These guidelines were developed by the Infectious Disease Management Program (IDMP). The IDMP is a collaborative organization consisting of the Infectious Diseases Consult Service, Clinical Pharmacy, Infection Control, and Microbiology.
All health care providers are encouraged to receive influenza vaccination prior to the influenza season. In addition, there is a zero tolerance policy regarding health care providers working with upper respiratory symptoms or febrile illness. However, in the event of accidental person-to-person transmission of influenza, antiviral agents are recommended. Treatment should be initiated following an exposure and within 48 hours of the onset of symptoms (Attachment 1).
Post-exposure Prophylaxis and Treatment
1. Health care providers with febrile illness or upper respiratory symptoms are restricted from work. When a health care provider has fever and/or upper respiratory symptoms consistent with influenza and has contact with an adult oncology patient, he/she shall be restricted from work until afebrile and symptoms have improved. Employee Health shall evaluate the health care provider.
2. The health care provider shall be screened for influenza A, influenza B, adenovirus, parainfluenza virus and RSV for epidemiological purposes.
3. The health care provider shall be referred to their primary medical provider for treatment of influenza, if indicated. Treatment will not be provided by Employee Health Services.
4. The recommended treatment for the symptomatic health care provider is oseltamivir 75 mg by mouth twice daily.
5. The nurse manager will identify the patient(s) exposed to the health care provider and notify Infection Control and the attending physician(s) of the exposed patient(s).
6. Infection Control will verify that patients meet the criteria of an exposure (refer to B.2).
7. Exposed immune compromised patients will begin prophylactic antiviral therapy (oseltamivir 75 mg by mouth daily) regardless of their influenza vaccine status.
B. Patient to Health Care Provider Exposure:
1. Patients with symptoms consistent with influenza should have the polyvalent test ordered and treatment with an antiviral agent should be initiated (A.4).
2. If a patient is identified with influenza and is not currently on Droplet Precautions, all health care providers who are exposed to the patient shall be evaluated by Employee Health Services for antiviral prophylaxis. An exposure is defined as an in-room exposure of at least 10-15 minutes, OR face-to-face, hand-to-hand contact with the patient or hand-to-surface contact with the patientís environment.
3. Employees who did not receive influenza vaccine shall be encouraged to receive the vaccine and antiviral prophylaxis with oseltamivir (provided by Employee Health Services at no charge).
4. Antiviral therapy is not recommended for immunized health care providers, unless the circulating virus is not covered in the vaccine.
C. Influenza Outbreak (A or B):
1. An outbreak is defined as ≥ 2 nosocomial cases of influenza within a one-week period on the same unit. Infection Control will make the determination of an outbreak, and the unit nurse manager shall be notified.
2. All patients on the involved unit shall receive prophylactic antiviral therapy with oseltimavir (A.7). The Infectious Diseases Consult Service shall recommend the duration of therapy.
3. All patients with documented or suspected influenza will be considered for treatment with oseltamivir (A.4).
4. Health care providers shall be evaluated by Employee Health Services (A.2-4, B.3).
5. Vaccinated employees will not receive antiviral therapy, unless the circulating virus is not covered in that seasonís vaccine.Unvaccinated employees will be immediately offered vaccine and started on prophylactic antiviral therapy for two weeks following vaccination. For health care providers who decline influenza vaccination, duration of prophylaxis will be d