Health and Safety
H1N1 Flu Watch
November 4, 2009 H1N1 Influenza
Update
H1N1 influenza is now circulating everywhere throughout the
province and is affecting many OPSEU members where they work, at home and in the
community. Many members are turning to their union for information and
assistance to address work-related concerns about influenza. Following are some
of the most commonly raised concerns and some useful sources of additional
information:
I work in a Correctional or Youth Justice facility where
H1N1 influenza vaccine is being offered to inmates or youth but not to staff. Is
that the right approach?
OPSEU says this is the wrong approach. Correctional Officers,
Youth Service Officers and other staff work in the same environment where
inmates and youth live, and their duties often require them to be in close
proximity to inmates or youth. Many inmates and youth are at high risk of
contracting influenza and other infectious illnesses because their underlying
health status is poor, hygiene conditions in the facilities are often not
optimal, and their living environments are often very crowded. These same
conditions also put staff at risk. It is OPSEU’s position that Correctional
facilities and Youth Justice facilities should be offering H1N1 influenza
vaccine to staff at the same time as vaccine is being offered to inmates or
youth.
OPSEU members, through their Joint Health and Safety Committees,
should strongly encourage their employers to request the Ministry of Health and
Public Health Units to release vaccine that can be offered to employees at risk.
I work in a Correction or Youth Justice facility where we
have a local pandemic influenza plan, but there is a lot of confusion about how
to implement it. What should I do?
OPSEU members in these facilities should request that their
Joint Health and Safety Committee have an urgent meeting to review their
pandemic flu plan in light of the current influenza situation in the province
and their facility. Local Infection Prevention and Control Committees should
also be involved in this discussion. Areas to be considered are: screening of
new admissions for Influenza-Like Illness (ILI); screening of other
inmates/youth for ILI if an inmate/youth develops flu symptoms; staff
self-screening for flu symptoms; encouraging staff to stay home when ill with no
reprisals from employers; where inmates/youth will be housed while awaiting
medical assessment and when they are diagnosed with flu; issues around personal
protective equipment such as availability, accessibility, respirator fit-testing
and training; and, communication to staff about health and safety measures and
changes to measures.
The Ministry of Health and Long Term Care (MOHLTC) has released
two new guidance documents for Corrections and Youth Justice Centres which
provide useful information. Links to these documents are below.
I work in a Developmental Services home where two of our
residents have been diagnosed with influenza. Although one has been transferred
to hospital, we are caring for the other resident in the home. What should staff
do?
OPSEU members in Developmental Services workplaces should be
requesting that their JHSC or Health and Safety Representative have an urgent
meeting to discuss measures and procedures to protect staff from influenza in
the workplace. If employers refuse to meet or say that pandemic planning is not
a health and safety issue, remind them that their obligations under Sections 8
and 9 of the Regulation for Health Care and Residential Facilities require
employers to consult with the JHSC or Health and Safety rep when developing
measures and procedures to protect staff from infectious illnesses.
Some workplaces have pandemic influenza plans or emergency plans
while others do not. Plans should address issues such as: screening of residents
for ILI; screening of staff for ILI; encouraging staff to stay home when ill
with no reprisals from employer; where sick residents will be housed; additional
hygiene measures to reduce risk of exposure to influenza; issues around personal
protective equipment such as availability, accessibility, respirator fit-testing
and training; and, communication to staff about health and safety measures and
changes to measures.
Although the MOHLTC has not developed guidance specifically for
Developmental Services workplaces, it has released guidance for Long Term Care
and for Home Care workers which will provide useful tips relevant to DSS
workplaces. Links are below.
Additionally, the MOHLTC has adopted the following definition of
health care worker from the Canadian Immunization Committee for the purposes of
priority access to H1N1 vaccine: “Healthcare workers including hospital
employees, other staff who work or study in hospitals (e.g. students in health
care disciplines and contract workers), other health care personnel (e.g. those
working in clinical laboratories, nursing homes, and home care agencies), and
child care workers are at risk of exposure to communicable diseases because of
their contact with patients or material from individuals with infections, both
diagnosed and undiagnosed.” The definition includes “regulated and unregulated
professionals” and those who “provide direct/indirect patient care.” Health care
workers are considered to be a priority group to receive vaccine before the
general public. OPSEU believes this definition should include DSS workers as
well and encourages members in this sector to insist that they are offered the
vaccine as a priority group.
I work in an office and one of my co-workers in the next
cubicle went home sick today with influenza symptoms. What should I do?
Wherever you work, your employer should have developed a
pandemic influenza or emergency management plan. JHSCs and Health and Safety
reps should have had input into the measures and procedures in the plan to
protect workers. JHSCs and Health and Safety reps should strongly encourage a
meeting with employer representatives to either review the existing plan or to
develop a plan with measures and procedures including an effective communication
strategy to protect and inform workers.
It is believed that influenza is primarily spread through large
droplets that directly contact a person’s nose, mouth or eyes. These droplets
are produced when an infected person coughs, sneezes or talks sending infectious
droplets into the air. Influenza may also be spread when a person touches an
area contaminated with influenza viruses and then touches their nose, mouth or
eyes. In a workplace where a worker has been working with H1N1, it would be
advisable to wipe down commonly used areas with disinfectant wipes to reduce the
risk of contact transmission. It is a good practice in general, even if no one
is ill, to implement good cleaning practices to ensure that commonly touched
items such as door handles, telephones, and counters are cleaned regularly.
Workers should be encouraged to practice frequent hand hygiene using soap and
water or alcohol-based hand cleanser.
In an office setting where a worker has contracted influenza, it
would be advisable to alert staff to be vigilant about their own health since
they may have been exposed to the virus. Staff who develop flu symptoms should
be encouraged to stay home with no reprisals from the employer.
The MOHLTC has useful guidance on how to stay healthy and how to
do a self-assessment for influenza symptoms. Additionally, the U.S. Department
of Labour has published a valuable document to assist workplaces prepare for an
influenza pandemic which contains guidance for office settings as well as other
higher risk workplaces. See links below.
I am pregnant (or have a serious underlying health
condition) and my doctor has advised me to try to avoid exposure to people with
H1N1 until I can be vaccinated. What should I do?
If you have a medical reason supported by a doctor’s note to
request a workplace accommodation you should follow the regular procedure used
by OPSEU members in your workplace when they request an accommodation. Different
OPSEU locals follow different processes when assisting members with
accommodation issues. Some locals have an Accommodation Committee to assist
members while in others, stewards, a member of the Local Executive or an OPSEU
member of the JHSC may assist. Advise your supervisor that you will be
requesting an accommodation and contact your Local steward, executive member or
health and safety representative to discuss how a safe accommodation could be
arranged and to schedule a meeting with your employer.
I’ve heard that doctors’ offices are too busy to book
appointments for people who need a doctor’s note before returning to work after
having the flu. Is that true and if so, what should I do when my employer
demands that I provide a doctor’s note?
Some employers have decided to relax the requirement for workers
to provide doctors’ notes during this time. In a recent press release, the
Ontario Medical Association encouraged employers to reconsider asking their
employees for a sick note from a physician because of an absence from work. “In
order to help reduce the transmission of H1N1 and other illnesses, Ontario’s
doctors believe it is wise for patients to stay home when they have flu-like
symptoms,” said Dr. Suzanne Strasberg, President of the OMA. “Employers need to
recognize that by requiring a sick note, they are encouraging those who are
experiencing their worst symptoms and are most infectious to go out, when they
should just be home in bed.”
The OMA statement goes on to note that people with mild flu
symptoms who do not need medical care may place others at risk if they come to
the doctor’s office just to get a note. Additionally, the OMA states that during
this time, doctors’ resources are better spent focusing on patients who need
their care, rather than producing notes to satisfy employer policies.
Locals and individual OPSEU members should inquire whether their
employers will relax current requirements to produce doctors’ notes while the
pandemic is creating huge demands on our health care system.
H1N1 Resources
October 23, 2009 H1N1 Influenza
Update
The Ministry of Health and Long-Term Care (MOHLTC) has released
updated clinical guidelines for Long-Term Care Settings, Ambulatory Care and
Emergency Departments.
In all three guidance documents, occupational health and safety
and infection prevention and control advice continues to take a precautionary
approach recommending ongoing screening for influenza like illnesses (ILI), good
hand hygiene, and appropriate use of personal protective equipment, including
N95 respirators where necessary. Section five of each document contains the
updated Infection Prevention and Control/Occupational Health and Safety
guidance.
Long-Term Care settings
Key health and safety/infection prevention and control measures
recommended are:
-
Passive screening (signage at the entrance) should continue;
advising persons not to enter if they have ILI symptoms.
-
Daily screening of residents for ILI.
-
Healthcare providers should continue to self-screen for ILI
and should not come to work if they are ill.
-
Healthcare providers caring for or assessing
patients/residents with ILI should wear gloves, gowns (if hazard of skin or
clothing contamination), eye protection, and fit-tested N95 respirators.
-
Coughing residents should be instructed to wash their hands,
cover mouth and nose with a surgical mask if possible and be placed in a
separate room or stay 2 metres away from others while awaiting assessment.
Ambulatory Care settings
Key health and safety/infection prevention and control measures
recommended are:
-
Encourage patients to self-screen at home for ILI and screen
patients by phone when making appointments.
-
Screen patients for ILI at reception using either signage or
by receptionist.
-
Patients with ILI symptoms should be asked to wear a
surgical mask and, if possible, stay at least 2 metres away from others or
in a separate room while awaiting assessment.
-
Healthcare providers should continue to self-screen for ILI
and should not come to work if they are ill.
-
Healthcare providers performing clinical assessments of
patients with ILI should wear gloves, gowns (if hazard of skin or clothing
contamination), eye protection, and fit-tested N95 respirators.
-
Coughing patients should be instructed to wash their hands
and cover mouth and nose with a surgical mask
Emergency Departments
Key health and safety/infection prevention and control measures
recommended are:
-
Active screening (screening by a person) of patients for ILI
symptoms using Febrile Respiratory Illness screening tool.
-
Patients with fever or other ILI symptoms to be advised to
wear a surgical mask and to be placed in separate room or remain at least 2
metres away from others while awaiting assessment.
-
Healthcare providers should continue to self-screen for ILI
and should not come to work if they are ill.
-
All Emergency room staff within 2 meters of ILI patients
should wear fit-tested N95 respirators and eye protection.
-
Healthcare providers performing clinical assessments of
patients with ILI should wear gloves, gowns, eye protection, and fit-tested
N95 respirators.
New October 14, 2009 Important Health
Notice:
http://www.health.gov.on.ca/english/providers/
program/emu/health_notices/ihn_20091014.pdf
New Long Term Care guidelines:
http://www.health.gov.on.ca/en/ccom/flu/h1n1/
pro/docs/ltc_guidance.pdf
New Ambulatory Care guidelines:
http://www.health.gov.on.ca/en/ccom/flu/h1n1/
pro/docs/ambulatory_guidance.pdf
New Emergency Department guidelines:
http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro
/docs/emergency_guidance.pdf
September 30, 2009 H1N1 INFLUENZA UPDATE
Overview
Flu season is fast-approaching and everyone is
wondering how different it will be this year given that the H1N1
influenza is now the main type of flu circulating in our communities
and workplaces. Researchers and scientists are looking to the
Southern Hemisphere for answers, as countries they are just emerging
from their winter flu season where H1N1 was the predominant flu
virus.
The U.S. Centres for Disease Control and Prevention
(CDC) reports that there were no changes to the epidemiology (the
causes, transmission and control) of the H1N1 virus in the Southern
Hemisphere during their winter. The virus behaved much as it did in
Canada and the U.S. this spring. Also, researchers and scientists
can see no significant changes to the virus itself, since its first
appearance. In the temperate regions of the Southern Hemisphere,
disease caused by H1N1 is declining, although it continues to infect
substantial numbers in tropical regions. These observations are good
news for us. This should mean that while the virus will probably
continue to spread rapidly here because so few people have ever been
exposed to a similar virus, in most cases it is not making people
sicker than usual seasonal influenza. Overall, mortality rates from
H1N1 are no higher than for seasonal influenza.
Those who appear to be at greatest risk of
contracting H1N1 influenza are younger people. By the end of August,
Ontario reported that more than half the cases of confirmed H1N1
influenza were under 20 years old. This is unlike seasonal
influenza. Those who appear to be at greatest risk of getting very
ill and developing complications are pregnant women and those with
other health conditions such as heart or lung disease, diabetes,
cancer, immune suppression and morbid obesity. Pregnant women do not
appear to be at any greater risk of contracting the illness, but
they do appear to suffer more complications from it. People living
in remote and isolated communities such as native reserves appear to
be at higher risk of contracting influenza and developing
complications. It appears that people born before 1957 have some
immunity to the illness.
In the weeks ahead, we expect to see increasing
numbers of people contract H1N1. This will affect workers, their
families, and workplaces. There continue to be unanswered questions
and confusion over issues such as vaccines, the use of antiviral
drugs such as Tamiflu, how to determine whether a case of H1N1
influenza is work-related, and what precautions to take in which
circumstances.
Following are some frequently asked questions and
topics raised by OPSEU members:
What’s happening with flu vaccines this year,
especially in health care workplaces?
Seasonal flu vaccine: For a number of years Ontario
has been promoting seasonal flu vaccine by running free flu vaccine
clinics in various settings. In health care workplaces, employers
have strongly encouraged workers to be vaccinated, and in cases of
flu outbreaks, Medical Officers of Health have at times ordered
employers to send unvaccinated employees home to reduce transmission
of influenza among vulnerable patient populations. This year it’s
different. On September 24, the province announced that in October
it will provide seasonal flu shots only to people aged 65 and over
and to residents of long-term care homes. Seasonal flu vaccine will
not be available to the rest of the population until December or
January
The province explains that this decision is based on
a potential association between seasonal flu vaccines given in
previous years and an increased risk of getting infection with H1N1
virus. This potential association was observed in Ontario, BC and
Quebec in recent months; however this experience has not been
reported in countries that have just come through their flu season
or anywhere else. Whether or not this preliminary research is
accurate, it probably makes sense not to widely promote the seasonal
flu vaccine at this time anyway, given that H1N1 will probably be
the main circulating flu this winter and seasonal flu vaccine will
have no effect on H1N1 transmission.
H1N1 influenza vaccine: The province expects to have
H1N1 vaccine available for distribution by November. It is following
recommendations published by the Public Health Agency of Canada and
will first offer the new vaccine to the following groups of people
presumed to be at greater risk of either contracting the illness or
developing more serious complications:
-
People with chronic
medical conditions under age 65
-
Pregnant women
-
Healthy children from
6 months to 5 years old
-
Persons living in
remote and isolated settings or communities
-
Health care workers
involved in pandemic response or the delivery of essential
health care services
-
Household contacts and
care providers of persons at high risk who cannot be immunized
or may not respond to vaccine
There is no indication yet how health care employers
will respond to these new directives. It may be that for workplaces
that have a seasonal flu vaccine immunization policy and program, it
will be applied to H1N1 vaccines. However, given the newness of the
vaccine, ongoing discussion about whether one dose or two will
confer immunity, the role that age may play in vaccine uptake and
natural immunity, there are clearly more questions than answers
surrounding the expected vaccination campaigns in workplaces. Local
unions and their Joint Health and Safety Committee members should
begin to investigate and initiate discussions with employers about
these issues.
What’s happening with Tamiflu? My employer says it
will provide Tamiflu to workers to prevent influenza.
The provincial government has stockpiled enough
antiviral drugs, a combination of Tamiflu and Relenza, to treat 25
percent of the population if they contract influenza. OPSEU is aware
that some employers, particularly in the health sector have also
stockpiled large quantities of Tamiflu, which they plan to
distribute to employees in some circumstances.
The OPSEU Health and Safety Unit has received
reports from some workplaces where employers are planning to either
offer or request employees to take Tamiflu as a prevention measure
even though they may not have been exposed to influenza. Currently,
no provincial or federal government or public health institution is
recommending the long-term use of antivirals such as Tamiflu for
prevention (prophylactic) purposes. Canadian and U.S. health
authorities, at this time recommend the use of antivirals for
treating influenza, not preventing it. Very little is known about
the effects of long-term use of Tamiflu or other antivirals.
Additionally, there are concerns that overuse of Tamiflu may
contribute to H1N1 becoming resistant to the drug.
If your employer is proposing a program to offer
prophylactic use of Tamiflu, seek advice from your own physician and
ensure that your Joint Health and Safety Committee has been
consulted about the program. Your employer cannot force you to take
Tamiflu or any other antiviral.
My employer says that since H1N1 influenza is not
very severe, we don’t need to wear N95 respirators when caring for
patients with H1N1 influenza. Is that correct?
Good scientific evidence continues to mount
demonstrating that fit-tested N95 respirators protect wearers from
exposure to influenza viruses. In September, a study of 2,000
hospital workers in Beijing was published which demonstrated that
N95 respirators reduced the risk of respiratory illness by 60
percent and the risk of confirmed influenza by 75 percent. Surgical
masks worn by workers were shown to have no effect in reducing
illness. This study was published just after the U.S. Institute of
Medicine released a report to the CDC which affirmed existing CDC
guidance that health care workers caring for H1N1 influenza patients
should wear fit-tested respirators, not surgical masks.
In Ontario, guidance from the Ministry of Labour,
Important Health Notices from the MOHLTC and our provincial pandemic
influenza plan, all call for workers in the health care sector
caring for patients with H1N1 influenza or patients suspected of
having H1N1 to wear fit-tested N95 respirators.
If you work in a health care or other workplace
where a risk assessment demonstrates that workers are at risk of
being exposed to airborne infectious illnesses such as pandemic
influenza or Tuberculosis, your employer should have implemented a
Respiratory Protection Program which includes fit-testing
respirators, purchasing adequate supplies and worker training on the
use and care of respirators. If you are expected to use an N95
respirator and your employer does not have a Respiratory Protection
Program in place, advise your local union and your JHSC, and ask for
assistance.
My employer says that since H1N1 influenza is being
spread in the community, I shouldn’t file a WSIB claim even if I
think I caught the illness at work. Is that correct?
No, that is not correct. While it is believed that
H1N1 influenza will be the predominant circulating influenza this
fall and winter, workers in some workplaces or those who perform
some duties may be at greater risk of contracting influenza because
of their work. For example, a worker in a long-term care home where
there is an influenza outbreak among the patients, or an admitting
clerk or a technologist in a hospital who is exposed to large
volumes of potentially ill clients daily, will probably be at
greater risk of contracting influenza at work than an office worker
who has no public contact with ill people. Workers in day care
centres and schools may also be at greater risk.
It is not possible to predict how the WSIB will
adjudicate claims for work-related H1N1 influenza. As with any WSIB
claim, whether for an illness or injury, the worker will be expected
to demonstrate the link between her/his work and the illness. If you
or one of your members believes that they have contracted H1N1
influenza because of a work-related exposure, then a WSIB claim
should be made. If WSIB denies a claim for H1N1 influenza, consult
with OPSEU for advice and possible assistance with an appeal of the
decision.
Next Steps
OPSEU continues to advise local JHSCs and Health and
Safety Reps to review your employer’s pandemic influenza or
emergency plan to ensure that it is adequate to meet workplace needs
in this oncoming influenza season. Whether you work in a health care
workplace, a correctional facility, an office, a store, a college, a
group home, with the public or in isolation, your workplace should
have a pandemic influenza plan that addresses health and safety
concerns of workers.
In each type of workplace, different measures and
procedures may be appropriate. Hand-washing stations, maintaining
social distancing, not coming to work ill and good cough and cold
etiquette may be all that’s needed in one workplace, while other
workplaces may consider erecting barriers between public and staff.
Other workplaces where patients with influenza are cared for may
need much more protective precautions as well as staff training.
There are numerous excellent resources you and your JHSC or your
Health and Safety Rep can turn to. Here are a few:
June 12, 2009 H1N1 INFLUENZA UPDATE
On June 11, 2009, the World Health
Organization (WHO) raised the global pandemic level
from Phase 5 to Phase 6 signalling that a global
pandemic is underway with sustained human to human
transmission in several WHO countries. To countries
with no H1N1 cases yet, this means that spread to
their country is imminent, but to Canada, the
influenza has already been spreading for some time.
As of June 11, 2009 there were 1 638 confirmed cases
of H1N1 Influenza in Ontario. Ten people who have
the H1N1 flu virus were in hospital as of June 9, a
number of whom have underlying medical
conditions.
The WHO decision is based upon
geography rather than severity of the illness,
therefore the decision does not mean anything new in
Ontario at this point. Following the WHO
announcement on June 11, 2009, Ontario MOHLTC issued
a new health notice explaining impact of the
announcement in Ontario, that existing guidelines
and reduction to lab testing for non-high risk
individuals will continue unchanged.
Since most cases in Ontario remain
mild and are being considered equivalent to the
regular flu, Ontario is attempting to turn its focus
from identifying mild cases (and focusing on counts)
to focusing on prevention of spread and monitoring
for severity and ensuring that those individuals
under 2, over 65, or with underlying medical
conditions receive priority for lab testing and
obtain appropriate care. This approach will ensure
that Ontario remains ready to respond with its ready
pandemic plan should the H1N1 become more severe and
it also means that severe cases receive faster
attention and treatment.
OPSEU members should continue to be
vigilant in their workplaces to ensure that
precautions are in place to prevent spread of H1N1
and that the guidelines for Emergency Departments,
Ambulatory Care, and Long-Term Facilities are being
adhered to. The changing focus in lab testing means
that many mild cases of H1N1 will no longer be
specifically diganosed, therefore we need to assume
that the numbers will be under-estimated and use
precautions wherever we go, and ensure
that workplaces adopt precautions that prevent
spread. While basic precautions include
hand-washing, disinfectant, staying home if sick,
signage, passive monitoring, and good housekeeping,
there are other recommendations that OPSEU Joint
Health and Safety Committees or health and safety
representatives might make to enhance prevention.
Examples include suggesting ways to change the work
process to prevent spread, such as conference
calling instead of meeting, or re-defining work
priorities in ways that make sense in
particular workplaces.
Below are the most current
documents:
NEW! June 11, 2009
Important Health Notice
Guidance for Management of Patients with Influenza-like Illness
(ILI) in Ambulatory Settings
Guidance for Management of Patients with Influenza-like Illness
(ILI) in Emergency Departments
Important Health Notice
Quick Reference: May 19th Updates to H1N1 Flu Virus Guidance
Documents (these are now replaced for ambulatory and emergency
management in the above two documents, but is still useful for
guidance in long term care settings)
Guidance for Influenza-like-illness (ILI) Management in Long
Term Care (LTC)
Screening Tool for Influenza-like-illness (ILI) in Health Care
Settings (both ambulatory and emergency)
Signage for Ambulatory Settings
Occupational Health and Safety Requirements for the Health Care Sector
Information on the use and fit-testing of N95 Respirators
Ministry of Health and Long Term Care H1N1 Flu Virus
(Human Swine Flu) site has regular updates and links
to other useful sites
Ontario’s Agency for Health Protection and Promotion
provides regularly updated information on H1N1 Flu
(Human Swine Flu)
OPSEU’s “A Healthcare Workers Guide to Pandemic
Influenza”
June 9, 2009 H1N1 INFLUENZA UPDATE
As of June 5, Ontario has confirmed a total of
1078 cases of H1N1 influenza, with 184 of those occurring since
June 3, 2009. While most cases in Ontario remain mild, six
people with the virus are currently hospitalized, and two others
with chronic medical conditions who contracted H1N1 virus have
died.
On June 2, the MOHLTC released “Quick
Reference: May 19th Updates to H1N1 Flu Virus Guidance Documents”
to highlight the changes and updates made May 19th in the
directives for emergency ambulatory settings, emergency
departments, and long term care facilities. The quick reference
guide clarifies what procedures changed and why the changes were
made.
On June 4, Ontario Ministry of Health and Long
Term Care (MOHLTC) issued a health notice announcing the release
of new versions of both Emergency Ambulatory settings and
Emergency Departments’ guidance documents. It appears that
there are no changes being made and no replacement of the
Guidance for Influenza-like-illness (ILI) Management in Long
Term Care. The MOHLTC notice also announces that hours of
operation for the Health Care Provider hotline will be reduced.
Changes in ambulatory and emergency settings
call for a reduction in laboratory testing for H1N1 Influenza
due to the fact that H1N1 is the predominant circulating strain
of influenza in many communities at this time, with most cases
being mild. Specifically, the documents state that health care
providers in ambulatory care settings and emergency departments
should only submit laboratory specimens in cases where lab
results are required for clinical management of hospitalized
cases of influenza-like-illness (ILI) or where patients are at
high risk for complications from influenza (ie immunocompromised,
pregnant, persons under the age of 2 years and over 65 years of
age).
NEW! June 4, 2009
Guidance for Management of Patients with Influenza-like Illness
(ILI) in Ambulatory Settings
NEW! June 4, 2009
Guidance for Management of Patients with Influenza-like Illness
(ILI) in Emergency Departments
NEW! June 4, 2009
Important Health Notice
NEW! June 2, 2009
Quick Reference: May 19th Updates to H1N1 Flu Virus Guidance
Documents (these are now replaced for ambulatory and emergency
management in the above two documents, but is still useful for
guidance in long term care settings)
Guidance for Influenza-like-illness (ILI) Management in Long
Term Care (LTC)
Screening Tool for Influenza-like-illness (ILI) in Health Care
Settings (both ambulatory and emergency)
Signage for Ambulatory Settings
Occupational Health and Safety Requirements for the Health Care Sector
Information on the use and fit-testing of N95 Respirators
Ministry of Health and Long Term Care H1N1 Flu Virus
(Human Swine Flu) site has regular updates and links
to other useful sites
Ontario’s Agency for Health Protection and Promotion
provides regularly updated information on H1N1 Flu
(Human Swine Flu)
OPSEU’s “A Healthcare Workers Guide to Pandemic
Influenza”
Wednesday May 27, 2009 H1N1 INFLUENZA UPDATE
As of May 26, 2009, the total number of H1N1 flu
cases in Ontario is 371. A 44-year old Toronto man with a
chronic pre-existing medical condition passed away on May 23rd.
On May 24th laboratory testing confirmed a positive test for
H1N1 in this individual. It is not clear what role the H1N1
virus played in the fatality which is now under investigation by
the Office of the Chief Coroner.
No new guidance or Important Health Notices have
been issued by the MOHLTC this week. However, the MOHLTC
reported that today it plans to post a clarification document
explaining existing guidance for Ambulatory care, Emergency
departments and Long Term Care. This document is being
developed in response to numerous requests by stakeholders to
interpret guidance documents and to explain the rationale behind
them. At today’s teleconference with MOHLTC, the Ministry
advised that new guidance is also being developed for community
and home care settings. Additionally, it may revise existing
guidance as more information about the spread and virulence of
H1N1 influenza is gathered.
Please continue to watch the OPSEU website and
the links below for updates on H1N1 Influenza:
Ministry of Health and Long Term Care H1N1 Flu Virus
(Human Swine Flu) site has regular updates and links
to other useful sites
Ontario’s Agency for Health Protection and Promotion
provides regularly updated information on H1N1 Flu
(Human Swine Flu)
OPSEU’s “A Healthcare Workers Guide to Pandemic
Influenza”
Wednesday May 20, 2009 H1N1 INFLUENZA UPDATE
Ontario currently has 272 confirmed cases of
N1N1, only 57 of which have a travel history to Mexico or other
affected regions. While a few individuals have been
hospitalized, all cases remain mild and most people have fully
recovered.
Due to the increased person-to-person
transmission and the declining link to travel to Mexico or other
affected regions, a number of guidance documents have been
changed to remove links to Mexico in screening and care, and
other processes are either heightened or remain the same.
Highlights include:
-
Since travel to an affected area is no
longer an appropriate predictor of H1N1influenza infection,
a fit-tested N95 respirator, in addition to droplet and
contact precautions should be used by health care workers
when within 2 metres of caring for all patients with
influenza-like-illness (ILI) in emergency departments,
ambulatory settings and NOW long term care settings. This
is a new development for Long Term Care settings, as the May
19, 2009 guidance upgrades precautions in these settings,
upgrading from using routine contact and droplet precautions
to using fit-tested N95 respirators when caring for patients
with ILI
-
Triage staff in emergency departments should
wear both eye protection (new) and fit-tested N95
respirators when conducting active surveillance of patients
presenting with respiratory symptoms
-
In emergency and ambulatory settings, (and
now long-term care settings), fit-tested N95 respirators
shall be worn when providing care to all patients with ILI,
now regardless of any link to Mexico or any other affected
area
-
All patients presenting to Emergency
departments, receiving care in ambulatory settings, and
attending at long term care facilities should continue to be
actively screened using the updated May 19, 2009 screening
form
-
Passive surveillance continues; signage
shall be posted in ambulatory settings and emergency
departments asking people to self-report symptoms and in
long-term care settings asking them not to enter if
exhibiting symptoms of ILI
-
The requirement in ambulatory settings for a
physical barrier remains (ie. Window or plexi-glass barrier)
or the receptionist should maintain a 2 metre (6 foot)
distance from all patients if possible. New in updated
guidelines; if no barrier exists and a 2 metre distance is
not possible, a fit-tested respirator and eye protection
should be worn
For complete information, review the new
documents below:
New
May 19, 2009,
Important Health Notice—Information for Health Care
Professionals
New
May 19, 2009,
Guidance for Management of Patients with Influenza-like-illness
(ILI) in Emergency Departments
New
May 19, 2009,
Clinical Guidance for Management of Patients with
Influenza-like-illness (ILI) in Ambulatory Settings
New
May 19, 2009,
Signage for Ambulatory Settings
New
May 19, 2009,
Screening Tool for Influenza-like-illness (ILI) in Health Care
Settings (both ambulatory and emergency)
New
May 19, 2009,
Guidance for Influenza-like-illness (ILI) Management in Long
Term Care (LTC)
Other useful
sites:
Occupational Health and Safety Requirements for the Health Care Sector
Information on the use and fit-testing of N95 Respirators
Friday May 15, 2009 H1N1 INFLUENZA UPDATE
As of May 14, 2009, the total number of H1N1flu
cases in Ontario is 155. All of the cases are mild; one person
with H1N1 flu has been hospitalized for other medical reasons.
MOHLTC has released a new fact sheet
"Occupational Health and Safety Requirements for the Health Care
Sector" which describes duties and responsibilities [MORE] of
employers, supervisors and workers under the Occupational Health
and Safety Act and its regulations. All of these obligations
continue during the current influenza outbreak. The
Occupational Health and Safety Act is available at the following
link:
http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90o01_e.htm
A worker who is required by his or her employer
or by the Regulation for Health Care and Residential Facilities
(http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_930067_e.htm
) to wear or use any protective clothing, equipment or device
shall be instructed and trained in its care, use and limitations
before wearing or using it for the first time and at regular
intervals. Employers are encouraged to document
that workers are trained, dates when training was conducted and
materials covered during training. A worker must work in
compliance with the Act and its regulations and use or wear any
equipment, protective devices or clothing required by the
employer.
The other new document, "Information on the use
and fit-testing of N95 Respirators" is specifically aimed at the
healthcare sector, but provides useful guidance to any workplace
where N95 respirators may be required. N95 respirators filter
out tiny airborne particles when the respirator fits and is
properly used. Individuals who are required to wear N95
respirators must be fit tested at least every two years to
ensure a proper fit.
Please continue to watch the OPSEU website and
the links below for updates on H1N1 Influenza:
New
Occupational Health and Safety Requirements for the Health Care Sector
New
Information on the use and fit-testing of N95 Respirators
Friday May 8, 2009 H1N1 INFLUENZA UPDATE
As of May 7, 2009, there were 56 lab-confirmed
cases of H1N1 Influenza A in Ontario. Travel to Mexico accounts for
37 of the cases and an additional 12 cases had close contact with a
confirmed case. Seven cases are still being investigated. All
cases are mild and no one in Ontario has been hospitalized.
The MOHLTC has
released a new document, “Information on the Novel H1N1 Influenza
Virus for Primary Care Practitioners.” Although most of the
information on the document is useful, the Ministry, apparently in
an attempt to reduce anxiety among primary care practitioners,
included the following point: “Health care professionals including
family physicians and other primary care practitioners are more
susceptible to infection with influenza viruses at home and in the
community than in the work place.” This is a confusing and
potentially misleading statement. It is incorrect to say in general
that there is a greater risk of exposure to influenza in the
community than in health care workplaces.
The risks to health
care practitioners of exposure to influenza must be assessed in each
workplace and within different workplace areas. For example, there
are probably greater risks of exposure in a busy emergency
department than in a grocery store. There may also be greater risks
in a family physician’s office than in a long term care setting.
Both OPSEU and the representative from the Ontario Medical
Association requested the Ministry to either remove or revise the
statement to reflect these points. The Ministry agreed to review it,
but made no commitment to change it.
OPSEU continues to
advise its members to request meetings of their Joint Health and
Safety Committees to review and update their pandemic influenza or
emergency plans. This is particularly important in the health care
sector and workplaces where employers have been requested to
stockpile 4 weeks worth of personal protective equipment and other
emergency supplies. OPSEU has received numerous reports of health
care workplaces that do not have their 4-week supplies, especially
N95 respirators. We have also received reports of some workplaces
that have stockpiles where some items are outdated or degraded. For
example, the elastic on N95 respirators may have begun to break down
over time. JHSCs should ensure that respirator fit-testing is
current and that functioning N95 respirators are available.
It appears that this
influenza outbreak is relatively mild. However, it is possible that
the virus will emerge again in our regular ‘flu season’ in the fall
and it is possible that a second wave of H1N1 influenza will be more
virulent. It is prudent to take advantage of the opportunity of this
mild outbreak to review and revise your pandemic influenza or
emergency plans as well as to ensure that everyone has received
education on the plans so that everyone is prepared in the event of
a more serious outbreak.
The MOHLTC has decided, based on the reduced volume
of calls, to reduce the hours of operation of its Health Care
Providers Hotline starting this weekend. The hotline will operate on
Saturday, May 9 from 0800 to 1600; it will be closed on Sunday; and,
starting on Monday, May 11, it will be open from 0900 to 1700. The
hotline number is: 1-866-212-2272.
The daily 3 p.m.
updates by the Chief Medical Officer of Health (CMOH) will be scaled
down from a press conference to a daily press release starting next
week.
Please continue to watch
the OPSEU website and the links below for updates on H1N1 Influenza
(Human Swine Flu).
New Information
on the Novel H1N1 Influenza Virus for Primary Care Practitioners
New
Important Health Notice May 7, 2009
Wednesday May 6, 2009
H1N1 INFLUENZA UPDATE
As of May 6, there are 49 lab-confirmed
cases of H1N1 influenza in Ontario. Travel to Mexico or
contact with a person who has H1N1 and who traveled to
Mexico remains the most frequent source of the illness.
Because laboratory testing capacity has been increased,
cases of H1N1 are now being confirmed faster.
New guidance has been released for the management of
influenza-like-illness (ILI) in Long Term Care facilities.
Unfortunately, the health and safety/infection prevention and control
guidance for workers is not as protective as OPSEU believes it should
be. OPSEU takes the position that the precautionary principle, which
states that action to reduce risk need not await scientific certainty,
should be applied as we establish protective measures against this new
virus.
The three main weaknesses in the document are as
follows:
-
There is no recommendation that persons entering a
LTC facility be screened by a person (active screening) for ILI
before entering the home. The guidance note advises that signs be
posted reminding people not to enter if they have ILI symptoms. This
is known as passive screening or self-screening. Self-screening may
not be effective if people are determined to enter despite having
ILI symptoms or if they do not understand the questions on the sign.
Advice: OPSEU takes the position that active screening of people
entering the facility is more protective of worker health and
safety.
-
Healthcare workers are advised to wear an N95
respirator when directly caring for a resident with ILI symptoms who
has had contact with a person with a confirmed case of H1N1 flu.
OPSEU does not believe that this advice is protective enough. If a
visitor with ILI enters the facility, they may not know if they have
H1N1. If the visitor later is diagnosed with a confirmed case of
H1N1, this information may not be communicated to the LTC facility
and workers may not be protected adequately. Advice: OPSEU believes
it would be prudent for healthcare workers to wear an N95 respirator
when in direct contact with residents with ILI who have been in
contact with a person with confirmed or possible H1N1 influenza.
-
Healthcare workers are advised to wear a surgical
mask to care for residents with ILI and a fit-tested N95 respirator
during aerosol-generating procedures such as tracheal or oral
suctioning. This is confusing advice and does not reflect the
application of the precautionary principle. It is reasonable to
advise the use of an N95 respirator during aerosol-generating
procedures. However, requiring workers to wear a surgical mask when
caring for residents with ILI in some circumstances and to wear an
N95 respirator when caring for residents with ILI who have had
contact with a confirmed case of H1N1 will confuse workers and may
not be protective enough. Advice: OPSEU believes it would be prudent
for healthcare workers to wear an N95 respirator when in direct
contact with residents with ILI who have been in contact with a
person with confirmed or possible H1N1 influenza.
OPSEU continues to advise its members on Joint Health
and Safety Committees, and Health and Safety Representatives, to meet to
review and update their pandemic influenza plans. In particular, JHSCs
in LTC facilities should meet to review this new guidance and to
determine what precautions to implement.
Please continue to watch the OPSEU website and the links
below for updates on H1N1 Influenza (Human Swine Flu).
Monday May 4, 2009
H1N1 INFLUENZA UPDATE
All but three of these cases have a
travel history to Mexico. The three cases without
Mexican travel history had close household contact with
someone who had a confirmed case. These three cases
indicate that human-to-human transmission has happened
in Ontario. All 16 cases are mild and all are recovering
at home. OPSEU will continue to participate in these
teleconferences now scheduled three times weekly.
The World Health Organization pandemic
threat level remains unchanged at Phase Five.
A new Important Health Notice (IHN) released
on May 3 contains no new health and safety advice for
healthcare workers. OPSEU members are advised to continue to
follow the health and safety advice contained in the April
30, 2009 document, “Guidance for Clinical Care of Patients:
Ambulatory Setting” which states that those providing direct
care to patients with an Influenza Like Illness (ILI) and a
history of travel to Mexico within the previous 7 days
practice hand hygiene, wear fit-tested N95 respirators and
eye protection, wear gowns and gloves where there is a risk
of contamination with respiratory secretions, and that
surfaces potentially contaminated with respiratory
secretions be cleaned with hospital-grade disinfectant.
The May 3, 2009 Important Health Notice
focuses on guidelines for laboratory testing for patients
with ILI and recommendations for the use of antivirals.
Treatment with antiviral drugs is recommended only in very
specific circumstances, all associated with symptoms of ILI
and travel to Mexico or close contact with someone who
traveled from Mexico.
Please continue to watch the OPSEU website
and the links below for updates on H1N1 Flu (Human Swine
Flu).
Helpful links and documents:
Friday May 1, 2009
H1N1 INFLUENZA UPDATE
OPSEU President Warren (Smokey) Thomas
yesterday communicated with OPSEU members in every
sector about the Swine Flu outbreak, now being called
Influenza H1N1
Sisters and Brothers,
This is an important message from
your union regarding a possible influenza pandemic.
As you know, Ontario is in an "enhanced state" of
readiness and we need to remain proactive and
vigilant in all OPSEU workplaces to reduce the
chance of illness and further spread of H1N1 flu
(previously called Swine Flu).
The
attached memo
 from our
Health and Safety Unit contains important advice to
worker members of joint health and safety committees
and health and safety representatives in all OPSEU
workplaces.
As president, leader, or highest
ranking member of your local, please ensure that
this information is forwarded to your OPSEU
representatives on joint health and safety
committees and/or to all health and safety
representatives at all workplaces in your local.
I encourage you and your local
leadership to work in tandem with your worker safety
representatives as they move forward with this
important work.
All OPSEU members should check for
updates about the H1N1 flu situation on the OPSEU
website at
http://www.opseu.org/hands/respiratory-illness-mexico-2009.htm
In solidarity,
Warren ( Smokey ) Thomas
President
Thursday April 30, 2009
UPDATE
Ontario today is reporting eight cases of
swine flu in Ontario. All cases are considered mild and no
one has been hospitalized. Ontario remains at an enhanced
state of vigilance, but an emergency has not been declared.
The World Health Organization, yesterday
upgraded its Influenza Alert from Phase 4 to Phase 5,
indicating that there is now evidence of human-to-human
transmission of this novel virus in at least two countries.
WHO is advising that all countries activate their pandemic
preparedness plans. In response to the WHO announcement,
Ontario is advising local authorities to begin activating
local pandemic plans, is providing enhance monitoring of
flu-like illnesses and is stepping up its communications to
the healthcare system and the public.
OPSEU continues to advise it members in
every sector who act as Health and Safety Representatives or
who sit on Joint Health and Safety Committees (JHSC) to
request an urgent meeting with their employer to review and
update, if necessary, their pandemic influenza/emergency
plans. A memo is being sent out by President Warren (Smokey)
Thomas to all OPSEU locals advising them to initiate JHSC
meetings and offering JHSC members and Health and Safety
Representatives health and safety advice.
The Ministry of Health and Long Term Care
today released a new Important Health Notice which increases
Public Health reporting requirements of cases of Influenza
Like Illness (ILI), as well as changes to Laboratory
Guidelines. Additionally, the MOHLTC has released updated
guidance for Clinical Care of Patients in Ambulatory
Settings which provides health care workers with important
infection prevention and control information. Healthcare
workers providing direct care to patients with a travel
history to Mexico and symptoms of ILI are advised to wear
fit-tested N-95 respirators, eye protection, gloves and
gowns where there is a risk of contamination with
respiratory secretions. Good cleaning with hospital-grade
disinfectant is recommended for any surfaces that may have
been contaminated with respiratory secretions.
Please continue to watch the OPSEU website
and the links below for updates on the swine flu situation
as it continues to change.
Helpful links and documents:
NEW
Important Health Notice, April 30, 2009 Information for
Healthcare Providers
NEW
Guidance for Clinical Care of Patients: Ambulatory settingss
– provides important infection prevention and health and
safety information
NEW
April 30, 2009
MOHLTC news release
NEW
World Health Organization
April 30, 2009 update
Ministry of Health and Long Term Care Swine Flu site has
regular updates and links
Ontario
Agency for Health Protection and Promotion provides
regular swine flu updates
Wednesday April 29, 2009
UPDATE
Ontario is now reporting seven laboratory
confirmed cases of swine flu. Six of the cases are known to
involve travel to Mexico and the seventh case is still being
investigated. All are considered mild and the individuals
are recovering at home. Ontario remains at an enhanced state
of vigilance, but no emergency declaration has been made.
The provincial government has issued a new
Important Health Notice which provides the latest
guidelines and links to information.
Although no emergency declaration has been
made, the Emergency Management Unit of the Ministry of
Health and Long Term Care (MOHLTC) today convened its first
teleconference of health care sector stakeholders to review
the current situation and to establish working communication
links. OPSEU participated and will take part in any future
teleconferences. No new information was provided, other than
the guidance contained on the April 29, 2009 Important
Health Notice. Participants were reminded that health care
workers have access to the Healthcare Providers Hotline
(1-866-212-2272) for questions on Important Health Notices.
OPSEU advises its members in every sector
who act as Health and Safety Representatives (in workplaces
with fewer than 20 employees) or who sit on Joint Health and
Safety Committees (in workplaces with 20 or more employees)
to request an urgent meeting with their employer or a JHSC
meeting to review their pandemic influenza plans. Employers,
supervisors, Health and Safety Representatives and JHSCs
should consider whether their plans are adequate to protect
worker health and safety if the swine flu outbreak continues
to spread.
All workplaces, particularly healthcare
sector and other sectors with frequent close public contact
should perform risk assessments to determine which workers
are at risk of close contact with potentially infected
individuals. In workplaces where it is determined that
workers will be expected to be in close contact (2 meters or
less) with people potentially ill with swine flu,
appropriate personal protective equipment such as fit-tested
NIOSH-approved N-95 respirators must be available.
Additionally, adequate supplies such as gloves, gowns and
face shields must be available where workers work with
potentially ill patients, residents or clients. In
healthcare facilities, access to the facility should be
limited to a few entrances and screening of potentially ill
visitors and clients/patients should be done. All workplaces
should consider whether their communication networks within
the workplace and from outside the workplace are up-to-date
and working. All workplaces with public contact should
ensure that adequate hand-wash solution is available. All
workplaces should review their pandemic plans with all staff
to ensure that everyone understands their roles, their
duties and their rights.
Please continue to watch the OPSEU website
and the links below for updates on the swine flu situation
as it continues to change.
Helpful links and documents:
Tuesday April 28, 2009
UPDATE
The World Health
Organization (WHO) has moved the Mexican swine flu outbreak
to Phase 4 (of 6) to indicate human to human transmission,
however, no cases have been confirmed in Ontario.
Ontario remains at an “enhanced state” of vigilance—one
level up from “routine.” Declaration of Enhanced
Conditions means that a potential emergency is developing at
a local level. Under these conditions, surveillance and
monitoring activities are enhanced. The situation is
fluid. OPSEU members should keep updated by
watching the website. Note that—along with the
signage for ambulatory locations released yesterday, today a
new sign for patients needs to be posted in patient areas.
These are the
latest documents/links:
NEW
Document: Appendix 1: Sample Case Finding/Surveillance
form
NEW Swine
Flu site for Ontario which contains a running total of
confirmed cases in Ontario: so far 0
NEW
Document April 28, 2009: Minimum Case Information to
Collect for OAHPP Laboratory Surveillance of Influenza
NEW
Document April 28, 2009: Patient Advisory Sign Template
NEW
Read about Ontario’s emergency response process
NEW:The
Ontario Agency for Health Protection and Promotion
provides advice on infection control
April 26
Notice Re: Ambulatory settings
Signage to be posted in ambulatory settings
Monday April 27, 2009
UPDATE
Cases of Mexican Swine flu have been identified
in Mexico, the U.S. and now Canada. Four cases were found
among school children in Nova Scotia, and two cases in British
Columbia. The two adult cases in BC are reported to have
had minor symptoms and have recovered. All six of these cases
were linked to Mexican travel. So far, no cases have been
identified in Ontario.
At this time Ontario remains on alert; Ontario
remains in a state of enhanced surveillance. Today’s
Ontario Health notice explains that ambulatory care settings may
experience an increase in visits and provides guidance in the
management of ambulatory patients. Clinical symptoms
include high fever, headache, ocular pain, shortness of breath
and extreme fatigue.
For updates on the Mexican Swine Flu outbreak
click here to check the Ontario Agency for Health Protection and
Promotion. This site also links to the Centre for
Disease Control (CDC) and the World Health Organization (WHO).
Severe Respiratory Illness in Mexico
April 24, 2009
On April 21, 2009, Ontario's Chief Medical Officer
of Health announced an outbreak of Severe Respiratory Illness (SRI)
in Mexico.
There have been no reported cases of the illness in
Canada. However, the Ministry of Health has released an
Important Health Notice which describes
symptoms of the illness, screening questions to use in hospital
emergency departments and precautions for healthcare workers to take. If
cases of SRI are discovered in Ontario, healthcare workers providing
direct care (in the same room or in close contact) to SRI patients are
advised to wear properly fit-tested N-95 respirators. All other
healthcare workers are to follow Routine Practices. Patients who meet
the definition of SRI are to be cared for in a single room.
For more details, follow the link to the April
23, 2009 Important Health Notice and Appendix.
Important Health Notice: Information for Healthcare
Professionals: Clusters of Severe Respiratory Illness in
Mexico
Appendix: Sample Case Finding/Surveillance Form
For more information:
Lisa McCaskell, Senior Health & Safety Officer 416-443-8888, ext 8772
March 21, 2005 MedLine March 2005: LHINs and layoffs campaign; SARS agreement; pharmacy technicians; sharps and needlesticks;bargaining and moreiv>
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