April 30 2009 Download a pdf of this document
On April 29, 2009 the World Health Organization Director General announced that she had decided to raise the current level of influenza pandemic alert from phase 4 to phase 5 based on the increased spread of the virus to other countries.
The good news is that to date the confirmed cases in Canada continue to be a milder form of influenza. However, as with any influenza virus outbreak the situation can change at any time. The current focus of the Public Health Agency of Canada is to slow (mitigate) the transmission of the virus.
Guidance for Health Care Workers:
Unfortunately this week there has been several written communications distributed to health care workers in Alberta from Alberta Health Services and Alberta Health and Wellness that provide conflicting information and guidance regarding respiratory protection when providing care to patients with suspected and confirmed influenza A (H1N1).
In addition, the Public Health Agency of Canada issued two versions of “Interim Guidance: Infection prevention and control measures for Health Care Workers in Acute Care Facilities, one dated April 28 and one dated April 30, 2009. The April 28th version advises health care workers to wear an N95 respirator when a patient is coughing and the patient is unwilling or unable to comply with respiratory hygiene. The April 29th version states that N95 respirators are required if the patient is coughing forcefully and is unwilling or unable to comply with respiratory hygiene.
The change in the guidance leads to the question, how will a nurse be able to predict that a patient will cough forcefully once she/he enters the room.
On April 28, 2009 Dr. Andre Corriveau, Chief Medical Officer of Health for Alberta Health and Wellness issued a letter regarding Guidelines for Human Swine Influenza A (H1N1) for ambulatory health care settings (doctor's offices, drop-in clinics, community health centres, outpost nursing stations etc.) that stated that N95 respirators are indicated for aerosol-generating procedures such as the collection of NP aspirate, intubations, nebulizer treatments, bronchoscopy or suctioning and are indicated for everyone in the room. In addition, he advises that the use of surgical masks for all other contact with suspected or confirmed cases of influenza A (H1N1) are adequate.
On April 29, 2009 Dr. Gerry Predy, Senior Medical Officer of Health for Alberta Heath Services issued a memorandum regarding human swine flu in Alberta that advised, “If dealing with patients suspected of having Serious Respiratory Illness or when performing aerosol generating procedures, N95 masks are recommended”. This guidance is in line with UNA's policy statement regarding respiratory protection.
The guidance regarding respiratory protection provided by Dr. Corriveau is clearly contrary to the recommendations of the Centres for Disease Control and UNA's position statement. This guidance does not embody the precautionary principle as outlined in Justice Campbell's January 2007 SARS Commission final report.
“Perhaps the most important lesson of SARS is the importance of the precautionary principle. SARS demonstrated over and over the importance of the principle that we cannot wait for scientific certainty before we take reasonable steps to reduce risk”
In his report Justice Campbell also identified that conflicting information and guidance that was distributed to health care worker from public health, Ontario health care employers, infection control and the Ontario government was a significant factor in the spread of SARS to health care workers.
On April 29, 2009 David Harrigan sent e-mail to Dr. Corriveau expressing our very serious concern regarding the guidance provided in his April 28, 2009 correspondence and the lack of continuity in the guidance being provided to health care workers.
Dr Corriveau responded on April 30, 2009 advising that the guidelines he distributed “…reflect the level of caution needed in Alberta at present”.
UNA Position Statement:
It is the position of United Nurses of Alberta that until such time as there is scientific certainty regarding the mode of transmission of Swine Influenza A (H1N1) all Employees covered by the Multi-Employer/UNA Collective Agreement that are required to provide patient care for suspected or confirmed swine influenza A cases must be provided with an appropriate supply of fit-tested N95 respirators and mandatory education regarding the care of procedures for donning and doffing N95 respirators.
Along with respiratory protection until the manner of causation is known, in addition to routine practices, infection control measures for suspected and confirmed cases of the swine influenza should include contact precautions, respiratory hygiene, accommodation, eye protection, surveillance and reporting.
What You Need to Know:
Get Fit Tested! - The Multi-Employer/UNA Joint Committee has reached an agreement regarding N95 Respirator Provision and Fit Testing, which requires the employer to provide N95 respirator fit-testing to all employees covered by the Multi-Employer/UNA Collective Agreement. Fit-Testing is mandatory as per Article 35.02 (a)
Ensure you have enough N95 respirators - The Joint Committee agreement obligates the Employer to ensure that an appropriate supply of N95 respirators is available.
You may be temporarily transferred - In the event of an emergency Article 44: Mobility (44.05 (e)) allows the Employer to reassign Employees from any site to perform work at any other site in emergency circumstances. An emergency is defined as “an unforeseen combination of circumstances or the resulting state that calls for immediate action”. Contact you Local representative or Labour Relations Office for additional information regarding emergency transfers.
Do not report to work if you are sick - Nurses should not be reporting to work if they have influenza like illness (fever and respiratory symptoms). Nurses who do report to work are putting patients and their co-workers at risk of infection and illness. The Alberta Government is asking that individuals with flu like symptoms stay home from work and avoid public places when ill.
You do not have to put your health at risk - The agreement between the parties states that employees who have not been fit-tested for an N95 respirator or are unable to achieve an effective facial seal shall not be expected to enter or provide services in an area where a suspected or confirmed case of swine influenza A has been identified. These Employees may be deployed to another area.
You need to assess whether you believe that you need to provided with N95 respirators (fit-tested), gown and eye protection. If your employer refuses then ask to be reassigned.
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Swine Influenza - Respiratory Protection for Nurses
Regular Updates will be posted as soon as new information is available.
For additional information and assistance contact your Local representative, Labour Relations Officer or UNA Occupational Health and Safety Officer
April 29, 2009 from Public Health Agency of Canada PHAC GUIDANCE DOCUMENT - VERSION 1- Interim Guidance: Infection prevention and control measures for Health Care Workers in Acute Care Facilities - Human Cases of Swine Influenza A
(H1N1)
April 28, 2009 from Alberta Health & Wellness TO: ALL ALBERTA NURSES Re: Guidelines for Human Swine Influenza A (H1N1)
April 28, 2009 from Public Health Agency of Canada PHAC GUIDANCE DOCUMENT - Interim Guidance: Infection prevention and control measures for Health Care Workers in Acute Care Facilities - Human Cases of Swine Influenza A (H1N1)
April 29 2009 from Dr. Gerry Predy Alberta Health Services RE: Human Swine Influenza in Alberta
Alberta has two confirmed cases of swine flu
N95 Respirator Provision & Fit-Testing Multi-Employer/UNA Joint Committee Tentative Agreement SEP 12, 2008
Links to More Information
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