.
• Use Standard and droplet precautions for care of patients with suspected or confirmed 2009 H1N1 influenza infection.
  • Facilities and personnel should assess need for and appropriateness of personal protective equipment (PPE) on an ongoing basis.
  • Maintain adherence to hand hygiene by washing with soap and water or using alcohol-based hand sanitizer immediately after removing gloves and other equipment and after any contact with respiratory secretions
  • At minimum, healthcare personnel should adhere to droplet precautions for seven days after illness onset of illness.
  • Respiratory Protection:
    • For aerosol-generating procedures (e.g., bronchoscopy, intubation under controlled or emergent situations, cardiopulmonary resuscitation, open airway suctioning and airway induction)
      • Individual institutions should perform an institution-specific risk assessment.
      • Healthcare personnel performing or assisting in these procedures should wear a fit-tested disposable N95 or higher respirator; respirators should be donned when performing the aerosol generating procedure and removed when exiting the procedure room. This should be in the context of a comprehensive respiratory fit-test program with appropriate user training.
      •  Use of an airborne infection isolation room with negative pressure handing and up to 6 to 12 air exchanges per hour should be considered for elective procedures such as bronchoscopy or sputum induction that are likely to generate small particle aerosols