National Pandemic Influenza Preparedness Plan



Sultanate of Oman Ministry of Health Department of Communicable Disease Surveillance and Control, Department of Communicable Disease Surveillance & ControlDirectorate General of Health Affairs, Ministry of Health HQ,PO Box 393, MUSCAT 113, Sultanate of OmanFax: + (968) 24 601832Address for Communication: Directorate General of Health Affairs, Ministry of Health HQ, Sultanate of OmanContentsContents2Reader Information3Acronyms3 1. Background42 National Preparedness Plan2.1 Introduction 52.2 Phases of Influenza Pandemic52.3 Declaration of Pandemic83. The Components of Preparedness3.1 Enhanced Influenza Surveillance83.2 Case detection93.3 Case investigation & Management93.4 Laboratory Surveillance103.5 Infection control103.6 Non-Pharmaceutical interventions113.7 Pharmaceutical interventions123.8 Information Dissemination12List of Annexure (1 to 6)13List of Algorithms (1 to 6)24Reader informationPolicyThis is the official policy document of the Ministry of Health, Sultanate of OmanDocument PurposeFor information and actionTitleNational Pandemic Influenza(H1N1) Preparedness PlanPublication Date2005 revisedRevision DateMay 2009AuthorDepartment of Communicable Disease Surveillance & Control, Directorate General of Health Affairs, Ministry of Health HQOther ContributorsExperts from the “National Task Force on Influenza Pandemic Preparedness”.The plan has been reviewed by the legal Department of Ministry of HealthTarget AudienceAll Director Generals, Directors, of the Regions, Governorates and Hospitals including the MOICs of the health centres, EHC’s, polyclinics, CDC’s, and other Ministry of Health institutions. Non-MoH health organizations viz. SQU Hospitals, AF hospital, ROP hospital, PDO clinics, Palace health services, ISS health services, all private hospitals and clinics and including those who are directly or indirectly involved in the pandemic management.DescriptionThis document outlines the framework of how the Ministry of Health, Sultanate of Oman would respond to an influenza pandemic. It is based on the recommendations of the World Health Organization for the national pandemic preparedness plan.Cross ReferencesKey Influenza Documents on the WHO and CDC websitesContact DetailsH.E. Dr. Ali Jaffer M. Suleiman, Director General, Directorate General of Health Affairs, Ministry of Health, PO Box 393, Muscat 113, Sultanate of Oman.dg-ha@.omDr. Salah Al Awaidy, Director, Department of Communicable Disease Surveillance and Control, Directorate General of Health Affairs, Ministry of Health, PO Box 393, Muscat 113, Sultanate of Oman. awadymoh@.omAcronymsAIAvian InfluenzaDCDSCDepartment of Communicable Disease Surveillance & ControlFAOFood and Agriculture Organization (UN)HPAIHighly pathogenic Avian InfluenzaGF TADsGlobal Framework for the control of Transboundary Animal Diseases (FAO/OIE)GLEWSGlobal Early Warning System (FAO/OIE/WHO)ILIInfluenza Like IllnessMoA&FMinistry of Agriculture and FisheriesMoHMinistry of HealthNADSSNational Animal Disease Surveillance SystemOIEOrganization Mondiale de la Santé Animale (World Organization for Animal Health)PDOPetroleum Development OrganizationPPEPersonal Protective EquipmentRADISCONRegional Animal Disease Surveillance and Control NetworkROPRoyal Oman PoliceSNSStrategic National StockpileSQUHSultan Qaboos University hospitalWHO (OMS)World Health Organization (Organization Mondiale de la Santé)1 BackgroundInfluenza is one of the most common causes of febrile and respiratory illness. The risk of severe illness and/or death is higher among adults >65 years old; among persons of any age with underlying chronic diseases including lung or heart disease, metabolic diseases, and immune-suppression; and among children <2 years old. Vaccination represents the major strategy to reduce the impact of influenza and is recommended for high-risk persons.Influenza viruses circulating in the population are continuously evolving (antigenic drift and antigenic shift), which requires that vaccines be redesigned and produced annually to provide the best match to the influenza strains that are circulating. Pandemics occur when novel influenza A viruses most probably derived from animal or avian influenza viruses develop ability to spread effectively among people. By definition pandemics involve the circulation of strains for which almost all of the world’s population lack pre-existing immunity. Influenza pandemics resemble major natural disasters. It is impossible to anticipate when the next pandemic might occur or how severe its consequences might be. On an average, three pandemics per century have been documented since the 16th century, occurring at intervals of 10–50 years. The first pandemic of influenza of the 20th century, the “Spanish flu,” began in 1918 and, by the time it ended the following year, by conservative estimates, it had resulted in more than 20 million deaths worldwide. Later pandemics in 1957 and 1968 caused far fewer deaths but still posed a substantial burden on the health care system, and resulted in substantial economic costs and social disruption. Following the events which happened in Mexico and USA, where in many individuals are affected by Novel H1N1 influenza virus, the concerns for pandemic influenza is growing as more information are made available. This novel influenza virus H1N1 is a combination (re-assorted) of Human, Avian (bird) and swine influenza viruses. WHO has declared H1N1 influenza situation as an international public health emergency. On 29th of April 2009 the pandemic influenza alert has been upgraded to phase5 which means the global spread (pandemic) is likely as human-to-human transmission has been established. As of writing this plan, 11 countries have officially reported 257 cases of influenza A (H1N1) infection. The United States Government has reported 109 laboratory confirmed human cases, including one death. Mexico has reported 97 confirmed human cases of infection, including seven deaths. The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (19), Germany (3), Israel (2), Netherlands (1), New Zealand (3), Spain (13), Switzerland (1) and the United Kingdom (8). 2. The National Preparedness Plan 2.1 IntroductionPlanning and preparedness are essential to optimally achieve the goals and objectives of a pandemic response. The Main Aim of this document is to provide a national framework for an integrated countrywide response to an influenza pandemic H1N1, with clear operational plans for the response at all levels. Main document, "National Pandemic Influenza Preparedness Plan" is already prepared by Ministry of Health which has provided guidance for the preparedness so far remains valid. Some modifications based on current available information about novel H1N1 virus are incorporated in this supplement plan. The objectives of this plan for an influenza pandemic H1N1 are to:Ensure optimal coordination, decision-making, and communication between national, state, and local levels Detect influenza strains through clinical and virology surveillance of human casesDeliver antiviral drug therapy and prophylaxis and avoid inappropriate use of these agents, which may result in antiviral resistance Provide optimal medical care and maintain essential community services Communicate effectively with the public, health care providers, community leaders and the mediaThe national authorities will provide overall direction, guidance and coordination, while provincial (Regions/Governorates) health affairs departments and the private medical clinics will form the front line with respect to management of ill persons and administration of interventions such as vaccine and antiviral medications and possibly community-level interventions such as isolation and quarantine. Information and guidance provided in this plan will serve as a platform for the development of plans at the regional level. 2.2 Phases of an Influenza Pandemic In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans. The grouping and description of pandemic phases have been revised to make them easier to understand, more precise, and based upon observable phenomena. Phases 1–3 correlate with preparedness, including capacity development and response planning activities, while Phases 4–6 clearly signal the need for response and mitigation efforts. Furthermore, periods after the first pandemic wave are elaborated to facilitate post pandemic recovery activities.The current WHO phase of pandemic alert is 5.In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans. In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat. In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion. Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave. Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature. In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required. Phase changesIt is important to stress that the phases were not developed as an epidemiologicalprediction, but to provide guidance to countries on the implementation of activities. Whilelater phases may loosely correlate with increasing levels of pandemic risk, this risk in thefirst three phases is simply unknown. It is therefore possible to have situations whichpose an increased pandemic risk, but do not result in a pandemic.Alternatively, although global influenza surveillance and monitoring systems are muchimproved, it is also possible that the first outbreaks of a pandemic will not be detected orrecognized. For example, if symptoms are mild and not very specific, an influenza viruswith pandemic potential may attain relatively widespread circulation before beingdetected; thus, the global phase may jump from Phase 3 to Phases 5 or 6. If the rapidcontainment operations are successful; Phase 4 may revert back to Phase 3.When making a change to the global phase, WHO will carefully consider whether thecriteria for a new phase have been met. This decision will be based upon all credibleinformation from global surveillance and from other organizations.2.3 Declaration of PandemicWHO Director General has declared H1N1 influenza situation as an international public health emergency. On 29th of April 2009 the pandemic influenza alert has been upgraded to phase5 which means the global spread (pandemic) is likely as human-to-human transmission has been established.3. The Components of Preparedness One of the lessons learned from the SARS outbreaks of 2003 was the importance, in the event of an incident on the scale of an influenza pandemic, of strong international and national leadership and coordination, and a clear national ‘command and control’ structure. The appropriate people at all levels must have authority to make key decisions and act on them, and there must be a clear chain of accountability. The response to an influenza pandemic H1N1 should be on a nationwide basis, and therefore clear demarcation of roles is required between all the stake holders.3.1 Enhanced Influenza SurveillanceSpecific objectives of this surveillance activity are to guide global prevention and controlactivities through the following actions:1. Detect and confirm cases of H1N1 influenza A virus infection2. Establish the extent of international spread of H1N1 influenza A virus infection3. Assist in the early severity assessment of the diseaseTimely surveillance information will be the key to early identification of an influenza pandemic, and to the development of evidence based interventions at all stages. Oman contributes to internationally co-ordinated laboratory based influenza virus surveillance, which is co-ordinated by the World Health Organization (EMRO). Monitoring influenza disease activity is important to facilitate resource planning, communication, intervention, and investigation. A high level of vigilance for clusters of cases of respiratory disease provides an early warning mechanism.Influenza is a common condition and has symptoms similar to those of many other viral respiratory infections. Early detection of a new virus therefore requires clinicians as well as laboratory staff to be alert to the possibly unusual, for example respiratory illness in a patient, with a link to areas where a new virus has been already identified, or to a person with a travel history to affected areas/countries.In order to detect cases the existent surveillance mechanisms should be further strengthened at all levels. The sentinel SARI surveillance at Sohar, Ibra and Salalah Hospitals will continue so also the laboratory based influenza surveillance at Barka PC, Amerat HC, Al Khod HC and Salalah PC.The existing surveillance (ILI under the Group 'C') should be further strengthened as follows: Influenza like illnesses (ILI) and LRTI including pneumonia for all age groups should be monitored from all health institutions on a weekly basis. ICD-10 codes for these conditions are J01, J02-03, J04, J10-11, J12-18, J20-21 and J40-42. These conditions should be reported for males and females, for inpatient and outpatient by age groups (MoH Monthly Statistical Booklets – for Health Institution and In-patient). These weekly surveillance reports should be sent by all health institutes including private to the office of the Director General or Director of Health Services of the Governorates and Regions.The compiled weekly reports of the Governorates and Regions should be sent to the Department of Communicable Disease Surveillance & Control on every Monday (international week) by e-mail/fax.3.2 Case detectionCase definitions for infections with H1N1 influenza A VirusSuspect Case (Refer Algorithm 1) Acute febrile respiratory illness (Fever > 380 C) with the spectrum of disease from influenza-like illness (ILI) to pneumonia inclusive of severe acute respiratory illness (SARI) with onset... - Within 7 days of close contact with a confirmed case of H1N1 influenza A virus OR- Within 7 days of travel to countries where one or more confirmed case of H1N1 influenza A virus were reported OR - Resides in a community where there were one or more confirmed cases of H1N1 influenza A virusProbable caseSuspect case with an influenza test that is positive for influenza A, but is unsubtypable by reagents used to detect seasonal influenza virus infection ORSuspect case who died of an unexplained acute respiratory illness and who is considered to be epidemiologically linked to another probable or confirmed case.Confirmed caseSuspect or Probable case with laboratory confirmed H1N1 influenza A virus infection by one or more of the following tests.? Real-time RT-PCR? Viral culture? Four-fold rise in H1N1 influenza A virus specific neutralizing antibodies.3.3 Case Investigation & Management Health Institute anywhere in Oman that identifies unusual clusters of acute respiratory illness should immediately notify the Regional DGHS. Regional Epidemiologist should investigate using the WHO case summary form (Annexure 4 ) if the epidemiological compatibility is decided under the guidance of Department of Communicable Diseases Surveillance and Control. Definition of clusterA cluster is defined as two or more persons presenting with manifestations of unexplained,Acute respiratory illness with fever >38°C or who died of an unexplained respiratory illness andthose are detected with onset of illness within a period of 14 days and in the same geographicalarea and/or are epidemiologically linked.Triggers/signals for the investigation of possible cases of H1N1 influenza A virus are? Clusters of cases of unexplained ILI or acute lower respiratory disease? Severe, unexplained respiratory illness occurring in one or more health care worker(s)who provide care for patients with respiratory disease? Changes in the epidemiology of mortality associated with the occurrence of ILI or lowerrespiratory tract illness, an increase in deaths observed from respiratory illness or anincrease in the occurrence of severe respiratory disease in previously healthy adults oradolescents? Persistent changes noted in the treatment response or outcome of severe lowerrespiratory illness.Close contact: having cared for, lived with, or had direct contact with respiratory secretions orbody fluids of a probable or confirmed case of H1N1 influenza A virus. For contact surveillance refer Algorithm 2.Epidemiological risk factors that should raise suspicion of H1N1 influenza A virus include:? Close contact to a confirmed case of H1N1 influenza A virus infection while thecase was ill? Recent travel to an area where there are confirmed cases of H1N1 influenza A virus All suspected cases from any institute of the region should be transferred, investigated, admitted and managed at designated isolation facility (usually regional hospital) ONLY. For case referrals refer Algorithm 3. For receiving referred case at designated isolation facility please follow Algorithm 4. For any H1N1 influenza A virus case please refer to Algorithm 5.3.4 Laboratory SurveillanceLaboratories are essential to confirm diagnosis, elucidation of characteristics of the virus, and to overall surveillance. The capability and capacity of the Central Public Health Laboratory will soon be upgraded to identify novel influenza strains. A proportion of isolates, including all unusual ones from the Oman, would be referred to the International Influenza Reference Laboratory, at WHO-EMR, Cairo for detailed identification.Details of the sample collection, storage and transport are included in the algorithm 6 of this document. 3.5. Infection controlIt is critical that health-care workers use appropriate infection control precautions when caring for patients with influenza-like symptoms, particularly in areas affected by outbreaks of A(H1N1) influenza,in order to minimize the possibility of transmission among themselves, to other health-careworkers, patients and visitors. The WHO infection prevention and control guidance is attached in annexure 5.Ensure the availability of personal protective equipments (PPE) and laboratory supplies at the designated locations. All these should be accessible round the clock to the health care staff. 3.6. Non-pharmaceutical public health interventions The main aim of non-pharmaceutical intervention is to prevent the spread of infection. Each individual is expected to practice following general preventive measures for influenza:Avoid close contact with people who appear unwell and have fever and cough. Wash your hands with soap and water thoroughly and often. Practice good health habits including adequate sleep, eating nutritious food, and keeping physically active. The persons who are not well should be cared for at home unless the person is seriously ill which require hospital admission keeping following guidelines in mind Separate the ill person from others, at least 1 meter in distance from others. Cover your mouth and nose when caring for the ill person. Either commercial or homemade materials are fine, as long as they are disposed of or cleaned properly after use. Wash your hands with soap and water thoroughly after each contact with the ill person. Improve the air flow where the ill person stays. Use doors and windows to take advantage of breezes. Keep the environment clean with readily available household cleaning agents. The person who is unwell having high fever, cough or sore throat is expected to follow following steps: Stay at home and keep away from work, school or crowds. Rest and take plenty of fluids. Cover your mouth and nose with disposable tissues when coughing and sneezing, and dispose of the used tissues properly. Wash your hands with soap and water often and thoroughly, especially after coughing or sneezing. Inform family and friends about your illness and try to avoid contact with people.If a person thinks that he requires medical attention then following is expected from himContact by telephone your primary health care physician or healthcare provider near your home before travelling to a health facility, and report your symptoms. Explain why you think you have influenza A (H1N1) (for example, if you have recently travelled to a country where there is an outbreak in humans). Follow the advice given to you.If it is not possible to contact your healthcare provider in advance, communicate your suspicion of infection as soon as you arrive at the facility. Cover your nose and mouth during travel. 3.7 Pharmaceutical Interventions VACCINECurrently no vaccine is available for this novel H1N1 influenza virus. It is widely believed that it will require at least few months for vaccine to be developed and made available for general use. No evidence is available to support the use of conventional seasonal influenza vaccine to prevent novel H1N1 influenza virus responsible for causing pandemic.ANTIVIRAL AGENTS:Antiviral agents active against influenza are the only major medical countermeasure available. However, there are limitations to their use, their effectiveness in a pandemic situation has yet to be tested and anti-viral resistance may be – or become – a problem.Oman has stockpiling the antiviral drugs required for an influenza pandemic. The Ministry of Health has procured 10,000 courses (10 tablets per course) for either prophylactic or therapeutic use available for the Strategic National Stockpile (SNS). As with other resources, given the possible scale of a current pandemic, the drugs will need to be given in the most effective way on operational, clinical and cost-effectiveness grounds taking into account the stocks available. Two drugs of the newer class of neuraminidase inhibitors (Zanamivir [Relenza] and Oseltamivir [Tamiflu]) are effective against Novel influenza H1N1 virus as per the WHO reports. 3.8 Information DisseminationThe overall communications strategy covers the gathering, collation and dissemination of information for a variety of audiences, which can be divided broadly into:3.8.1 Strategic communicationsTwo way strategic communications will involve the MoH, and all other governmental agencies and organisations involved in the response, including the private health establishments and the international agencies. The Government briefings and public information will be controlled and monitored by Director, Communicable diseases surveillance and Control under the supervision of higher officials of the ministry of health.3.8.2 Professional information and guidanceRegular information bulletins to the health professionals will be issued by Director, Communicable diseases surveillance and Control as required, and as urgency indicates, via already established routes. 3.8.3 Communications with the public and the mediaMedia communications will be co-ordinated initially by the MoH, PRO office. They will also co-ordinate cross government communication and depending on the scale will also co-ordinate the media and public communication for the other Government Departments involved. At present only national authorities are designated as official spokesperson of the government for this pandemic.4. List of AnnexureAnnexure 1National Task Force (MoH) Annexure 2Inter-Ministerial Committee on AIAnnexure 3National Rapid Response TeamAnnexure 4Case Notification FormAnnexure 5Infection Control Guidelines (General)Annexure 6List of AlgorithmsAnnexure 1National Task Force (Ministry of Health)National Spokespersons for Ministry of HealthHE Dr. Ali Jaffer M. Suleiman, DGHADr. Salah Al Awaidy, Director, DCDSCProvincial Spokesperson (Governorates & Regions)Director/Director General of Health ServicesNameDesignationOfficeFaxMobileMinistry of Health HQHE Dr. Ali Jaffer M. Suleiman (Chairman)Director General of Health Affairs 246008082469609999335681Ph. Nusaiba Habib Mohd.Director General of Medical Supplies246999732460159399240990Dr. Salah Al Awaidy(Focal Point)Director, Communicable Disease Surveillance & Control 246019212460183299315063Dr. Suleiman Al BusaidyDirector, Central Public Health Laboratory247059432479369999426288Ms. Sabah Al BahlaniDirector, Health Education & Information2456260999332792WHO Country Office-OmanDr. Jihan TawilahWHO Representative, Oman2460098924602637MoH and Sultan Qaboos University HospitalDr. Mohammed Al BalushiDirector, Al Nahda Hospital2483574624831578Dr. Mohammed Al HosniHead of Child Health, Royal Hospital245995522459917399474441Dr. Yaqub Al MahrooqiChest Specialist, Royal Hospital99427669Dr. Abdullah BalkhairInfectious Diseases, SQUH244133552441341999293797Ms. FaridaHead of Nursing, Al Nahda Hospital24837511Ext. 111224837522Department of Communicable Disease Surveillance and Control, MoH HQ (Field Staff)Dr. Shyam BawikarAdvisor Epidemiologist24601921,246075242460183299368327Dr. Idris Al AbaidaniSurveillance Section Head95208040Mr. Salem Al MahrooqiNational Surveillance Supervisor99029195Mr. Bader Al RawahiNational EPI Supervisor99430689Annexure 2Inter-Ministerial Committee on H1N1 Influenza, Sultanate of OmanNameDesignationOfficeFaxMobileMr. Ali Amer Al KiyumiNature Conservation, Ministry of Regional Municipalities, Environment and Water Resources246022852460228399444808Mr. Said Darwesh Al AlawiDG of Health Affairs, Ministry of Regional Municipalities, Environment and Water Resources246925642469254799389883Mr. Ali Said Al HammadiDirector General of Planning, Ministry of Interior247072262479059999420909Mr. Mudriq Kathiem Al MoosawiDirector General of Commerce & Industry247741002481203099418909Mr. Nasr Ali Al WahaibiDirector General of Animal Wealth24693912469446599382717Dr. Salah Thabit Al AwaidyDirector, Communicable Disease Surveillance and Control246019212460183299315063Mr. Mubarak Khamis Al AraimiAsst. Director General of Information and Press Affairs246976772452103424602928Mr. Mussallam Salem Al JenebiAsst. Director General of Customs, Royal Oman Police245212042452120499319131Dr. Sultan Eissa Al IsmailiAsst. Director General of Animal Wealth & Veterinary Services246985122469446599380316Dr. Ali Abdullah Al SahmiHead of Veterinary Services (Focal Point)24696300 Ext. 15102469446599371816Annexure 3RAPID RESPONSE TEAMIn the event of suspected case notification of HPAI in Oman the rapid response team will initiate an epidemiological field case investigation to confirm the diagnosis and necessary interventions within 24-48 hours. The National Rapid Response Team for Avian InfluenzaNameDesignationOfficeFaxMobileDr. Salah Al Awaidy TEAM LEADERDirector, Communicable Disease Surveillance & Control (DCDSC)246019212460183299315063Dr. Suleiman Al BusaidyDirector, CPHL247059432479369999426288Dr. Shyam BawikarAdvisor Epidemiologist, DCDSC24601921246075242460183299368327Dr. Idris Al AbaidaniSection I/c, Surveillance, DCDSC95224261Mr. Basim ZayedCoordinator, Infection control, DCDSC 99534234Mr. Salem Al MahrooqiSurveillance Supervisor, DCDSC99029195Dr. Ali Al SahmiFocal Point for AI: Ministry of Agriculture & Fisheries 24696300 Ext. 15102469446599371816Support TeamDr. Mohammed Al HosniHead of Paediatrics, Royal Hospital 99474441Dr. Saif Al AbriHead of Medicine, Royal HospitalDr. Yaqoob Al MahrooqiChest disease specialist, Royal Hospital99427669Ph. Anisa RasoolMedical stores in-charge, MoH99476978Mr. Mohammed Al FarsiLogistician &Transport, DGHA 99360541Regional/Provincial Rapid Response TeamName and DesignationOfficeFaxMobileDirector/Superintendent of Health AffairsTEAM LEADERRegional Epidemiologist OR Communicable Disease Focal Point Health inspector from the affected WilayatSupport TeamExecutive Director, Regional HospitalRegional Laboratory in-chargeInfection control staff nurse, Regional HospitalHOD, Medicine, Regional HospitalHOD, Paediatrics, Regional HospitalDirector of Administration, DGHS, Logistic supportVeterinary Doctor - Ministry of Agriculture and FisheriesAnnexure 4Hospital stickerAnnexure 5Infection prevention and control in health care in providing care for confirmed or suspected A(H1N1) swine influenza patientsInterim guidance provided by WHO on 29 April 2009BackgroundThe current situation regarding the outbreaks of A(H1N1) swine influenza is evolving rapidly, andcountries from different regions of the globe have been affected.Based on epidemiological data, human-to-human transmission has been demonstrated alongwith the ability of the virus to cause community-level outbreaks which together suggest thepossibility of sustained human-to-human transmission. Health-care facilities now face thechallenge of providing care for patients infected with A(H1N1) swine influenza. It is critical thathealth-care workers use appropriate infection control precautions when caring for patients withinfluenza-like symptoms, particularly in areas affected by outbreaks of A(H1N1) swine influenza,in order to minimize the possibility of transmission among themselves, to other health-careworkers, patients and visitors.As at 29 April, human-to-human transmission of A(H1N1) swine influenza virus appears to bemainly through droplets. Therefore, the infection control precautions for patients with suspectedor confirmed A(H1N1) swine influenza and those with influenza-like symptoms should prioritizethe control of the spread of respiratory droplets. The precautions for influenza virus with sustainedhuman-to-human transmission (e.g. pandemic-prone influenza) are described in detail in thedocument “Infection prevention and control of epidemic- and pandemic-prone acute respiratorydiseases in health care WHO Interim Guidelines” 1.This guidance may change as new information becomes available.Fundamentals of infection prevention strategies1. Administrative controls are key components, including: implementation of Standard andDroplet Precautions; avoid crowding, promote distance between patients (≥ 1 m); patienttriage for early detection, patient placement and reporting; organization of services; policieson rational use of available supplies; policies on patient procedures; strengthening of infectioncontrol infrastructure.2. Environmental/engineering controls, such as basic health-care facility infrastructure 2 ,adequate ventilation, proper patient placement, and adequate environmental cleaning canhelp reduce the spread of some respiratory pathogens during health care.3. Rational use of available personal protective equipment (PPE) and appropriate hand hygiene.1 Available at For more details, see Essential environmental health standards in health care. Geneva,World Health Organization, 2008. Available at MEASURES:? Avoid crowding patients together, promote distance betweenpatients? Protect mucosa of mouth and nose? Perform hand hygiene2Summary PrecautionsFor staff providing care to patients with suspected or confirmed A(H1N1) swine influenzainfection and for patients with influenza-like symptoms.Standard3 and Droplet Precautions4 should be strengthened when working in direct contact withsuspected or confirmed A(H1N1) swine influenza infected patients. Key elements:? use a medical or surgical mask? emphasize hand hygiene and provide hand hygiene facilities and supplies.As per Standard Precautions2, if there is a risk of splashes onto face:? use face protection! Use either (1) a medical or surgical mask and eye-visor or goggles,or (2) a face shield and,? use a gown and clean gloves.? DO NOT FORGET HAND HYGIENE AFTER PPE REMOVAL!Aerosol generating procedures (e.g. aspiration of respiratory tract, intubation, resuscitation,bronchoscopy, autopsy) are associated with increased risk of infection transmission, andthe infection control precautions should include using:? particulate respirator (e.g. EU FFP2, US NIOSH-certified N95);? eye protection (i.e. goggles);? a clean, non-sterile, long-sleeved gown;? gloves (some of these procedures require sterile gloves).KEY ELEMENTS FOR HEALTH CARE1. Basic infection control recommendations for all health-care facilitiesStandard and Droplet Precautions when caring for a patient with an acute, febrile,respiratory illness.2. Respiratory hygiene/cough etiquetteHealth-care workers, patients and family members should cover mouth and nose with atissue when coughing and perform hand hygiene afterwards.3. Infection control precautions for suspected and confirmed A(H1N1) swineinfluenza infectionPlace patient in adequately-ventilated room. If single rooms are not available, cohortpatients in wards keeping at least 1 meter distance between beds. Standard, andDroplet Precautions for all persons entering the isolation room.4. Triage, early recognition and reporting of A(H1N1) swine influenza infection.Consider A(H1N1) swine influenza infection in patients with acute, febrile, respiratoryillness who have been in an affected region within the one week prior to symptom onsetand who have had exposure to an A(H1N1) swine influenza infected patient or animal.3 Standard Precautions: basic precautions designed to minimize direct unprotected exposure to potentially infectedblood, body fluids or secretions (who.int/csr/resources/publications/standardprecautions/en/index.html)4 Droplet Precautions: health-care workers to wear medical mask gowns and clean gloves when providing direct care.Placement of patients with same diagnosis in designated areas may facilitate the application of infection controlprecautions35. Additional measures to reduce nosocomial A(H1N1) swine influenza virustransmissionLimit numbers of health-care workers/family members/visitors exposed to the A(H1N1)swine influenza patient.6. Specimen collection/transport/handling within health-care facilitiesUse Standard, and Droplet Precautions for specimen collection. Use StandardPrecautions for specimen transport to the laboratory. Health-care facility laboratoriesshould follow good biosafety practices.7. Family member/visitor recommendationsFamily members/visitors should be limited to those essential for patient support andshould use the same infection control precautions as health-care workers.8. Patient transport within health-care facilitiesSuspect or confirmed A(H1N1) swine influenza patients should wear a medical/surgicalmask.9. Pre-hospital careInfection control precautions are similar to those practiced during hospital care for allinvolved in the care of suspected A(H1N1) swine influenza patients. (e.g. transportationto hospital).10. Occupational healthMonitor health of health-care workers exposed to A(H1N1) swine influenza patients.Antiviral prophylaxis should follow local policy. Health-care workers with symptomsshould stay at home.11. Waste disposalTreat any waste that could be contaminated with A(H1N1) swine influenza virus asinfectious clinical waste, e.g. used masks.12. Dishes/eating utensilsWash using routine procedures with water and detergent. Use non-sterile rubber gloves.13. Linen and laundryWash with routine procedures, water and detergent; avoid shaking linen/laundry duringhandling before washing. Use non-sterile rubber gloves.14. Environmental cleaning and disinfectionClean soiled and/or frequently touched surfaces regularly with a disinfectant. e.g. doorhandles.15. Patient care equipmentDedicate separate equipment to A(H1N1) swine influenza patients. If not possible, cleanand disinfect before reuse in another patient.16. Duration of A(H1N1) swine influenza infection control precautionsFor the duration of symptoms.17. Patient dischargeIf the A(H1N1) swine influenza patient is discharged while still infectious (i.e. dischargedwithin the period of infection control precautions: see 16 above), instruct family memberson appropriate infection control precautions in the home.18. Prioritization of PPE when supplies are limitedMedical/surgical mask for the care of all A(H1N1) swine influenza patients and handhygiene are priorities.419. Health-care facility engineering controlsIf available, A(H1N1) swine influenza patients must be placed in adequately-ventilatedsingle rooms. Aerosol-generating procedures should be performed in well ventilatedspaces.20. Mortuary careMortuary staff and the burial team should apply Standard Precautions i.e. perform properhand hygiene and use appropriate PPE (use of gown, gloves, facial protection if there is arisk of splashes from patient's body fluids/secretions onto staff member's body or face).21. Health-care facility managerial activitiesEducation, training, and risk communication. Adequate staffing and supplies.22. Health care in the communityLimit contact with the ill person as much as possible. If close contact is unavoidable,use the best available protection against respiratory droplets and perform hand hygiene.Annexure 6 List of AlgorithmsAlgorithm # 1Case Action guidanceAlgorithm # 2Contact SurveillanceAlgorithm # 3Case Transfer ProtocolAlgorithm # 4Case Arrival at the Referral HospitalAlgorithm # 5Case ManagementAlgorithm # 6Laboratory InvestigationMinistry of Health Sultanate of Oman. PANDEMIC INFLUENZA H1N1 PREPAREDNESSREGIONAL ACTION PLAN MUSANDUM GOVERNORATE MAY 2009 DIRECTORATE OF HEALTH AFFAIRS & DHS MUSANDAM GOVERNORATE ???? ?????? ???? ?????? ??????? ??????? ????? ?????? 3/5/2009??? ??? ?????? ???? ?????? ??????? ??????? ????? ?? ???? ??? ????? ???????:3/5/2009? ?????? ?????? /???? ?? ??? ?? ???? ?????? – ???? ????? ??????? ?????? ????? ????? ?????? ???????? ????? ???????? ???????? ???????? ???? ???????? ???????? ??????? ?? ??? ??????/???? ??????? ???????? ?? ????? ??? ???????? ???? ??????? ?? ??? ?????? ??????? ??? ????????? ????? ???????? ????????.??? ??? ???? ???????/????? ???? ??????? ?????? ?????? ???? ?.???? ??? ???? ?? ????? ????? ?????? ?????? ?? ??? ???????? ???????? ????? ??? ????? ????? ?????? ???????? ??????? ?????? ??????? ??? ??????? ???????? ??????? ??????? ???? ??? ??????? ????? ????? ??????.???? ???????? ?? ????? ???? ?????? ??? ??????? ??? ?? ????????? ?? ??? ??????? ?? ????? ??? ????? ??????? ?????? ?? ??????? ??????? ???.?????? ???? ???????? ???? ??????/ ???? ??????? ????? ?????? ??? ???????? ??????? ???? ???????? ????? ???? ?????? ??????? ???? ????? 15 ???:??? ???? ????? ???? ?????? ????????????????????????? ???? ?????? ???? ????????. ????? ?? ???? ????? ???????????? ???? ??? ????????????? ?? ????????? ????????????? ?? ??? ????????? ?????????? ?? ??? ?? ??? ???????????? ?????? ????????????? ????? ???????????? ???? ??????? ?? ??? ?????????????? ???? ???? ????????? ????? ??????? ??????? ??????? ??????????? ????? ????????? ?? ???? ?? ?????? ????????? ????????????? ???? ??? ???????????? ????? ???? ?????? ???? ??? ????????? ????? ???? ???????? ???? ???????????? ???? ??????? ?????? ?????/???? ???? ??????/???? ???? ?????SWINE INFLUENZA-MEETING MINUTESOn 3/5/09 a meeting was conducted at DHSM conference room under the chairman ship of Dr Mohd Mohd Amro Ghobashy,Supdt of Health affairs. Following Health care providers of the region attended the meeting-Medical officer incharge of all Hospitals&H/C except Leema H/C.-Infection Control incharge of all Hospitals&H/Cs except Leema H/C.-Dr Ashraf El Sayed,HOD (Paed),Khasab Hospital-Dr Zakaria Ibrahim,HOD (Med),Khasab Hospital-Dr Ashraf Jamal,Infection control doctor i/c,Khasb Hospital-Mr Abdullah Juma ,infection control nurse i/c,Musandum region-MCH Co-ordinator-Supdt of pharmacy&medical stores-Acting head of Nursing-Regional Vaccine store incharge-Dr D.P.Shah,doctor incharge ,Khasab private clinicSupdt of Health affairs welcomed all for the meeting and following points discussed.-Swine influenza H1N1 is now of global concern.Since its outbreak is alarming,we as health care providers of Oman too to be prepared well enough,even though present situationin Oman is safe.-Global preparedness and situation updates were informed by Dr Ghobashy.-WHO recommendations and reports were shown on slides during meeting.-A Lecture is made to all staffs about swine influenza on 30/4/09 by Supdt of Health affairs in the regional lab symposium.-All Hospitals and private clinics must give awareness to all staffs and enough PPE to be made available-Regional Hospital is well equipped with an isolation ward and anti viral drugs-All Hospitals and Health centers can refer the cases to regional Hospital as per the protocol.-Dibba Hospital can receive from patients from Madha H/C and manage the case there itself since they have the facility.-Even Dibba Hospital can refer cases to Regional Hospital.-All Hospital must follow the swine influenza A(H1N1) case Action protocol of the Region/Governorate.A copy of the same to be available in each clinic.-Expressed thanks to Dr.Ahmed madhani,M.O incharge Madha H/C.-Dr Mariam asked to send E-mail for her the updated Algorithm-Weekly ILI report to be send to DHSM from all health institutions as it is an on going programme in Musandum region since last 3 yrs.-All health institutions must send the feed back of their preparedness on swine influenza management and the name of the staff responsible,based on Avian Influenza preparedness of Musandum Governorate.-Influenza A H1N1 update Mo.12 distributed to all members during the meeting.-Infection control protocol in case of acute Respiratory diseases to be distributed to all clinics.-There was a meeting with all Epidemic Preparedness Team on 3/5/09 at 11.30am and also Arabic lecture delivered about the same by Supdt.of Health Affairs.-No other points discussed.-Meeting concluded at 11.00 hrs.DHSM CONTD…WORKSHOPS CONDUCTED ON SWINE INFLUENZA HINICATOGERIES30/4/0917/5/09STAFF NURSE3136SPECIALISTS1203M.O79LABORATORY713PHARMACY1DIETITAN1DENTISTS1OTHERS2(IT) KHASAB HOSPITALPreparation for manangement of swine influenzaA,Meeting was conducted at MOIC Office on 1/5/09 at 12.10 pm.The following members were present.1.Dr Rakesh Sharma,Actg MOIC2.Mr Ahmed Darwish.A.O3.Dr Omaima A Wehab,MOIC Public Health4.Dr Zakariya Boghdady,HOD (Med)5.Dr Arshad Jamal,HOD(Surg)6.Dr Ashraf El Gazar,HOD(Paed)7.Mrs Amal Hassan,Nursing supervisor8.Mrs Shaikh Al Kamali,MRO9.Mr Bader Darwish,I/C Pharmacy&Medical store10.Dr Wael Lotfi,pathologistThe minutes of the meeting are as followsDr Sharma Actg MOIC after welcoming participants gave a briefing on swine influenza situations as an International public health emergency and need for health care team to be ready.He delegated the responsibilities as follows1.Dr Ashraf El Gazar HOD(Paed) will be responsible to check WHO website on (http.WWW.who.int) on computer twice a day in addition to being I/C Communicable disease&Paed cases.2.Mr Haris Biomedical technician should ensure all ecquipments such as ventilators and defibrillator located in the treatment room of Isolation ward arew fully functional.3.MOIC Public Health should make a team for surveillance in community and Mr Ali Khatab to initiate necessary steps if suspected/confirm cases come to notice.4.Dr Wael Lotif is responsible for investigations of all cases of ILI and LRTI including pneumonia for all age groups.Weekly reports should be sent to the supdt of health affairs5.Dr Arshad Jamal HOD(surg) and Mr Abdullah Juma will be responsible for Infection control in Hospital and Polyclinic including procurement of necessary materials.6.Mrs Shaikha and Mr Khalid are responsible for inpatient/outpatient statistics and reporting of the same.7.Dr Zakaria HOD (Medicine) is responsible for training all GPs and Staff Nurses regarding swine influenza and responsible for preparing detailed protocol for swine influenza management in addition to management of adult cases.8.Mr Bader is responsible to ensure that all the medications and equipments stocks are updated.9.Mrs Amal is responsible to keep ready the Swine influenza Isolation ward to receive any cases and prepare duty roster for Nursing staffs and Supervisor staff for smooth functioning of Isolation ward.B,As of now the Isolation ward including treatment room with all items including ventilator,defibrillator,oxygen cylinder,IV lines.disposibles and medications is filly ready in addition to two isolation rooms for patients which can be increased to three as and when need be.C,990 tablets of TAMIFLU 75 mg are available in medical store.D,Nursing Supervisor Mrs Amal has under taken detailed briefing of Nursing staff in above context.Copy of her report is attached here with.E,WHO website is being checked on daily basis by Dr Ashraf El Gazar and latest updated information as and when available will be circulated to all Health Care workers.F,Dr Zakaryia has been requested to prepare presentation and conduct briefing of all doctors at the earliest in consonance with guidelines and,protocols and materials from Supdt of Health affairs under his kind guidance. DIBBA HOSPITAL Preparation for management of swine influenzaINTRODUCTION Dibba Hospital is a local health institute in Musandum region.The Hospital is provided with 40 beds and serves as primary and secondary health care.The catchment population is 6,222(Annual health report 2006)Disasters have been divided in internal disaster(refers to an incident that disrupts the every day,routine service of the medical facility itself)and External disaster(that has occurred outside the hospital and has not had a direct impact on the hospital servicecapabilities)Our external disaster plan consists of thre responsible phases.Phase 1 is an alert phase,during which staff remains at their regular dutiesand wait for further instructions from their supervisors(MOIC and Nursing incharge in co-ordination with hospital engineer).Phase 2 is a response phase and designated staff report to supervisors or the command post for instructionsPhase 3 is expanded response phase during which additional persons are required.Therefor,off duty staffs are called in to the hospital.and existing staffs may be relocated within the hospital.The hospital engineer and his team will be responsible for repairing and laboratory equipments failure,potential chemical spills,and loss of radiography capability,suction,communication,lighting,medical gases and structural stability.Also adequatenumber of security personnelwillm report to areas of congestion to prevent thegeneral public from entering the facilityand to clear hallwaysto ensure that patient care,particularly in critical areas,is not hampered. Main Disaster team consists ofMOIC;Dr Aisha Al Shehi Team incharge,contact numbers 99367157,28836600,26836281Willayat Health Superintendent;Mr Ali Abdullah GSM 99422201Physician and acting MOIC/Acting team incharge;Dr Wesam Hanna 26836793,Ext 312,GSM 99834319Paediatrician;Dr Mahmood K,26836794.EXT 307,gsm 92726360Anaesthetist;Dr Amani 26836446,ext 309Surgeon;Dr Gamal 26836446,ext 311,GSM 99643749Nurse I/C;Fatima Mohd GSM 92298226,26836699,26836109Administrative Supdt;Atiqa Ali,GSM 92299883Onec Company representative Mr Babu GSM 92174490The above team is responsible to announace the emergency situations and co operate with the main committees at regional and centaral level as well as thwe other non medical committies available in the villayat.See attached algoritham,case action protocol,DGHSDuring external disaster and emergencies the following actions will be taken1,Stopping all routine admissions and routine opd cases,discharge stable patients2,Use the available isolation roomfor any suspected case till paitent transfer to regional hospital if needed according to regional protocol.3,Keep male ward room no 3ready to be used as isolation room in case,if suspecting case increasing more than two.4,All medical and paramedical staff should be 24 hours oncall5,Ambulance to be kept 24 hours available for shiftingor transferring of patients6,Suspected cases will be managed according to the swine influenza case action protocol,regional/Governorate April 2009 and according to WHO protocol,infection prevention and control in health care ,providing care for confirmed or suspected H1NI swine influenza patients.Dibba Hospital PPE equipments currently not adequate,accordingly a formal letter have been sent to Ph Moza,head of pharmacy and medical stores at musandum region to provide as with enough N95 mask and medications like TAMIFLULaboratory acting incharge Muna will follow up with central/regional lab to provide special media for swab culture,inorder to be taken in Dibba Hospital and to sent immediately for central lab for confirmation.Infection control focal point of Dibba Hospital have been informed to follow up for WHO protocol implementation in providing care for confirmed or suspected swine influenza H1N1 patients.The following steps/lectures and meeting have been done in Dibba hospital since the start of phase 4 swine influenza world wide-On 29/4/09 meeting with all HODs,Willayat Health Supdt,AO,Nurse I/C,opdI/C,infection control focal point,Lab I/C,Pharmacy I/C,Public health I/C,to discuss and update Dibba Hospital swine influenza protocol and update main team and discuss infection control plan and responsibilities-On 5/5/09 CME conducted with all hospital staff about hand wash,saves lives(WHO celebration)to encourage hand hygiene and emphasis on using the recommened protocol an d guide line for hand washOn 6/5/09 CME conducted with all HODs,GPs,department I/CS,Infection control focal point and Nurses to discuss regional/local plan of swine influenza and infection control in health care in providing care for confirmed or suspected swine influenza H1N1.Regional algorithm and WHO protocol to be strictly followed in Dibba Hospital. BUKHA HOSPITALPANDEMIC INFLUENZA PREPAREDNESS PLAN 2009 In view of the above and with the reference of letter no MH/DHSM/HHC/5/09/1048 on 6/5/09 below mentioned are the details from our institutions with respect to the above stated topics-ACTION PLAN-Formation of preparedness team;Dr Maryam salah Al Sawaleh (Head of Willayat Health services)GSM 99319892-alsawaleh76@MOIC(Dr Maryam Salah Al Sawaleh)Mr Mohd Ahmed Mohd,(AO)GSM 99006767 AnnammaV.O,GSM 92200751,annathampy@yahoo.co.ukInfection control staff(SSN Badriya Al Dahoori)GSM 99435123Lab I/C ,GSM 99464972XRAY I/C,GSM 92385011-Educating the public about Influenza A H1N1 .In this regard our doctors are providing advisory details to relevant OPD patients on their travel habits,etc,according to the current Influenza A H1N1 trends.-Continue updating the doctors and the other staffs with the most recent WHO reports about Influenza A H1N1 and the most recent recommendations.-Three doctors and two nurses attended the awareness lecture on swine influenza conducted by Dr Mohd Mohd Amro Gobashy on 30/4/09.Orientation given to other staffs in the hospital about the disease.-H1N1 Influenza case action protocol is distributed to all the clinics and in the wards and explained to the doctors and to the staffs.-prepration of the weekly ILI reports which are forwarded to DHSM as before done since 3yrs.-Infection control protocol in case of acute respiratory disease distributed to all clinics and wards.-Use a medical or surgical mask and emphasize on hand hygiene and provide hand hygiene facilities and supplies.-Ensure the availability of personal protective equipments and accessible round the clock to the health care staff,(surgical mask, gloves and mask).-In case of suspected cases1-Inform Head of wilayat health service (Dr Mariam Al shehi)and M.O.IC., Nursing supervisior,and infection control nurse , and other members of the preparedness team.2-suspected case to be first informed and consulted with Supdt of health affairs , HOD medicine in case of adult and HOD paeds in case of children.3-If the case is fitting the criteria of suspected case then to refer by ambulance with staff nurse to khasab hospital.>suspected case transfer1.Isolate the case in the treatment room in the IPD.2.He/she should wear a surgical mask.3.Do not allow contact with others (relatives).4.patients documents/belongings should be collected by the health care provider.5.Doctor/health care provider should wear PPE(surgical mask,gown, gloves).6.carry out only most required procedures on the case and avoid unnecessary contact.anize ambulance with staff nurse to escort the case immediately8.The ambulance staff must use PPE.*A lecture is given to all the staff about Influenza AH1N1 on 10/5/09 in Bukha hospital paediatric ward at 1p.m.*We are planning for continues education,orientation and training of health workers and school students about the disease and the possible ep0idemic.STAFFS RESPONSIBLE*Dr Mariyam saleh Al sawaleh (Head of wilayat health services, GSM-99319892 alsawaleh76@*M.O.I.C (DR Mariam saleh Al sawaleh)*Mr Mohd Ahmed Mohd (A.O) GSM 99006767*Annamma V.O.GSM 92200751,annathampy@yahoo.co.uk *Infection control staff ( SSN Badriya Al Dahoori GSM,99435123)*x ray incharge GSM 92385011*Lab incharge GSM, 9946972. LEEMA HEALTH CENTRESWINE INFLUENZA A H1N1 PREPAREDNESSPREPAREDNESS TEAM1.Dr AHLAM Mohd khalil (M.O.I.C)2.Dr Mohanned Babiker( M.O)3.Mr Ali suliman Ahmed (A.O)4.Mr Ali Hassan Hilal (Nsg incharge)5.Ms Saliamma kurian (S/N)6. Ms Suma Stephen ( lan i/c )PLAN OF ACTION*All staffs oriented and lectures given about Swine influenza and explained what to do in case of emergency.*Lecture given to school and discussion conducted among the students (attended 43)*Lecture given to CSGM and explain how to orient public and avoid unnecessary panic.*Leema staffs vaccinated against influenza.*Ready to meet any emergency.*when identify the case as suspect isolate the patient with mask and staffs to wear PPE.No isolataion facility in leema health centre.*Inform Supdt of health service and focal point of communicable disease of khasab hospital.* Inform public health i/c of khasab *Arrange the transfer of the patient to regional hospital.*Weekly ILI report to supdt of health affairs and the focal points. KUMZAR HEALTH CENTRESWINE INFLUENZA A H1N1 PREPARDNESS Sultanate of Oman Ministry of Health Directorate of Health Services Musandam GovernorateKumzar H/C H1N1 Influenza A Case Action Protocol Suspect human case of H1N1 Influenza A INITIAL CONTACT (In the H/C seen by Doctor /NurseSuspect Case DefinitionAcute febrile respiratory illness(fever>38C)with the spectrum of disease from Influenza- Like Illness(ILI)to pneumonia inclusive of severe acute respiratory illness(SARI)with onset-----Within 7 days of close contact with confirmed case of H1N1 Influenza A virusOR-Within 7 days of travel to countries where one or more confirmed case of H1N1 Influenza A virus were reported OR-Resides in a community where there were one or more confirmed cases of H1N1 Influenza A virus.If No If YesNo further action -Inform Dr on call(if seen by nurse) -Inform: -Supdt of Health affairs/Dr Mohd Ghobashy (99381424) -Dr Zainab MCH Coordinator-99468845.During initial contact Compatible case-place surgical mask on the patient Inform Executive Director-Khasab Hospital-HCWs should also use surgical mask Dr Jolly philp(99220513)for admission& -place the patient away from other patients organize suitable method to transfer the until referral . patient (according to weather&case)-resuscitate the patient if neededCase Transfer to Khasab HospitalSuspect case H1N1 Influenza A virus detected inKumzar H/C (by nurse or Doctor) (Epidemiologically &clinically compatible)-Dr/health inspector should wear PPE-N95 respirator mask,gown,gloves) Suspect caseImmediately- -Inform G P on call(if Do not carry out any procedure on seen by nurse) the case& avoid unnecessary contact-isolate case in a room.Boat&Helicopter should not accompany - Do not allow contact the case to the hospital(also they should use PPE) withothers(relatives) -patients documents/ belongings should be Collected by the health inspector Before referral inform consultSpecialist on call ( Paediatric or medicine)Dr. Mohd Ghobashy ( 99381424)Dr. Zainab (99468845)Instruction for transfer of cases -Organize method of transfer according To advice of the Specialist (by boat or by air) , with a staff nurse escort-Staff should use PPE Quarantine Hospital for HPA1 in ----Inform Executive Director, Khasab hospitalDr.Jolly Philip (GSM 99220513) for Admission to Khasab Hospital) Suspect case MADHA HEALTH CENTRE1.A person with an acute respiratory illness who was a close contact to a confirmed cases of swine influenza virus infection while the case was ili or 2 Aperson with an acute respiratory illness with a recent history of contact with an animal with confirmed or suspected swin e influenza or3.A person with acute respiratory illness who has traveled to an area where there are confirmed cases of swine influenza within 7days of suspect cases illness onset. PPDDDIF NONo further actionCONSULT FOR EPIDIMOLOGICAL COMBATIBILITYDR.MOHD GHOBASHY (99381424&26731655)DR AHMED AL MADHANI (99448498&26739090)CONSULT FOR CLINICAL COMPATIBILITYDR ZAKRIYA, HOD MED (26730138&26730155)DR ASHRAF, HOD PAED (26730138&26730155)CASE TRANSFER PROTOCOLQUARANTINE HOSPITAL IN MUSANDAMKHASAB HOSPITAL SUSPECTED CASE EPIDIMOLOGICALLY & CLINICALLY COMBATABLESUSPECT CASE1.ISOLATE THE CASE IN A ROOM2.HE/SHE SHOULD WEAR A SURGICAL MASK.3.DO NOT ALLOW ANY CONTACT WITH OTHERS (RELATIVES)4.PATIENTS DOCUMENTS /BELONGINGS SHOULD BE COLLECTED BY HEALTH INSPECTOR.HEALTH CARE WORKER1.DOCTOR/HEALTH INSPECTORMUST WEAR PPE(3M MASK,GOWN,GLOVES).2.DO NOT DO ANY PROCEDURE ON THE CASE AND AVOID INNECESSARY CONTACT. INFORM DR MOHD GOBASHY (99381424) DR.ZAKRIYA &DR ASHRAF (26730138) CONTACTS???? ??? ????????????? ?????????? ?? ??????? ??????? ??????? ??? ??? ???????? ????????????? ?????????????? ?????99448498???? ??????.???? ????????26739213???? ????? ?????????.?????00971507006585???? ???????????? ??????00971504345678?????? ?????????????? ???? ????????00971503915777???? ??????? ????????? ???? ???????? 92440179???? ???????? ??????? ???????? ???????? ????????? ?? ??????? ??????? ??????? ??? ??? ???????? ????????????? ???????????????????99381424???? ?????? ???????.?????26730138???? ??? ???????? ????.?????26730138???? ??? ??????? ????.????99367157???? ????? ?????? ????.????? ?????26836777???? ??? ??????? ?????.?????26836777???? ??? ???????? ?????.???? CONTACT OF SUSPECT CASETO CONDUCT HOME VISIT. PPE SHOULD BE WORN DURING THE VISIT (MASK, GOWN , GLOVES )TO ENLIST ALL INFORMATION OF ALL CLOSE CONTACTS.(ADDRESS, MOVEMENT, CONTACT TELEPHONE, ETC)ASK AND CHECK FOR FEVER AND RESPIRATORY SYMPTOMSCONTACT IF FEVER OR RESPIRATORY SIGNS AND SYMPTOMSASYMPTOMATIC CONTACTSHOUSE QURATAINE FOR 10DAYS FROM THE DAY OF CLOSE CONTAACT WITH SUSPECTED CASEDAILY VISIT BY THE DOCTOR TO THE HOUSE FOR THE CHECK UP ( FEVER AND RESPIRATORY SYMPROMS)CONTACTS ADVICE1.RESTRICT MOVEMENT OF CONTACTS2 SHOULD NOT REPORT ON DUTYFOLLOW UP DOCTOR TO INFORM AND CONCULTDR MOHD GHOBASHYIF THE CONDAACTS DEVELOPS SYMPTOMS OF FEVER AND RESPRATORY SYMPTOMSCONTACT ADVISORY1DO NOT VISIT ANY CLINIC/GOVTOR PVT2.MINIMIZE CONTACT WITH FLY AND RESRICT MOVEMENT.3. CALL DOCTOR IS THE ONE WHO IS DOING THE FOLLOW UPFOLLOW UP DOCTOR TO INFORM AND CONSULTFOLLOWUP DOCTOR SHOULD CALL THE MOIC TO ARRANGE SUSPECT CASE MADHA HEALTH CENTRE1. THE STAFF MUST START USE PRECAUTION PROCESS (MASK, GOWN,GLOVESAND CLEAN USING70% ALCOHOL OR SOAP WITH WATER)2.PATIENT MUST WEAR A MASK3.SHIFT THE PATIENT TO THE DELIVERY WARD IMMEDIATELY.4. STOP THE RELATIVES FROM COMING IN CONTACT WITH THE PATIENT.5.RESTRICT THE STAFF WHO ARE DEALING WITH THE PATIENT TO THE PHYSICIAN AND THE NURSE ONLY WHO MUST STOP BEING IN CONTACT WITH OTH ER PATIENTS.6.CALL THE MOIC AND NURSE INCHARGE..7. RECORD THE ATTENDANTS WITH THE PATIENTS, THE OTHER PATIENS WHO ARE IN THE CLINIC AND THE STAFF WHO ARE ON DUTY.1.APERSON WITH ACUTE RESP ILLNESS WHO WAS A CLOSE CONTACT TO A CONFIRMED CASE OF SWINE INFLUENZ H1N1 VIRUS INFECTION WHILE THE CASE WAS ILL OR2.A PERSON WITH AN AC.RESP ILLNESS WITH ARECENT H/O CONTACT WITH AN ANIMAL WITH CONFIRMED OR SUSPECT SWINE INFLUENZAH1N1 VIRUS INFECTION OR3.A PERSON WITH AN AC RESP ILLNESS WHO HAS TRAVEL TO AN AREA WHERE THEREARE CONFIRMED CASE .INFLUENZAH1N1WITHIN 7DAYS ................
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