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Viral Respiratory Illness

MITIGATION
No cases to a large numbers in the Facility, but all cases are imported (NO nosocomial transmission).

MITIGATION
Triage Activities/facility access controls

1.Notify the Infection Control Coordinator or designee of any transfers from facilities that do have VRI cases.
2. If large numbers, instruct all patients with respiratory symptoms to wear a surgical mask (if not contraindicated).  Manage these patients with droplet precautions until determined that the cause of symptoms is not an infection that requires droplet precautions.  Instruct patients who cannot wear a mask to cover the nose and mouth with tissues when coughing or sneezing.

PREPAREDNESS

3.Instruct all patients with respiratory symptoms to wear a surgical mask (if not contraindicated).  Manage these patients with droplet precautions until determined that the cause of symptoms is not an infection that requires droplet precautions.  Instruct patients who cannot wear a mask to cover the nose and mouth with tissues when coughing or sneezing.

4.In the presence of known cases of VRI worldwide but no known SARS-CoV/Flu transmission in the area around the facility:

Place signs at all entry points detailing symptoms of and any current epidemiologic risk factors for VRI.  Signs should direct any person meeting these criteria to the Emergency Department Isolation Room for evaluation.

Initiate screening of patients on entry to the emergency department for symptoms and epidemiologic links suggesting VRI.  Patients with febrile illness and epidemiologic risks should perform hand hygiene, wear a surgical mask, and be placed on airborne precautions.  Cohorting, with all patients wearing surgical masks, shall be established if airborne isolation is not possible.

Intake/triage staff shall practice frequent hand hygiene and wear surgical masks during respiratory season.

RESPONSE

5.In the presence of known SARS-CoV/Flu transmission in the area around the facility:

Actively screen all persons entering the facility for symptoms; all persons shall be required to perform hand hygiene upon entry to the facility.

Instruct all patients presenting with febrile illness or respiratory symptoms to wear a surgical mask and place them in airborne precautions.  All patients wearing masks shall be cohorted.

Intake/triage staff shall follow full VRI personal protection guidance.

No Visitation will be allowed unless necessary for translation and/or minor children; visitors shall receive Infection Control Training.

Specific VRI patient-flow routes shall be from the Emergency Department to Elevator 1 to 8 or 9 Central or to an isolation room dependant on the number of VRI patients (see attached list of Isolation Rooms).  If movement is needed for procedures, the same route will be followed with VRI Personal Protection Guidance.

Rooms housing VRI patients shall receive terminal cleans.

Limit elective admissions/procedures.

An area shall be designated as a VRI evaluation center.  All febrile patients who present to the emergency department shall be sent to a fever assessment clinic.

Maintain a log of all visitors to VRI patients to aid in contact tracing.

Designated personnel

1.All Emergency Department, CCU/ICU and Respiratory staff has been fit-tested for N-95 respirators.  They will be assigned to evaluate possible VRI cases.  They shall follow full VRI personal protection guidance in such cases.
2.Only selected, trained, and fit-tested staff will be assigned to VRI patient care (including designated ancillary personnel).
3.A selected, trained, and fit-tested team with access to the highest levels of respiratory protection will be designated as the response team for emergency resuscitation of known or potential VRI patients.

Patient Placement

1.All Emergency Department, CCU/ICU and Respiratory staff has been fit-tested for N-95 respirators.  They will be assigned to evaluate possible VRI cases.  They shall follow full VRI personal protection guidance.
2.Patients being admitted with VRI shall be placed on 8 or 9 Central (9 being the first choice) or to an isolation room dependant on the number of VRI patients (see attached list of Isolation Rooms).

RECOVERY

Surveillance

1.Active surveillance for healthcare workers providing care to VRI patients will be performed daily.
2.Monitor all healthcare worker absenteeism and illnesses; evaluate link to known VRI cases.
3.Monitor and evaluate all new fevers and respiratory illnesses in patients and healthcare workers.  Anyone with unexplained fevers or any respiratory illness will be placed on VRI precautions, and evaluated in accordance with the VRI evaluation algorithm (see attached).

Healthcare worker restrictions

1.Healthcare workers  shall notify the Employee Health and Wellness department and have daily symptoms checks, if:
They are caring for a VRI patient in another facility
They are also working in another facility that has reported nosocomial SARS-CoV/Flu transmission.
They have close contact with VRI patients outside the hospital.
There will be no eating or drinking in VRI patient care areas.

2.Personnel with unprotected exposures to a VRI patient during high risk procedures shall be furloughed and daily checks instituted to evaluate possible symptoms.
3.Healthcare workers with other (non-high risk) unprotected exposures to a VRI patient shall have daily checks to evaluate for possible symptoms.  If symptoms should develop, furlough will be considered.

Nosocomial transmission has occurred and the nosocomial cases have NO clear identified source (unlinked transmission).

MITIGATION
Triage Activities/facility access controls

1.Notify the Infection Control Coordinator or designee of any transfers from facilities that do have VRI cases.

2.Instruct all patients with respiratory symptoms to wear a surgical mask (if not contraindicated).  Manage these patients with droplet precautions until determined that the cause of symptoms is not an infection that requires droplet precautions.  Instruct patients who cannot wear a mask to cover the nose and mouth with tissues when coughing or sneezing.

PREPAREDNESS

3.In the presence of known cases of VRI worldwide but no known SARS-CoV/Flu transmission in the area around the facility:
1.Place signs at all entry points detailing symptoms of and any current epidemiologic risk factors for VRI.  Signs should direct any person meeting these criteria to the Emergency Department Isolation Room for evaluation.
2.Initiate screening of patients on entry to the emergency department for symptoms and epidemiologic links suggesting VRI.  Patients with febrile illness and epidemiologic risks should perform hand hygiene, wear a surgical mask, and be placed on airborne precautions.  Cohorting, with all patients wearing surgical masks, shall be established if airborne isolation is not possible.
3.Intake/triage staff shall practice frequent hand hygiene and wear surgical masks during respiratory season.

RESPONSE

4.In the presence of known SARS-CoV/Flu transmission in the area around the facility:

Actively screen all persons entering the facility for symptoms; all persons shall be required to perform hand hygiene upon entry to the facility.

Instruct all patients presenting with febrile illness or respiratory symptoms to wear a surgical mask and place them in airborne precautions.  All patients wearing masks shall be cohorted.

Intake/triage staff shall follow full VRI personal protection guidance.

No Visitation will be allowed unless necessary for translation and/or minor children; visitors shall receive Infection Control Training.

Maintain a log of all visitors to VRI patients to aid in contact tracing.

Specific VRI patient-flow routes shall be from the Emergency Department to Elevator 1 to 8 or 9 Central or to an isolation room dependant on the number of VRI patients (see attached list of Isolation Rooms).  If movement is needed for procedures, the same route will be followed with VRI Personal Protection Guidance.

Rooms housing VRI patients shall receive terminal cleans.

Limit elective admissions/procedures.

All visitors and healthcare workers shall have a fever check and perform hand hygiene on entry.

MCH shall be closed to admissions and transfers.

Designated personnel

1.All Emergency Department, CCU/ICU and Respiratory staff has been fit-tested for N-95 respirators.  They will be assigned to evaluate possible VRI cases.  They shall follow full VRI personal protection guidance.
2.Only selected, trained, and fit-tested staff will be assigned to VRI patient care (including designated ancillary personnel).
3.A selected, trained, and fit-tested team with access to the highest levels of respiratory protection will be designated as the response team for emergency resuscitation of known or potential VRI patients.
4.All persons in the facility shall wear surgical mask when not providing patient care (this is not meant to serve as VRI PPE but to limit the transmission if anyone has VRI).  When in contact with VRI patients, all persons should wear VRI PPE.

Patient Placement

1.All Emergency Department, CCU/ICU and Respiratory staff has been fit-tested for N-95 respirators.  They will be assigned to evaluate possible VRI cases.  They shall follow full VRI personal protection guidance.
2.Patients being admitted with VRI shall be placed on 8 or 9 Central or to an isolation room dependant on the number of VRI patients (see attached list of Isolation Rooms).
3.Cohorting of patients and staff to care for them shall be as follows:

Afebrile patients with no close VRI contact � Discharge as soon as medically indicated.

Afebrile patients with close VRI contact � discharge with contact restrictions and Ector County Health Department follow-up per their quarantine policy.
Febrile or symptomatic patients not meeting case definition
Patients meeting case definition.

RECOVERY

Surveillance

1.Active surveillance for healthcare workers providing care to VRI patients will be performed daily.
2.Monitor all healthcare worker absenteeism and illnesses; evaluate link to known VRI cases.
3.Monitor and evaluate all new fevers and respiratory illnesses in patients and healthcare workers.  Anyone with unexplained fevers or any respiratory illness will be placed on VRI precautions, and evaluated in accordance with the VRI evaluation algorithm (see attached).

Healthcare worker restrictions

1.Healthcare workers  shall notify the Employee Health and Wellness department and have daily symptoms checks, if:

They are caring for a VRI patient in another facility

They are also working in another facility that has reported nosocomial SARS-CoV/Flu transmission.

They have close contact with VRI patients outside the hospital.

There will be no eating or drinking in VRI patient care areas.

2.Personnel with unprotected exposures to a VRI patient during high risk procedures shall be furloughed and daily checks instituted to evaluate possible symptoms.
3.Healthcare workers with other (non-high risk) unprotected exposures to a VRI patient shall have daily checks to evaluate for possible symptoms.  If symptoms should develop, furlough will be considered.
4.Dependant on staffing issues, either:

Implement home/work restrictions all healthcare workers in the facility, or

Restrict movement to work and home for all healthcare workers who have worked in an area of the facility where nosocomial transmission has occurred.

US Patent Numbers 7,720,998 B2, 7,836,207