Recognize the symptoms of the influenza virus and make an informed decision to receive the influenza vaccination.

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1 Influenza Module Module Introduction The purpose of this module is to provide LHSC staff and affiliates with information about the influenza virus, the vaccination, new mask policy for when the influenza virus is circulating in the community (new policy introduced for the influenza season), and protocols for Alert Levels for Influenza for clinical unit staff and affiliates. Module Objectives Performance Objective 1: Recognize the symptoms of the influenza virus and make an informed decision to receive the influenza vaccination. Supporting Objectives: What are the symptoms of influenza? What are the myths surrounding the vaccination? Who should get the flu vaccination and why is it important to do so? Performance Objective 2: React appropriately by following protocol for an Alert Level One and an Alert Level Two for control measures for influenza on clinical units. Supporting Objectives: What is the protocol for the Alert Level One Control Measure on clinical units? What is the protocol for the Alert Level Two Control Measure on clinical units? What type of mask should be worn? When do I wear a mask and a shield? When do masks need to be changed? What do I do if I see an unimmunized colleague without a mask on? What about family and visitors during an Alert Level declaration?

2 Performance Objective 3: React appropriately by following guidelines when the influenza virus is circulating in the community based on new policy introduced in the influenza season. Supporting Objectives: What are the new guidelines and how does it affect my work? Who does this apply to?

3 Performance Objective 1: Recognize the symptoms of the influenza virus and make an informed decision to receive the influenza vaccination. Supporting Objective 1.1: What are the symptoms of influenza? In this module influenza symptoms are presented as comparisons to the symptoms of a common cold as people often get these two afflictions mixed up. 1. A severe headache: when you have the flu, you can expect to get a severe headache. Severe headaches with a cold are rare though. 2. A sudden onset, high fever: a typical symptom of the flu is a sudden onset, high fever, which lasts about 3-4 days. Fevers with a cold are rare. 3. Sneezing is common: sneezing and a runny, stuffy nose are common with both a cold and the flu. 4. Expect a sore throat: a sore throat is common with both a cold and the flu. 5. Severe chest discomfort: chest discomfort and coughing can become severe with the flu and are usually more moderate with a cold. 6. Fatigue: with the flu, you can feel extremely run down for 2-3 weeks or longer. You can feel fatigued with a cold too, but not nearly as bad or as long compared to a flu virus. 7. Severe aches and pains: aches and pains are common with the flu and can be severe. You ll get these with a cold too, but they re usually not as painful and don t last as long. 8. Complications: it s unusual to get complications with a cold, but with flu, you run the risk of getting pneumonia or another serious respiratory issue. These complications are potentially life threatening. The three significant differences of the flu virus as compared to a cold are: the sudden high fever, a really bad headache, and the possibility of serious complications developing.

4 Supporting Objective 1.2: What are the myths surrounding the vaccination? When it comes to getting the flu shot, there are a few common reasons for why people don t think they should or need to get immunized. This supporting objective aims to dispel these myths. Below are the myths and the reasons for why they are incorrect. 1. I didn t get an influenza shot last year and I didn t get sick. You may have avoided getting the flu so far, but your luck may run out. Every year, different types of influenza virus circulate. 2. I m young and healthy. I don t need the flu shot. You may be young and healthy, but the flu virus does not discriminate. Consider this interesting fact; you can be infected with the virus and not show or feel symptoms of it! 3. I got the flu shot last year so I don t need one this year. A new vaccine is produced every year to provide protection against the 3 most common strains predicted for the coming season. Also, immunity to vaccine antigens is measured based on antibody levels, and these levels decrease with time. 4. I m pregnant and I m not getting the flu shot because my immune system is already suppressed. Pregnant women are not more likely to get the flu than the rest of the population. But, because their immune systems are suppressed, they are more likely to develop complications from the flu virus. 5. The flu shot will give me the flu, not protect me against it. This is not true. The vaccine does not contain anything that would cause you to get the flu. 6. I don t know what the big deal is. The flu is just like a really bad cold. The flu is worse than a cold. Colds generally do not lead to more serious health issues. With the flu, a complication such as pneumonia is a possibility. 7. Influenza shots aren t worth it because they don t really work. The seasonal flu shot is 70 to 90 per cent effective when the vaccine is a good match to the virus types circulating during that particular influenza season. Those are good odds.

5 Supporting Objective 1.3: Who should get the flu vaccination and why is it important to do so? 1. Protect you and your loved ones at home by getting the flu vaccine. Anyone over the age of 6 months can and should get immunized. Avoid lost time from work, school, and the possibility of a ruined vacation! 2. In the health care setting, it has been shown that rates of transmission decrease as immunization rates increase. If roles were reversed and you were sick in hospital, you would probably rest assured that your health care worker was immunized, helping to protect you from the flu. 3. Serious side effects with the vaccine are very rare. 4. Contact Occupational Health and Safety Services or check our website for more information to find out how you can get your annual flu shot. Ever wanted to learn how the flu vaccine is made? Check out this video located at:

6 Performance Objective 2: React appropriately by following protocol for an Alert Level One and an Alert Level Two for control measures for influenza on clinical units. Supporting Objective 2.1: What is the protocol for Alert Level One Control Measure on Clinical Units? An Alert Level One refers to one confirmed hospital acquired case of the influenza virus. The following steps must be followed for an Alert Level One Control Measure: 1. Non-immunized staff should get their flu shot (unless medically contraindicated). 2. Staff members and affiliates who are not vaccinated should wear a surgical mask in the affected patient care area. This includes staff members and affiliates who are not immunized 14 days before the alert level has been declared. 3. If a mask is required for personal protective equipment for providing care to a patient with a droplet transmitted infection, appropriate procedures should be followed (hand hygiene, eye protection, and gowns) while within the affected patient care environment. 4. If airborne precautions are required, the mask should be replaced with an N95 respirator while within the affected patient care environment and usual infection control procedures for airborne precautions should be followed.

7 Supporting Objective 2.2: What is the protocol for Alert Level Two Control Measure on Clinical Units? An Alert Level Two refers to two confirmed hospital acquired cases of the influenza virus. The following steps must be followed for an Alert Level Two Control Measure: 1. Non-vaccinated staff and affiliates (which include staff immunized less than 14 days before the alert has been declared) may be excluded from work in the affected area until they have commenced taking a suitable prophylactic antiviral medication. 2. Vaccinated staff, (with documentation of their vaccination at least 2 weeks prior of the alert level declaration), continue to work without disruption of their work pattern. 3. Staff and affiliates vaccinated less than 14 days earlier, or staff not vaccinated, with no medical contraindications have the following options: Staff members can receive prophylactic antiviral medication and are permitted to work after the first dose of medication has been ingested Prophylactic medication must be taken uninterrupted until 14 days after date of vaccination or until the outbreak is declared over, whichever is less Staff member can choose not to take antiviral medication. He or she will not be permitted to work until 14 days from the date of vaccination or until the outbreak is declared over, whichever is less. Upon request and where suitable alternate work is available, staff who have not been exposed may be accommodated elsewhere in the organization 4. Staff and affiliates who have not previously been vaccinated and have provided OHSS with supporting satisfactory documentation indicating the reason for not receiving the vaccination, have the following options: Staff member can receive prophylactic antiviral medication as prescribed by OHSS. He or she will be permitted to work after the first dose has been ingested The prophylactic medication must be taken uninterrupted for 14 days after the date of the vaccination or until the outbreak is declared over, whichever is less If the staff member is unable to receive antiviral medication due to medical reasons, and cannot be accommodated elsewhere in the organization, he or she will remain off work without loss of regular pay until the outbreak is declared over Staff member can choose not to take antiviral medication with no supporting medical documentation. Staff will remain off work until outbreak is declared over and this time will be unpaid

8 5. For a confirmed Influenza B Alert Level Two, the antiviral medication must be zanamivir, or oseltamivir. Amantadine is not effective against Influenza B. 6. If a mask is required for personal protective equipment for providing care to a patient with a droplet transmitted infection, appropriate procedures should be followed (hand hygiene, eye protection, and gowns) while within the affected patient care environment. 7. If airborne precautions are required, the mask should be replace with an N95 respirator and usual infection control procedures for airborne precautions should be followed while within the affected patient care environment.

9 Supporting Objective 2.3: What type of mask should be worn? A surgical or procedure mask should be worn. Supporting Objective 2.4: When do I wear a mask and a shield? 1. This is routine practice for sprays and splashes to the face and mucous membranes. 2. With a failed ARI, you should follow droplet and contact precautions. Supporting Objective 2.5: When do masks need to be changed? 1. There s no specific time frame, but they should be changed if they re overly moist. 2. When disposing of a mask, make sure you put it in the correct waste receptacle and follow hand hygiene protocols. Supporting Objective 2.6: What do I do if I see a non-immunized colleague without a mask on? If you see a non-immunized colleague without a mask on and it s during an Alert, help them out by reminding them of their responsibility to their patients. Supporting Objective 2.7: What about family and visitors during an Alert Level declaration? Family and visitors who arrive to your clinical area during an Alert should immediately to the nursing reception desk to determine if they are well enough to visit a patient. If they are well enough but are not immunized, they will need to wear a surgical mask during their visit.

10 Performance Objective 3: React appropriately by following guidelines when the influenza virus is circulating in the community based on new policy introduced in the influenza season. Supporting Objective 3.1: What are the new guidelines and how does it affect my work? 1. If you have received a vaccination for this influenza season, you will be deemed fit to work and will continue to be scheduled and assigned work. 2. You are required to wear a procedure mask in any patient care area within LHSC if you are not immunized. 3. Patient care areas include in-patient areas as well as ambulatory patient areas. Entrances into both an inpatient unit as well as an outpatient clinic waiting area are considered patient care areas. 4. Masks are not required in general public areas such as coffee shop lineups and cafeterias. 5. After receiving your immunization, you will get a sticker that shows proof of your immunization. You may opt to put this sticker on your LHSC ID card. 6. If you do not wear a procedure mask as required or directed, you will be sent home without pay and may be subject to disciplinary action. Supporting Objective 3.2: Who does this apply to? The new mask policy applies to all LHSC staff and affiliates.

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