H1N1 - Isolation/Visitors Resources

This is a great discussion about key issues in H1N1 and pregnancy. Good for mothers and for providers. It is a YouTube video that is an hour long (scroll down the list of archived Webcasts to August 27, 2009). An important discussion on newborn isolation is at minute 34:40. This emphasizes clinical judgment for the need to isolate the baby after birth: if the mother is very ill then the baby is isolated. However, if the mother is on treatment and doing well then the need for isolation is not well established. This has not yet been put into writing as a formal recommendation by the CDC but is what many practitioners are doing in clinical practice.

OVERVIEW: The single best place to visit for connections to a wide variety of resources (some of which we have individually indexed).
KEY STEP: Visit here often for updates.

Clinician Outreach Communication Activity (COCA) Conference Calls are designed to serve as the venue for timely education and two-way communication with CDC Subject Matter Experts (SME).
FIND: Scroll to the September 29, 2009 date.
CONTENTS: Transcript and MP3 audio recording that go with the Slide Set (Slides are in the CMQCC H1N1 Documents area (below) or can be directly downloaded from this same site). The presentation is broken into 5 areas: Overview of influenza; Infection control guidance; Testing and treatment; Vaccination; and The Atlanta experience.

SUMMARY: This document has been developed to provide guidance for prevention and management of novel H1N1 flu infection in inpatient and out-patient obstetric settings. Severe illnesses among pregnant woman and infants have been reported in this outbreak, although the epidemiology and spectrum of illness among pregnant woman and infants are not fully understood at this time and are under investigation. Prevention of infection with novel influenza A (H1N1) virus in pregnant women and infants is the highest priority message in this guidance. Healthy pregnant women should have access to prenatal care and labor and delivery services in settings where they can be separated from persons who are ill or potentially ill with novel H1N1 flu infection. In addition, a cautious approach to the management of neonates with ill mothers is recommended which includes isolation and close observation. Recommendations are interim, based on current knowledge of the novel H1N1 flu outbreak in the United States, and may be revised as more information becomes available.
COMMENT: It is widely anticipated that this document will be revised shortly, particularly the sections on isolation.

REVISIONS FROM EARLIER GUIDANCE INCLUDE: criteria for identification of suspected influenza patients; recommended time away from work for healthcare personnel; changes to isolation precautions based on tasks and anticipated exposures; expansion of information on the hierarchy of controls which ranks preventive interventions in the following order of preference: elimination of exposures, engineering controls, administrative controls, and personal protective equipment; and changes to guidance on use of respiratory protection.

SUMMARY: Q+A for issues around infection control measures for inpatient H1N1 infections (goes with the Guidelines that were releases the same day). It does not address L&D, Postpartum and Nursery issues.

NOTE: This interim guidance has been updated to replace previously posted guidance entitled “Considerations Regarding Novel H1N1 Flu Virus in Obstetric Settings”, dated July 6, 2009. This document clarifies clinical considerations related to management of suspected or confirmed maternal infection with 2009 H1N1 influenza virus infection within labor and delivery, postpartum, and newborn care settings in hospitals. A cautious approach to the management of ill mothers and their newborns is still recommended, but several options are provided based on hospital configuration, staffing, and surge capacity.
SUMMARY: Pregnant women who enter the hospital setting with illness from suspected or confirmed 2009 H1N1 influenza virus infection represent a special population warranting clinical management that considers the specific risks that 2009 H1N1 virus exposure poses to the newborn infant. The location of the mother and newborn should be considered based on postpartum and/or newborn ward configuration and existing infection control policies. As clinically indicated providers should consider a TWO-STEP process to manage postpartum and newborn care.
ONE: Providers should consider temporarily separating the infected mother from the newborn within her room (in an isolette) or in separate rooms until the risk of infectious transmission is reduced, defined as having met ALL of the following criteria: * The mother has received antiviral medications for at least 48 hours and; * The mother is without fever for 24 hours without antipyretics and; * The mother can control cough and respiratory secretions. Once these criteria are met, the mother and infant can initiate close contact throughout the postpartum period with droplet precautions and the mother can begin infant feedings.
TWO: Once the mother and infant are able to initiate close contact, the following guidance is offered for mothers immediately prior to feeding and handling the infant in order to protect the newborn from droplet exposure: * The mother should wash her hands with soap and water; * The mother should put on a face mask; * The mother should observe all respiratory hygiene/ cough etiquette guidelines. These precautions should be followed for 7 days after symptom onset or 24 hours after resolution of symptoms, whichever is longer. Healthy term newborns of infected mothers with suspected or confirmed 2009 H1N1 should be considered exposed, rather than infected, if they are born in the hospital setting following infection control guidelines. These infants should be observed for signs of infection. Unless clinically indicated, these newborns should be cared for with standard precautions whether they are cared for in the mother’s room or in the term newborn nursery setting.

Slide set (55 slides) discussing the latest CDC guidelines with some background. Largely replaces the earlier CDC COCA slides.

A good general slide set made for OB Grand Rounds or Nursing Education. Covers epidemiology, pregnancy risks, triage assessment, treatment and prophylaxis, vaccine issues, and isolation/visitor policies.

Clinician Outreach Communication Activity (COCA) Conference Calls are designed to serve as the venue for timely education and two-way communication with CDC Subject Matter Experts (SME).
SLIDE SET: broken into 5 areas: Overview of influenza; Infection control guidance; Testing and treatment; Vaccination; and The Atlanta experience. Note that this slide set is in.pps format so that it is not editable.
TRANSCRIPT AND AUDIO TAPE: can be obtained using the citation noted in Web Resources with the same authors.