LAGUNA PROVINCIAL HOSPITAL

INFLUENZA A (H1N1) CONTINGENCY PLAN

Purpose

This plan informs health care personnel, public health, and

government officials at all levels of the necessary capabilities that
must be present for successful hospital management of an outbreak
of H1N1. It also enumerates the necessary actions that must be
taken to attain these capabilities. The performance of the
necessary actions will fall to parties including public health officials
and hospitals – administrators, medical staff, nursing and support
services. The goal of this guidance is to protect the health care
infrastructure and ensure the delivery of emergency medical
treatment and other essential care during a large scale epidemic or
pandemic.

Background

Novel influenza A (H1N1) is a new flu virus that was first detected in
May, 2009. It is thought that novel influenza A (H1N1) flu spreads in
the same way that regular seasonal influenza viruses spread; mainly
through the coughs and sneezes of people who are sick with the
virus.1 The novel influenza that hit our country is a mild one but
because this is a new virus, most people do not have immunity to it,
and illness may be more widespread as a result. In addition, the
vaccine to protect against novel H1N1 virus is not expected to be
available until before the end of this year. Therefore, health care
institutions, hospitals specifically, should prepare for high volumes
of sick and contagious people seeking care.

Disaster Preparedness Measures

1. Hospital Setup

a. Develop a triage area were patient will be screened

prior to being sent to appropriate services.
b. Develop or construct a holding area in the Emergency
Room were infectious cases are to be examined and
evaluated.
c. Identify and prepare a single room which will be use as
confinement / isolation area for admitted H1N1 cases.

2. Logistics

a. Supply office will prioritize the supplies, medicine and

equipment that will be needed by the hospital staff and
patients.

Laguna Provincial Hospital RPB

 b. Emphasis will be on the availability of PPE’s at critical
areas such as Emergency Room, Out Patient section,
Laboratories and Wards.
c. Stocked up on thermometers, surgical masks, N95
masks and impervious gloves for employees and visitors

3. Healthcare Personnel

a. Promote a healthy life style for all staff

b. Plan and promote immunization of staff specially those
who are assigned in high risk area
c. Continuous education and orientation for staff and
affiliate students
d. Identify additional manpower requirements and working
schedule needed to maintain critical functions
e. Retraining of staff for some other critical functions i.e.
throat swabbing
f. Keep updated on the latest DOH advisory, and
accordingly develop / implement policies and
precautions to safeguard employees’ health and well-
being

4. Guidelines

a. Disease Surveillance
i. Daily reporting of any incidence pertaining to
H1N1 cases
ii. Include in the list of reportable diseases
iii. Follow up / monitoring of H1N1 cases if any
iv. Laboratory personnel participates in throat
swabbing of cases in the community as requested
v. Results of these test will be monitored and
reported

b. Education of Employees
i. Inform employees on relevant H1N1 advisories
and guidelines issued by the DOH
ii. Advised employees on flu symptoms, overseas
travel, practice of personal hygiene, social
responsibility and the adoption of a healthy
lifestyle
iii. Advised employees not to come to work if they are
not feeling well. During mitigation phase, advised
employees who develop flu symptoms (e.g. fever,
cough, sore-throat) to wear surgical masks, and to
visit the hospital emergency department for initial
assessment and treatment.
iv. Staff exposed to someone with the following
symptoms-- elevated temp >37.8 degrees Celsius

Laguna Provincial Hospital RPB

 and respiratory symptoms to include coughing,
sneezing, sore throat, runny nose-- need to
practice droplet precautions:
-Surgical Masks
-Eye protection
-Handwashing

c. Precaution Reminders
i. Displayed health advisories to inform visitors on
preventive measures. Flu-related safety guideline
signs are being posted at entrances and will be
updated if/when a change occurs.
ii. H1N1 precautions have not changed. Continue to
practice the basic droplet precautions that have
been in place
iii. Visitation policies have not changed. To remain
consistent with community standards and avoid
unnecessary risk, we encourage the following
people to avoid visiting the hospitals:
-people who have weak immune systems;
-women who are pregnant;
-children 12 years old and under.

d. Environmental Cleanliness

i. Cleaning of all office space and common facilities

are at least daily
ii. Implement Infection control measures in line with
the advisories on public health measures issued
by the DOH
iii. Inform cleaning crew of daily cleaning procedure
and procedure for disinfection of areas exposed to
a case
iv. Frequently touched surfaces are washed/wiped
with 1:50 diluted household bleach. 70% alcohol
is used to wipe surfaces where use of bleach is not
suitable e.g. metal. Soiled surfaces are cleaned
with water and detergent before applying alcohol
or bleach
v. Cleaning crew is informed of symptoms, usage of
impervious gloves and N95 mask when cleaning
rooms use by H1N1 patients and type of
disinfectant to use
vi. Advice cleaning crew that cleaning equipment use
an isolation room should not to be use for other
rooms

5. Procedures On Handling H1N1 Suspect Case (CUO)

Laguna Provincial Hospital RPB

 a. Questionnaire or checklist will be given to all patients
registering at the out patient section.
b. Patient with flu like illness will be separated from the
crowd and assign a seat at the waiting area.
c. These patients will be examined and treated at a
designated holding area for infectious cases.
d. Patient that would fit the case definition as suspect case
or case under observation (CUO) will have to under go
confirmatory testing through throat swab, conducted by
trained personnel.
e. If patient’s condition does not need confinement they
will be treated accordingly and sent home and advice
self quarantine until the result of the test returned.
f. If patients conditions has complications or other co-
morbidities that needs confinements, patient may be
admitted and treated while isolation procedures is being
instituted. Patient may stay in the iso room until the
results return.
g. To ensure safe, patient-centered care, it is an
expectation that all employees, physicians and visitors
comply with isolation guidelines.
h. For patient that were sent home: If test result is
negative, then patient may continue treatment as a
case of seasonal flu and advice rest until his conditions
improved. If test result is positive then he may be
referred to RITM for further management or he may be
treated at home with oseltamivir at dose recommended
by WHO, if drug is available.
i. For confined patients, if test is negative patient will be
manage as seasonal flu and other illnesses will be given
appropriate treatment. If test is positive, patient may
be referred to RITM
j. For HCW that are involved in the care of confirmed
H1N1 cases they will be given prophylaxis of oseltamivir
as needed.

Prepared by:

Dr. Rene P. Bagamasbad, M.D., CHA

Laguna Provincial Hospital RPB