Swine flu (H1N1 virus) Information for Colleges Background information Swine flu has proved to be a highly infectious, if generally mild and relatively brief, illness. It is spread when healthy individuals come into close and prolonged contact with individuals who have flu symptoms or through contact with contaminated surfaces. The virus can pose a significant risk of infection on hard surfaces for up to 24 hours. To reduce the risk of infection spreading in a close community, infection control and prevention measures are advised. To minimise the risk of students with swine flu passing on the infection to others, the infected individuals will need to isolate themselves in their room while unwell and infectious. This will usually be until they are no longer symptomatic. While ill, they should only go out of their room to use the toilet or shower, and they will need to be supported and looked after by people who know their way around the College and Cambridge, so-called Flu Friends. Colleges, through their Tutorial Offices, are responsible for ensuring that all members of the College are informed about the somewhat limited, but important, role and responsibilities of Flu Friends, and for ensuring that every affected student has prompt access to support by a team of Flu Friends. Organizing Flu Friends There are three proposed models by which Colleges might organize Flu Friends. In each of these models, prompt informal exchange of mobile phone numbers among students will be essential; all students should also be asked, if possible in advance of their arrival, to provide the College, through the Tutorial Office, with their current mobile phone number. It is recommended that at least two of these models should be used, not only in a student s first weeks in Cambridge, but also to ensure prompt institutional action in response to students who at any stage of the year or of their course feel shy or vulnerable in the face of illness. The Action List for Cambridge Students asks all students to designate two Flu Friends before they become unwell, but Colleges should not rely on this scheme alone, particularly as it will clearly be harder for newcomers to Cambridge to find Flu Friends in their first days and weeks, although this model rightly gives individuals responsibility for their care. Hence the following three suggestions. The first model is to ask student representatives (JCR, GCR committees etc.) to add Flu Friend duties to those undertaken routinely by College families or nannies (i.e. welcoming groups of students spread across years and subjects). The size of these groups should mean that affected students, in any year, can contact at least one or more students from within their group. The second model is to allocate Flu Friend duties by location of room: the affected student then makes telephone contact with one or two previously identified near neighbours. As weeks pass and friendships develop, normal friendship groups may also be expected to undertake Flu Friend roles this is, of course, as intended by Government advice and is the third model. But Colleges will always need reliable and friendly figures who understand and can stick to the limited nature of Flu Friends responsibilities, are prepared to liaise with College and medical authorities promptly, and can provide an ongoing institutional response when affected students have been unable to find another Flu Friend, whether from among neighbours or their College family. It is suggested that JCR or GCR Committees may be asked to take on this supplementary role. University of Cambridge Page 1 of 12 August 2009
Role of the Colleges Colleges are expected: (1) to issue advance information to all students about swine flu, and to recommend to all students that they purchase some minimal and inexpensive self-care items as a precaution: these should include a forehead thermometer, alcohol-based cleaning gel for personal hand cleansing use, and over-the-counter flu relief medication as advised by a pharmacist, to alleviate symptoms and to lower temperature; (2) to use JCR and GCR Committees and the College infrastructure to help affected students gain access to medical treatment through the National Pandemic Flu Service and local medical authorities (GPs/CamDOC); (3) to distribute flu packs sourced by the College each containing a thermometer, face masks, cleaning and waste disposal materials and information for all affected students, and to keep a central stock of flu packs for Flu Friends available for use in accordance with advice; (4) to supply food, drinks and other necessities to students quarantined in their rooms and, through their housekeeping teams, to ensure that strict and thorough cleaning and waste disposal regimes of affected areas are implemented; (5) to keep in touch with the infected students to ensure that their needs are being met, and to report any deterioration in symptoms immediately to the local or national medical service: GPs, CamDOC, NHS Direct (see numbers below) and to the College authorities (through the College Nurse, Porter s Lodge, or Tutorial Office). Each of these will post any report received to the Colleges fluinfo email list, to ensure swift and appropriate follow up, including the implementation of appropriate cleaning regimes. University of Cambridge Page 2 of 12 August 2009
Medical management As soon as students develop symptoms they should contact, by phone, a designated person in College who will arrange for delivery of a flu pack, ask them to take their temperature using the thermometer in the pack, and ensure that initial contact is made with the National Pandemic Flu Service: Online: https://www.pandemicflu.direct.gov.uk/ Tel: 0800 1513 100 If symptoms are considered consistent with swine flu, anti-virals will be made available without charge. A Flu Friend will have to collect the tablets for the student from an anti-viral collection point in Cambridge (currently located at Chesterton Hospital). Unless very unwell, infected students will not be admitted to hospital and will not be routinely visited by the doctor/nurse. The information in the flu pack gives advice on when it will be appropriate to contact a doctor for re-assessment (e.g. increasing temperature, intensifying headaches, chest pains, shortness of breath, confusion, and/or decreased level of response). NB: several of the symptoms associated with swine flu are also associated with meningitis, a much more serious condition, about which students are regularly informed. It is imperative that individuals affected and/or Flu Friends make contact with GP / CamDOC, if they are concerned at the sudden deterioration in their own or a friend s condition. Alert symptoms Medical re-assessment should be sought urgently if the student complains of chest pains, a worsening headache or increasing fever, dislike of bright light, cold hands and feet, aching limbs particularly leg pain, a rash or a stiff neck, or has difficulty breathing, seems confused or cannot be roused. If they are concerned, Flu Friends should not hesitate to contact GP, CamDOC or NHS Direct, as well as the College Porter s Lodge, College Nurse, or Tutorial Office. General care Infected students will need to rest and drink lots of fluid, especially when running a fever. They will need to be supplied with fluids, if there is no source of drinking water in the room. If they are hungry, some simple food should be delivered to them. Their Flu Friends will help with shopping, keep in regular contact (times for this should be agreed mealtimes may be convenient), and alert a local GP practice (CamDOC or NHS Direct out of hours) and the relevant College authorities, if they become concerned that the student may be becoming seriously ill. University of Cambridge Page 3 of 12 August 2009
Logistics of managing and reporting cases The Bursar and housekeeper will procure and keep good stocks of general cleaning materials for cleaning across College and for flu packs, and provide clear instructions and pro formas for Porters and others taking details of affected students. The Tutorial Office should liaise closely with student representatives in College, providing information and reassurance as necessary and appropriate, and send weekly summaries of the number (but not names) of student cases each Friday to fluinfo@cam.ac.uk. The Bursar s Office or HR manager should make weekly returns of the staff absence reporting spreadsheet to Dr George Reid at the Office of Intercollegiate Services, at gar37@cam.ac.uk. This data will be collated and will enable the University s Emergency Management Team, who are receiving similar returns from University Schools, Faculties, Departments, and other institutions, to take timely strategic decisions about the resourcing of the University s response to the Pandemic. Flu Friends will collect the anti-viral medicines from a chemist or distribution point (NHS Direct or GP will have given instructions on this), and will then check up on affected students regularly, delivering food and drinks to their door at mealtimes and seeing them briefly once a day, ideally in the early evening (details and reassurance below). Avoiding cross-infection Infected students will need to stay in their room while symptoms persist and for the course of any medication authorised by the National Pandemic Flu Service. They should only leave to use the toilet and/or shower, which will be subjected to intensive regular cleaning, to include all hard surfaces (door handles, basins etc.). Infected students should NOT use kitchens or other shared facilities. They must wear a mask whenever others are present in their room (but face to face contact should be kept to a minimum), and when going to the toilet. These masks (when used by infected students) can be used more than once, but should not be used once they become moist. The information leaflet in the flu pack gives more detailed instructions. Showering Student wanting to take a shower should do so at quiet times. They must wash their hands before leaving their room and wear a mask except when in the shower cubicle itself. They should store their clothes in a plastic bag while showering and not use hooks or leave items of clothing on benches. What about the risk of infection to Flu Friend or College staff? In asking students to act as Flu Friends and asking College staff to take on additional cleaning or other duties, it is important to know that the risk of catching influenza from looking after a student with swine flu will be very small: the infection is usually only passed on through prolonged close contact that is within a metre of the infected person for an hour or more. It is anticipated that normally only medical personnel (including the College Nurse) will enter the student s room and that, when doing so, they will wear the appropriate PPE. There may, of course, be exceptional circumstances in which Flu Friends (or others) might have to go into the room and, in these circumstances, use should be made of the Flu Friend s flu pack, which contains a surgical mask and alcohol-based gel for cleaning hands afterwards. Packs contain instructions on how to put on and dispose of a face mask correctly; it is important to read the instructions carefully. After leaving the student s room the mask should be removed, placed in a plastic bag, which should be tied closed and then discarded in a domestic waste bin. Waste bins in kitchens must not be used for this purpose. University of Cambridge Page 4 of 12 August 2009
Any visits should be kept short and the visitor should remain more than one metre away from the infected student. It is essential to wash or disinfect hands immediately after leaving an infected student s room and before and after removing the face mask. It must be remembered that any plates, bottles or cutlery used in the room of an infected student need to be washed up in hot water and in washing-up liquid again, even if the items will already have been wiped with an alcohol wipe and washed up by the infected student. Student flu packs Flu packs contain a forehead thermometer which will provide detail of temperature (essential for initial telephone assessment by NHS Direct) and 10 surgical-type face masks, along with instructions on self-care and infection control. Students should have been asked in advance of coming into residence to purchase flu-relief medication. Students in rooms which do not have hand basins must also be given a tub of alcohol wipes for hand disinfection. The amounts supplied should be sufficient for the length of illness, except in the case of students living in shared rooms where their roommate is unable to move out. They will need additional masks, as the infected student will have to wear a mask while their roommate is in the room and it must be noted that each mask is only effective for about one hour of continuous use. The flu pack should be delivered as soon as possible and left outside the room, after the student has been alerted through a knock on the door that the pack has been left. The Flu Friend who has made the delivery should wait a short distance away until the infected student has been seen collecting the pack. University of Cambridge Page 5 of 12 August 2009
Role of the Flu Friend: supporting the student Students who are contacted by a fellow student (whether neighbour or College Family member) who thinks they may have swine flu, should make every effort to respond promptly and calmly, asking the student whether he or she has a thermometer and flu/pain relief medication, whether he or she has contacted the National Pandemic Flu Service, or whether he or she needs help to do so. Name and room number should be noted, and a student s flu pack should be collected from the Porter s Lodge, if required. In the very unlikely event that the infected student s room has to be entered to assist with a telephone call to the National Pandemic Flu Service, the Flu Friend must wear a mask (which is contained in the Flu Friend s pack); the infected student must also wear a mask. (See the paragraph above entitled What about the risk of infection to Flu Friend or College staff.) The Porter must be given details of the student affected and will ensure that relevant College staff (College Nurse, Tutorial Office and housekeeping staff) are informed, so that appropriate care and cleaning regimes can be put in place. Flu Friends will leave the patient s flu pack outside the door of the infected student and, both students wearing masks, next steps will be agreed. After the National Pandemic Flu Service has been contacted (https://www.pandemicflu.direct.gov.uk/; tel. 0800 1513 100) and it has been established that the infected student s symptoms are consistent with swine flu, the Flu Friend collects anti-viral medication (Tamiflu) for the sick student from an antiviral collection point. The closest is currently at Chesterton Hospital, where the out-of-hours GP service (CamDOC) also operates. The Porter s Lodge will be able to give directions. The student will have received a unique identifier, and must give the Flu Friend a copy of a form of personal identification to present at the anti-viral collection point. Flu Friends also need to have proof of identification for themselves when picking up medication from the collection point. Medication and the student s form of ID will then be dropped outside the door, along with any other supplies the student has requested. Flu Friends should have a conversation with the infected student at least once a day, in addition to supplying fluids and food at mealtimes. It is a good idea to keep notes of expenditure or to use a swipe card (duly cleaned with alcohol wipe), as appropriate. Contact with the infected student can be by phone, text or through the door. There is no need to enter the room, unless a particular concern is raised (for example, if the sick student does not respond to contact) in which case the mask in the Flu Friend s flu pack must be worn before entering. Flu Friends are NOT in a position of medical responsibility, nor expected to make medical judgements. Being a Flu Friend is a practical, limited, liaison role, and one of several sources of contact and reassurance that the affected individual will value while unwell. Each student will have identified two Flu Friends: each Flu Friend must establish the identity of the other designated Flu Friend, so that roles can be coordinated and duties shared in a way which is convenient for everyone concerned. Individuals who are sick with flu must rest and drink a lot of fluids, especially in the first few days when they may run a temperature. Sugared soft drinks will provide easily absorbed calories. Eating is not as important at this stage, but a bit of human contact will help alleviate anxieties. If students who have agreed to act as a Flu Friend subsequently or at any time feel unable to take on or continue in this role, they must ensure that alternative arrangements are made as a matter of urgency, either by contacting another member of the student s College family or a near neighbour. It is vitally important that all parties concerned, particularly the affected student, are informed of changes in their support team. If no substitute can be found, the Porters must be informed so that they can ensure that alternative arrangements for appropriate care are implemented. Porters must, in any case, be told about students who suspect that they are infected, so that the College is aware. University of Cambridge Page 6 of 12 August 2009
Role of the Tutor The Tutorial Office will inform Tutors when any of their Tutorial pupils are reported as infected with swine flu. Sick students must be contacted by their Tutor once a day via email or mobile phone or text ideally at meal times (but an alternative, mutually convenient time can be agreed in advance); lack of response must be followed up as a matter of urgency. Tutors must check that ill students have everything they need and they should be prepared to answer questions personally (or refer them to the Senior Tutor) from students and their families relating to the support that students receive. Role of the College Nurse (where relevant / available) Colleges Nurses are expected to maintain adequate stocks of masks, gloves and aprons, and distribute, as required liaise with sick students, Flu Friends, Porters, the Pandemic Flu team and GPs, as necessary visit sick students, if concerns have been received from Flu Friends, Fellows or staff answer questions and address concerns from students, Fellows and staff identify students with relevant pre-existing medical conditions, and assess and refer them, as appropriate, if/when they contract flu-like symptoms prioritise their work load, depending on changing circumstances and the effect of the Pandemic on the student population, e.g. consider possibility of cancelling surgery, if necessary Going home? Students will be advised against returning to their parental home while they are sick and infectious. If nevertheless they insist on doing so, it will be preferable for their parents to collect them, instead of infected students travelling by public transport. Someone diagnosed with swine flu will not be permitted to fly while infectious. University of Cambridge Page 7 of 12 August 2009
Housekeeping Waste disposal Students with swine flu will be asked to discard used tissues and face masks in plastic bags, which must be tied up and kept in the room, until the infected student has recovered or until it is advised that such bags can be collected and double-bagged by Flu Friends or College domestic staff. The bags can then be safely disposed of as domestic waste. They must, however, not be discarded into waste bins in kitchens. Infected students will be asked to wash water bottles, crockery, cutlery etc. in their sink or clean them with an alcohol wipe before passing them to their Flu Friends, who are asked to wash any items returned to kitchens again as an additional precaution. Ideally, disposable plates and crockery should be used. Vomit Housekeeping departments will be able to arrange for steam cleaning of vomit in the room, and ensure that affected soft furnishings are cleaned and/or replaced as necessary. Any cleaning staff entering the room should wear disposable gloves and aprons, as well as a mask. Cleaning the room afterwards The virus can survive on hard surfaces for up to three days, but it poses no significant risk of infection after 24 hours. Rooms should pose no significant infection risk from the day after the student has recovered. However, students will be asked to launder their bed linen and towels once they have recovered. University of Cambridge Page 8 of 12 August 2009
Action lists: Cambridge students (for Michaelmas Term) Before coming to Cambridge Buy and bring forehead thermometer Buy and bring over-the-counter flu medication and use according to instruction Buy and bring alcohol-based hand gel for own use Send Tutorial Office your current mobile phone number Bring 2 photocopies of ID documentation On arrival in Cambridge Agree two Flu Friends within College (Freshers should turn to College Family members and/or neighbours) Register with a Cambridge doctor Be familiar with meningitis symptoms At onset of a temperature above 38 o C and other flu-like symptoms Retreat to and stay in your room Contact National Pandemic Flu Service for symptom checking and medication Let Porters know Let Flu Friends know During illness Stay in room, except to use toilet and/or shower Call GP, CamDOC or NHS Direct if your condition deteriorates Keep in touch with parents Wear mask when answering door, when others present and/or if leaving room Wash hands before putting on mask and leaving room Inform your Director of Studies and supervisors that you are unwell University of Cambridge Page 9 of 12 August 2009
Action list: Flu Friends Respond calmly; check name, contact details, location, and name of second flu friend Collect Student s Pack from Porter s Lodge and deliver to infected student s door Ensure that contact is made with National Pandemic Flu Service Collect any anti-virals prescribed from Chesterton Hospital, taking student s name, date of birth, unique identifier code issued by National Pandemic Flu Service and copies of your own and the infected student s personal ID (copy of passport etc) to the collection point Keep in regular contact (2 3 times a day) Keep student supplied with fluids (2 3 litres a day); this can be collected from College kitchens Call GP/CamDOC/NHS Direct and Porter/College Nurse/Tutorial Office, if concerned University of Cambridge Page 10 of 12 August 2009
Action lists: College Bursars Review College action plan and establish protocols and equipment supplies for Porters, Housekeeping, Cleaning, Catering Use fluinfo@xxxcoll.cam.ac.uk as discreet means of coordinating response to cases among key college and course staff (Bursar, Senior Tutor, Housekeeper, Porter, College Nurse, HR manager) Procure equipment for students flu packs, seeking advice from Occupational Health/other Colleges/College Nurse as relevant Liaise regularly with Senior Tutor, College Nurse and Housekeeper to ensure isolation arrangements are effective, and to review College Nurse s work load, locum/cover arrangements, and resourcing issues Ensure that College staff are reassured, have necessary up-to-date information and equipment Refer any press enquiries to University Office of Communications Report weekly details of staff absences to the Office of Intercollegiate Services (gar37@cam.ac.uk) each Friday on spreadsheet already circulated University of Cambridge Page 11 of 12 August 2009
Action lists: Senior Tutors Before term starts Contact student representatives to brief them about the Flu Friends regime and share this guidance in full Send all students Human Swine Flu Information for Cambridge students, including hard copy in Freshers pack; post this guidance on internal, Raven-protected web pages Ensure that all relevant people know where to find key equipment, flu packs, contact sheets etc. Prepare and adapt as necessary preparatory and student information from templates provided Ensure that students mobile phone numbers can be centrally recorded and that the information is made available to Tutors and College Nurse Consider buying a small stock of mobile phones for student loan where necessary Discuss the roles of College Nurse and Flu Friends, to ensure that the College Nurse s work load is sustainable and to allow priority response is given to suspected cases of meningitis and to students with relevant pre-existing medical conditions Send weekly summaries each Friday of student cases (undergraduates and postgraduates, but not names) to fluinfo@cam.ac.uk When informed that a student is unwell Tutorial Office to ensure fluinfo@coll is aware, and to inform student s Tutor, who will make daily contact at agreed times via phone or text and check the Flu Friends system is working Liaise with student, Flu Friends, College Nurse and student welfare representatives as necessary During the illness Arrange alternative or additional Flu Friend if needed Visit infected student, if concerns are raised, e.g. if the student has not responded to contact or symptoms are deteriorating Contact necessary medical assistance (GP/CamDOC /NHS Direct) if student s symptoms get worse Liaise with Porters and College Nurse to arrange delivery of additional masks to students if required Maintain regular contact and liaison with student welfare representatives Deal with questions and concerns from parents and students Refer media enquiries to the Office of Communications Send weekly summaries each Friday of student cases (undergraduates and postgraduates, but not names) to fluinfo@cam.ac.uk University of Cambridge Page 12 of 12 August 2009