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Patient Care Checklist
This checklist is intended for use by hospital staff treating anyone with a medically suspected or confirmed case of new influenza A (H1N1) per local definition. This checklist highlights areas of care critical for the management of new influenza A (H1N1).
It is not intended to replace routine care.
UPON ARRIVAL TO CLINICAL SETTING/TRIAGE
BEFORE PATIENT TRANSPORT/TRANSFER
BEFORE ENTERING DESIGNATED AREA
Direct patient with flu-like symptoms to designated waiting area Put medical/surgical mask on patient if available and (isolation room or cohort)
Provide instruction and materials to patient on respiratory Put medical/surgical mask on patient if available and BEFORE EVERY PATIENT CONTACT
BEFORE LEAVING DESIGNATED AREA
(isolation room or cohort)
UPON INITIAL ASSESSMENT
Remove any personal protective equipment (gloves, gown, mask, Record respiratory rate over one ful minute and oxygen Put on eye protection, gown and gloves if there is risk of exposure to body fluids/splashes Dispose of disposable items as per local protocol If respiratory rate is high or oxygen saturation is below 90% Clean and disinfect personal/dedicated patient Clean and disinfect dedicated patient equipment and personal Record history, including flu-like symptoms, date of onset, travel, Change gloves (if applicable) and clean hands equipment that has been in contact with patient contact with people who have flu-like symptoms, Dispose of viral-contaminated waste as clinical waste Consider specialized diagnostic tests (e.g. RT-PCR) IF USING AEROSOL-GENERATING PROCEDURES
Use medical/surgical mask, eye protection, gloves when taking ALSO (e.g. intubation, bronchoscopy, CPR, suction)
BEFORE DISCHARGE OF CONFIRMED
Label specimen correctly and send as per local regulations with OR SUSPECTED CASE
Consider alternative or additional diagnoses Provide instruction and materials to patient/caregiver on Report suspected case to local authority (e.g. EU FFP2, US NIOSH-certified N95) if available Put on eye protection, and then put on gloves Provide advice on home isolation, infection control and limiting Perform planned procedure in an adequately ventilated room Record patient address and telephone number INITIAL AND ONGOING PATIENT MANAGEMENT
Supportive therapy for new influenza A (H1N1) patient as for any
BEFORE PATIENT ENTRY TO DESIGNATED AREA
AFTER DISCHARGE
Give oxygen to maintain oxygen saturation above 90% or if (isolation room or cohort)
respiratory rate is elevated (when oxygen saturation monitor not Dispose of or clean and disinfect dedicated patient equipment as Post restricted entry and infection control signs Provide dedicated patient equipment if available Give paracetamol/acetaminophen if considering an antipyretic Change and launder linen without shaking Ensure at least 1 metre (3.3 feet) between patients in cohort Give appropriate antibiotic if evidence of secondary bacterial Dispose of viral-contaminated waste as clinical waste Ensure local protocol for frequent linen and surface cleaning in Consider alternative or additional diagnoses *# See instructions on the back side for additional information and references. Decide on need for antivirals* (oseltamivir or zanamivir), Equipment on this checklist is recommended if available.
considering contra-indications and drug interactions This checklist is not intended to be comprehensive.
Additions and modifications to fit local practice
are encouraged.
ABOUT THIS CHECKLIST
GLOSSARY OF SELECTED CHECKLIST TERMS
The WHO Patient Care Checklist: new influenza A (H1N1) is intended for use by hospital staff treating a patient with a Clean hands: Hands can be cleaned either by handwashing with soap and water or by handrubbing with an alcohol-based
medically suspected or confirmed case of new influenza A (H1N1). This checklist combines two aspects of care: i) clinical handrub formulation. The preferred technique while caring for suspected or confirmed cases of new influenza A (H1N1) is management of the individual patient and ii) infection control measures to limit the spread of new influenza A (H1N1). handrubbing, unless hands are visibly soiled. Hands must be cleaned at five key moments: 1) before touching a patient; 2) before clean/aseptic procedure; 3) after body fluid exposure risk; 4) after touching a patient; and 5) after touching patient surroundings. WHO Patient Safety Checklists are practical and easy-to-use tools that highlight critical actions to be taken at vulnerable Designated area (isolation room / cohort): The placing of patients either colonized or infected with the same pathogen
moments of care. They are produced in a format that can be referred to readily and repeatedly by staff to help ensure that in one designated area. It is specifical y used when single or isolation rooms are not available. It al ows for identified health-care all essential actions are performed. WHO Patient Safety Checklists are not comprehensive protocols and are not intended to workers to provide care to these specific patients with the aim of trying to prevent spread of infection to others. Patients with confirmed infection should ideal y be in a separate cohort to those with suspected infection.
Cough etiquette: Health-care workers, patients and family members should cover mouth and nose (e.g. with a tissue)
How to use the checklist
when coughing or sneezing. If a tissue is used, discard it in a bin with a lid and then clean hands. Cough etiquette should be Staff can use this checklist in a variety of ways - ticking the boxes is optional. The objective is to ensure that no critical patient care communicated to patients through posters and leaflets. items are missed during or immediately fol owing care. Separate waiting area: Waiting area for symptomatic persons should be separate from general waiting area. This can be a
separate part of the general waiting area as long as there is at least one metre (3.3 feet) distance between the designated area - used as part of the patient’s clinical record; and the regular waiting area. Maintain at least one metre between symptomatic patients within this designated area. - reproduced as wal posters for hospitals or clinics; or Eye protection: This can either be an eye visor, goggles, or a face shield. Conventional eye glasses are not designed to protect
- printed up as cards for staff members to carry around with them. against splashes to eye mucosa and should not be used as eye protection.
Flu-like symptoms: Fever, cough, headache, muscle and joint pain, sore throat, runny nose, and sometimes vomiting and diarrhoea.
Parts of the checklist can also be extracted for use in any of these formats. Gown: A clean, non-sterile long-sleeved gown.
This checklist does not replace clinical guidance or clinical judgment. Its users should also familiarize themselves with the relevant Infection control guidance to patient/caregiver on discharge: If patient stil symptomatic or if patient less than one year
WHO guidance documents referenced below, which were used in the development of the checklist. old (Patients less than one year old may continue to be infectious for three weeks after cessation of symptoms): • Patient quarantined: the sick person should be placed in a separate room and should have limited social contact. Local modification
• Instruction on cough etiquette. • Al persons in the household should perform hand hygiene frequently and after every contact with the sick person. The WHO Patient Care Checklist: new influenza A (H1N1) may be reformatted or revised to accommodate local practice. • The caregiver should wear the best available protection to prevent exposure to respiratory secretions, and avoid contact with Facilities and individuals are cautioned, however, against making the checklist too complex.
body fluids or contaminated items; minimize close (less than 1 metre) and face-to-face contact with the patient; perform hand hygiene when indicated. Related guidance
Medical/surgical masks: Procedure or surgical masks to protect the wearer’s nose and mouth from inadvertent
Guidance relating to infection control:
exposures (e.g. splashes).
Particulate respirator: A special type of fit-tested mask with the capacity to filter particles to protect against inhaling
Infection prevention and control in health care in providing care for confirmed or suspected A (H1N1) swine influenza patients infectious aerosols (e.g. EU FFP2 and US NIOSH-certified N95). Interim guidance (Publication date: 29 April 2009) http://www.who.int/csr/resources/publications/infection_control/en/index.html Respiratory hygiene: See cough etiquette
Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. WHO Interim Guidelines (Publication date: June 2007) http://www.who.int/csr/resources/publications/WHO_CD_EPR_2007_6/en/ #RESPIRATORY RATE
Guidance relating to clinical management:
CHECKLIST
Clinical management of human infection with new Influenza A (H1N1) virus (Publication date: 21 May 2009) RESPIRATORY
DEVELOPMENT PROCESS
http://www.who.int/entity/csr/resources/publications/swineflu/clinical_managementH1N1_21_May_2009.pdf *Currently there are a lack of data on the clinical effectiveness of antivirals for this disease. Antiviral drugs are to be used In response to the pandemic threat by a new influenza A (H1N1) strain, the checklist according to national pandemic influenza preparedness plans. If antivirals are prescribed, oseltamivir or zanamivir should be used development process began on 30 April 2009. The checklist development group in the for influenza A (H1N1) patients because of increased risk of the resistance with other antivirals. Where antiviral drugs are available WHO Patient Safety Programme col aborated with technical experts in WHO Health for treatment, clinicians should make decisions based on assessment of the individual patient’s risk. Risks versus benefits should Security and Environment. They consulted experts in three areas: i) infection control, also be evaluated on a case-by-case basis. i ) clinical management of pandemic-prone Influenza, and i i) health care checklists. The design and content of the checklist were developed iteratively through successive Such guidance may be updated as the situation evolves. For the most up-to-date guidance on the checklist and other documents, rounds of consultation. Clinical teams in a number of settings tested its clarity and refer to the WHO web site (www.who.int) or contact your WHO country office. usability. Its use in clinical practice wil be the subject of ongoing evaluation.

Source: http://www.anselleurope.com/ansell/media/digital%20assets%20library/ah1n1_checklist.pdf