PICNIC

Picnic is a part of Physical Medicine & Rehabilitation Hospital's program provided by social worker department of Physical Medicine & Rehabilitation Hospital for the patients. Picnic was held on November 27, 2013 in Kuwait Zoo from 10 AM to 12 Noon and attended by 7 patients ( from ward 3 and ward 5 ) , social worker, occupation therapist and nurse. The aim of picnic is to refresh and make patients happy because patients stay in the hospital for long time. A side from that the patients can learn and recognize/memorize the object specially for the patients who have cognitive impairment. Read More ..

9 PATIENT SAFETY SOLUTIONS

LOOK ALIKE SOUND ALIKE (LASA)

Separate location for placing Look Alike Sound Alike medication

Arrange Look Alike Sound Alike medication in non-alphabetical orders

Reading the label before handling and preparing Look Alike Sound Alike medication and should be placed in labeled shelves

Tall man lettering, color difference and bold face technique are used to be easily differentiate Look Alike Sound Alike medications

MEDICATION RECONCILIATION

History of current treatment should be taken by the doctor from the patient, relatives or from medical record if available

Compare the current treatment with the new added treatment and document it in the reconciliation list

CONTROLLED OF CONCENTRATED ELECTROLYTES

“MUST BE DILLUTED”

CAN KILLED……..!!!!!!

Check and verify doctors order

A proper computation of dilution is needed and asks about double checking

Note all the things you have done

Keep on monitoring patient status

Identification of patient is a must when starting the infusion

Label the prepared solution to avoid confusion

Learn doing proper handover all the time

PATIENT HANDOVER

Use SBAR

Situation : chief complaint, current status

Background : previous history

Assessment : result of assessment, vital signs, investigations and symptoms

Recommendation : suggested and anticipated changes, complications, critical monitoring

AVOIDING CATHETER & TUBING MISCONECTION

Doctor’s order must be checked and verified

Re-check all lines and tubes before and after each shift

Avoid positioning of the functionally similar tube close to each other as much as possible

Stick label on high risk catheter (e.g. arterial, epidural & intrathecal)

Encourage patient and relatives to inform the healthcare providers on duty when they notice any problems on changes on the line or tubes

Trace all lines from their origin to the connection port to verify attachment before making any connection or reconnection or to administer medications and other solutions

PATIENT I.D BRACELET

please….WEAR ME

Write complete patient information clearly

Ensure that 2 identifiers are available (e.g. full 3 names and birth date)

Apply the bracelet to an appropriate limb within one hour

Replace the bracelet if any part of the patient’s information has become not clear

Make sure that you must ask patient name rather than telling his/her name

Each time care is provided, patient identification must be done by healthcare provider

CORRECT PROCEDURE AT CORRECT BODY SITE

Identification and verification of the right person, procedure and body site should be completed before transferring the patient to the treatment area as a safety priority

A written consent should be obtained after discussion with the patient

Establish the performance of correct procedure at correct body site as a safety priority

Relevant and complete documentation is needed during and after the procedure

Check the equipment’s needed for the procedure must be checked if it correct and functioning properly

SINGLE USE OF INJECTION

Remember the ten rights when you give patient medication

Always use the single injection as safety priority

Recapping should not be done to avoid needle stick or pick

Hand hygiene and proper protection must be applied before giving the medication

Waste management procedure, rules and regulation practices should be identified and implemented in a safe way

IMPROVED HAND HYGIENE

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5 MOMENTS FOR HAND HYGIENE

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HANDS WASHING

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ISOLATION TECHNIQUE

Definition

Isolation refers to the precautions that are taken in the hospital to prevent the spread of an infectious agent from an infected or colonized patient to susceptible persons.

Purpose

Isolation practices are designed to minimize the transmission of infection in the hospital, using current understanding of the way infections can transmit. Isolation should be done in a user friendly, well-accepted, inexpensive way that interferes as little as possible with patient care, minimizes patient discomfort, and avoids unnecessary use.

Precautions

The type of precautions used should be viewed as a flexible scale that may range from the least to the most demanding methods of prevention. These methods should always take into account that differences exist in the way that diseases are spread. Recognition and understanding of these differences will avoid use of insufficient or unnecessary interventions.

Description

Isolation practices can include placement in a private room or with a select roommate, the use of protective barriers such as masks, gowns and gloves, a special emphasis on handwashing (which is always very important), and special handling of contaminated articles. Because of the differences among infectious diseases, more than one of these precautions may be necessary to prevent spread of some diseases but may not be necessary for others.
The Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practice Advisory Committee (HICPAC) have led the way in defining the guidelines for hospital-based infection precautions. The most current system recommended for use in hospitals consists of two levels of precautions. The first level is Standard Precautions which apply to all patients at all times because signs and symptoms of infection are not always obvious and therefore may unknowingly pose a risk for a susceptible person. The second level is known as Transmission-Based Precautions which are intended for individuals who have a known or suspected infection with certain organisms.
Frequently, patients are admitted to the hospital without a definite diagnosis, but with clues to suggest an infection. These patients should be isolated with the appropriate precautions until a definite diagnosis is made.

Standard precautions

Standard Precautions define all the steps that should be taken to prevent spread of infection from person to person when there is an anticipated contact with:
• Blood
• Body fluids
• Secretions, such as phlegm
• Excretions, such as urine and feces (not including sweat) whether or not they contain visible blood
• Nonintact skin, such as an open wound
• Mucous membranes, such as the mouth cavity.
Standard Precautions includes the use of one or combinations of the following practices. The level of use will always depend on the anticipated contact with the patient:
• Handwashing, the most important infection control method
• Use of latex or other protective gloves
• Masks, eye protection and/or face shield
• Gowns
• Proper handling of soiled patient care equipment
• Proper environmental cleaning
• Minimal handling of soiled linen
• Proper disposal of needles and other sharp equipment such as scalpels
• Placement in a private room for patients who cannot maintain appropriate cleanliness or contain body fluids.

Transmission based precautions

Transmission Based Precautions may be needed in addition to Standard Precautions for selected patients who are known or suspected to harbor certain infections. These precautions are divided into three categories that reflect the differences in the way infections are transmitted. Some diseases may require more than one isolation category.

AIRBORNE PRECAUTIONS. Airborne Precautions prevent diseases that are transmitted by minute particles called droplet nuclei or contaminated dust particles. These particles, because of their size, can remain suspended in the air for long periods of time; even after the infected person has left the room. Some examples of diseases requiring these precautions are tuberculosis, measles, and chickenpox.
A patient needing Airborne Precautions should be assigned to a private room with special ventilation requirements. The door to this room must be closed at all possible times. If a patient must move from the isolation room to another area of the hospital, the patient should be wearing a mask during the transport. Anyone entering the isolation room to provide care to the patient must wear a special mask called a respirator.

DROPLET PRECAUTIONS. Droplet Precautions prevent the spread of organisms that travel on particles much larger than the droplet nuclei. These particles do not spend much time suspended in the air, and usually do not travel beyond a several foot range from the patient. These particles are produced when a patient coughs, talks, or sneezes. Examples of disease requiring droplet precautions are meningococcal meningitis (a serious bacterial infection of the lining of the brain), influenza, mumps, and German measles (rubella).
Patients who require Droplet Precautions should be placed in a private room or with a roommate who is infected with the same organism. The door to the room may remain open. Health care workers will need to wear masks within 3 ft of the patient. Patients moving about the hospital away from the isolation room should wear a mask.

CONTACT PRECAUTIONS. Contact Precautions prevent spread of organisms from an infected patient through direct (touching the patient) or indirect (touching surfaces or objects that that been in contact with the patient) contact. Examples of patients who might be placed in Contact Precautions are those infected with:
• Antibiotic-resistant bacteria
• Hepatitis A
• Scabies
• Impetigo
• Lice.
This type of precaution requires the patient to be placed in a private room or with a roommate who has the same infection. Health care workers should wear gloves when entering the room. They should change their gloves if they touch material that contains large volumes of organisms such as soiled dressings. Prior to leaving the room, health care workers should remove the gloves and wash their hands with medicated soap. In addition, they may need to wear protective gowns if there is a chance of contact with potentially infective materials such as diarrhea or wound drainage that cannot be contained or if there is likely to be extensive contact with the patient or environment.
Patient care items, such as a stethoscope, that are used for a patient in Contact Precautions should not be shared with other patients unless they are properly cleaned and disinfected before reuse. Patients should leave the isolation room infrequently.

Types of Isolation :
 Strict isolation.
 Contact isolation.
 Respiratory isolation
 Tuberculosis or acid-fast bacillus (AFB) isolation.
 Enteric precautions
 Drainage/secretion precautions
1. Strict Isolation
 Designed for highly contagious infections that are spread by both airborne droplet nuclei and contact transmission.
 Examples include:
 varicella,
 Disseminated herpes zoster,
 Viral hemorrhagic fevers.
Technique
 Private room.
 With negative airflow.
 The use of masks, gowns, and gloves for all persons entering the room.
2. Contact isolation
 designed for highly transmissible infections that are not spread by airborne droplet nuclei but are transmitted primarily by close and direct contact.
 Examples
 viral respiratory infections in children, such as respiratory syncytial virus (RSV)
 Patients with large draining wounds require contact precautions.
Technique
 Technique includes :
 Private room,
 Masks for those personnel providing close direct care to the patient,
 Gowns if soiling is likely,
 Gloves for touching infective material.
3. Respiratory Isolation
 designed to prevent transmission of diseases spread over short distances through the air (droplet transmission).
Examples include :
 children with Haemophilus influenza,
 epiglottitis,
 meningitis,
 pneumonia.
 patients with serious meningococcal disease;
 mumps and pertussis.
Technique
 Technique includes.
 Private room.
 Or cohering patients with the same organism.
 And masks for those personnel providing close direct care to the patient.
4. Tuberculosis or Acid-fast Bacillus (AFB)
 isolation—designed for patients suspected or known to have pulmonary or laryngeal tuberculosis.
 technique includes a private room with negative airflow
 and the use of appropriate respiratory protection (see tuberculosis).
5. Enteric precautions
 designed to prevent infections that are transmitted by direct or indirect contact with fecal material,
 such as Salmonella gastroenteritis.
Technique
 private room only if the patient has poor hygiene and is likely to contaminate the environment,
 gowns if soiling is likely,
 and gloves for touching infective material.
Drainage/secretion precautions
 designed to prevent infections transmitted by direct or indirect contact with purulent material or other drainage from an infected body site.
 Technique includes :
 gowns if soiling is likely
 and gloves for touching infective material.



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Insertion of Suprapubic Catheter

Dissection at the base of the bladder to reach the anterior vaginal wall and uterine cervix creates edema, interrupts the small nerve pathways, and thereby sets up the physiologic changes that produce urinary bladder atony. Therefore, catheter drainage of the urinary bladder is an essential feature of many pelvic surgical procedures. Fortunately, in most cases, these conditions reverse themselves in 3-5 days, and catheter drainage is no longer needed.

Suprapubic bladder catheterization is superior to transurethral bladder catheterization because it is cleaner. It also leaves the urethra open for voiding when urinary function has returned. The use of an ordinary Foley catheter (No. 16 French with 5-mL bag) is preferable to the commercially available suprapubic catheter kits because a Foley catheter, when inserted as described in this section, is usually not dislodged from the bladder during sleep or activity. In addition, the Foley catheter is less costly and is available in all surgical clinics. The instrument used for insertion of the Foley catheter is an ordinary Randall stone forceps. The fulcrum of this instrument is toward the rear, which keeps the overall diameter of the axis virtually unchanged except at the jaws and gives it an advantage over a Kelly clamp.

The operation provides drainage of the urinary bladder through a clean surgical incision and ensures that the catheter does not slip out of the patient or become dislodged within the abdominal wall.

Physiologic Changes. The procedure reduces edema at the base of the bladder, allowing the return of normal vesical function.

Points of Caution. After grasping the catheter with the jaws of the Randall forceps (Fig. 4) and before inflating the Foley balloon, the catheter should be drawn through the bladder until the tip can be seen in the urethral meatus. This ensures that the catheter tip and balloon are in the bladder and not in the subcutaneous or subfascial space.

Technique


This procedure can be performed in the inpatient treatment rooms of a hospital, clinic, or doctor's office. Local anesthesia is adequate for most patients. The bladder does not have to be empty. The patient is placed in the dorsal lithotomy position. The periurethral area and suprapubic area are surgically prepped and draped. A routine pelvic examination is performed prior to placement of the suprapubic catheter. If local anesthesia is to be used, a 4 x 4 cm area around the insertion site is infiltrated with 1% lidocaine. Infiltration should include the fascia and, if at all possible, a small area of the bladder wall.

A Randall stone forceps is inserted through the urethral meatus and used to elevate the dome of the bladder from the inside, pushing the suprapubic abdominal wall upward to the palpating finger.

Upward pressure is maintained on the forceps, and a small incision is made in the suprapubic skin and fascia until the forceps can be felt with the blade of the knife.

A sudden upward thrust of the forceps pierces the bladder wall and pushes the forceps through the incision. The jaws of the forceps are opened and used to grasp the tip of the Foley catheter.

The Foley catheter is pulled through the bladder, and the forceps is withdrawn from the urethra until the tip of the Foley catheter can be seen in the urethral meatus.

Traction is placed on the Foley catheter from above while the balloon is simultaneously inflated. This draws the catheter back into the body of the bladder.

When 5 mL of sterile saline solution have completely filled the Foley balloon, the catheter is firmly retracted upward.
It is not necessary to suture the catheter to the abdominal skin. A sterile dressing is applied, and the Foley catheter is connected to straight drainage......http://www.atlasofpelvicsurgery.com
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Chest Physical Therapy

Definition

Chest physical therapy (CPT) is the term for a group of treatments designed to improve respiratory efficiency, promote expansion of the lungs, strengthen respiratory muscles, and eliminate secretions from the respiratory system.
Purpose

The purpose of chest physical therapy, also called chest physiotherapy, is to help patients breathe more freely and to get more oxygen into the body.

Chest physical therapy includes postural drainage, chest percussion, chest vibration, turning, breathing exercises, coughing, and incentive spirometry. CPT is usually done in conjunction with other treatments to rid the airways of secretions. These other treatments include suctioning, nebulizer treatments, and the administration of expectorant drugs.

Chest physical therapy can be used with newborns, infants, children, and adults. People who benefit from chest physical therapy exhibit a wide range of problems that make it difficult to clear secretions from their lungs.

Patients who may receive chest physical therapy include those with cystic fibrosis, neuromuscular diseases (such as Guillain-Barré syndrome), progressive muscle weakness (such as myasthenia gravis), or tetanus. People with lung diseases such as pneumonia, bronchitis, and some forms of chronic obstructive pulmonary disease (COPD), including chronic bronchitis, also benefit from chest physical therapy. CPT should not be used in the treatment of patients diagnosed with asthma.

People without specific lung problems but who are likely to aspirate their mucous secretions because of diseases such as cerebral palsy or muscular dystrophy also receive chest physical therapy, as do those who are bedridden or confined to a wheelchair. In addition, CPT may be part of treatment after surgery for patients who develop difficulty taking deep breaths.
Precautions

While the doctor ultimately determines which type of therapy can be performed, health care professionals know that not all forms of chest physical therapy are appropriate for all patients. Postural drainage and percussion should not be administered to patients who:

* have just eaten or are vomiting
* have acute asthma or tuberculosis
* have brittle bones or broken ribs
* are bleeding from the lungs or are coughing up blood
* are experiencing intense pain
* have increased pressure in the skull
* have head or neck injuries
* have collapsed lungs or a damaged chest wall
* recently experienced a heart attack
* have a pulmonary embolism or lung abscess
* have an active hemorrhage
* have injuries to the spine
* have open wounds or burns
* have had recent surgery

Description

Chest physical therapy can be performed in a variety of settings including critical care units, hospitals, nursing homes, outpatient clinics, and in the patient's home. Depending on the circumstances, chest physical therapy may be performed by anyone ranging from a respiratory care therapist to a trained member of the patient's family. Patients can be taught to perform some therapies.

Lengths of therapies and their costs vary. Some therapies may be part of ongoing treatment for a chronic condition. Special equipment may be needed for some procedures, such as percussion, and may be covered by the patient's health plan.

Chest physical therapy encompasses a variety of procedures; which ones are applied depends on the patient's needs. Hospitalized patients are reevaluated frequently to establish which procedures are most effective and best tolerated. Patients receiving long term chest physical therapy are reevaluated about every three months.
Turning

Turning from side to side permits lung expansion. Patients who cannot turn themselves are turned by a care- giver. The head of the bed is also elevated to promote drainage if the patient can tolerate this position. Critically ill patients and those dependent on mechanical respiration are turned once every one to two hours around the clock.
Coughing

Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated. However, for patients with conditions like COPD, it can be painful to cough normally. An important part of chest

physical therapy is teaching patients to clear their airways by gentler methods, such as with a controlled cough or by "huffing."

Before either technique, patients are advised to sit upright and drink a glass of water. For the controlled cough, patients purse their lips and take a deep breath. They hold their breath for several seconds and then make two brief, gentle coughs. Huffing also starts with pursing the lips and taking a deep breath. After holding the breath for several seconds, patients exhale by using the stomach muscles to push the air out. The vocal chords remain open so that the cough has almost a whispery sound. Coughing and huffing are repeated several times a day as needed.
Deep breathing exercises

Deep breathing helps expand the lungs and forces better distribution of the air into all areas. The patient may initially need to lie down to do these exercises, but eventually it is done while sitting upright, then while walking.

Patients may find it helpful to monitor their breathing by placing a hand on their abdomen to provide a sense of their regular breathing pattern. The patient then starts by taking a deep breath through the nose, then purses the lips as if to whistle. The patient then exhales the air slowly through pursed lips. The exhalation should take twice as long as the inhalation. A patient may start by inhaling for two seconds and then exhaling for four. After taking several deep breaths, the patient breathes at a normal rhythm and begins another cycle of deep breathing. The patient builds up to taking deeper breaths, following a schedule given by the health care team. Generally, COPD patients practice deep breathing exercises for 20 minutes each day.
Incentive spirometry

The incentive spirometer helps the patient improve lung function. This self-administered therapy involves inhaling into a tube attached to a device. The specific technique and goal depends on the type of spirometer. The patient receives directions from the doctor, nurse, or respiratory therapist.

With a breath flow-oriented device, the patient inhales through a tube to raise a ball inside the plastic spirometer chamber. The drop in pressure causes the ball to rise, and the goal is to keep the ball in the air for as long as possible.

For a volume-oriented device, the patient sets a pointer on the chamber at the desired breath volume level. The patient inhales into the tube and attempts to raise a piston inside the chamber so that the volume marker reaches that level.

Hybrid volume accumulators combine a flow-oriented device with a volume-oriented device. A piston inside a cylinder responds to negative pressure from the patient's inhalation.

Some devices have a component designed for exhalation. If the model does not include an exhaling function, the patient breathes out air naturally.

At the end of the session, the patient takes a deep breath and then coughs. The length of therapy and the number of exercises done depend on the patient's condition and is determined by a respiratory therapist or other health professional.
Postural drainage

Postural drainage uses gravity to assist in draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. This therapy generally lasts a maximum of 30 minutes. If various positions are tried to induce a cough, the patient may remain in one position for from five to 15 minutes. The health care team guides the patient in determining the amount of time needed. Each position reaches a specific area of the lungs. Chest drainage positions include:

* the patient seated with head back
* the patient seated with head bent forward
* the patient lying face up with feet higher than the head
* the patient lying face down with feet higher than the head
* the patient lying first on one side, then the other, with feet higher than the head

Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Patients at home are given schedules set by their doctor or respiratory therapist. Percussion and vibration may be performed in conjunction with postural drainage.
Percussion

Percussion, also called cupping or clapping, involves rhythmically striking the chest wall with cupped hands. Mechanical devices can also be used. Percussion results in breaking up thick secretions in the lungs so that they can be more easily removed. Percussion is performed on each lung segment for one to two minutes at a time.
Vibration

Vibration therapy is done for one minute after percussion therapy or may be used instead of percussion therapy for patients who may be too sore or frail to tolerate percussion. The purpose is also to help break up lung secretions. Vibration can be performed either mechanically or manually. When done manually, the person performing the vibration places his or her hands against the patient's chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day for about five exhalations.
Preparation

Preparation for chest physical therapy starts with an evaluation of the patient's condition to determine which chest physical therapy techniques would be most beneficial. Since most therapies are done at home, patient education is extremely important. The doctor, nurse, physical therapist, or respiratory therapist instructs the patient or caregiver in chest physical therapy techniques. The therapy should be explained and demonstrated by the health professional. Then the patient or caregiver should try the therapy. This will demonstrate whether the patient understands the therapy or if more instruction is needed.
Aftercare

Patients should be advised to practice oral hygiene procedures to lessen the bad taste and odor of the secretions that they spit out.
Complications

Risks and complications associated with chest physical therapy depend on the health of the patient. Although chest physical therapy usually poses few problems, the health care team should be aware that in some patients it may cause:• oxygen deficiency if the head is kept lowered for drainage

* increased intracranial pressure
* temporary low blood pressure
* bleeding in the lungs
* pain or injury to the ribs, muscles, or spine
* vomiting
* inhaling secretions into the lungs
* heart irregularities

Results

The health care team should tell patients that CPT is often an ongoing treatment, with some or all therapies done daily. A positive response to treatment can be assessed by:

* increased volume of sputum secretions
* ease in breathing
* changes in breath sounds
* improved vital signs
* improved chest x ray
* increased oxygen in the blood as measured by arterial blood gas values

Health care team roles

The doctor typically orders chest physical therapy for a patient. A nurse or respiratory therapist provides therapy when a patient is hospitalized. For people seen on an outpatient basis, the emphasis is generally on patient education.
Patient education

Effective patient education is vital because chest physical therapy is often performed at home. A doctor, nurse, or respiratory therapist explains and demonstrates techniques such as breathing, percussion, and incentive spirometry. The patient or caregiver performs the therapy under the health professional's observation to be sure it can be done correctly independently.

Nurses and respiratory therapists also participate in public awareness education, such as anti-smoking campaigns.
Training

Chest physical therapy is part of training for physicians and nurses specializing in cardiopulmonary treatment, and for respiratory therapists (also known as respiratory care practitioners). Therapists must have at least an associate degree, which is earned after completion of a two-year program. There are also four-year bachelor degree programs for this profession. Graduates with both types of degrees are certified after passing the examination given by the National Board for Respiratory Care.
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Activities of Daily Living Evaluation

enotes.com,

Definition

An activities of daily living (ADL) evaluation is an assessment of an individual's physical and sometimes mental skills. In the area of physical or occupational therapy, it reflects how well a disabled patient or someone recovering from disease or accident can function in daily life. It is also used to determine how well patients relate to and participate in their environment.

Purpose

ADL evaluations help practitioners determine how independent patients are and what skills they can accomplish on their own, as well as to gauge how independent each individual can become after intervention by a health professional. The goal of practitioners performing ADL evaluations is to help patients become as independent as possible, using appropriate adaptations if needed.
Description

Many ADL indexes exist, such as the Katz Index, Revised Kenny Self-Care Evaluation, and the Barthel Index. These indexes typically evaluate patients on their self-care skills and rate each individual according to how functional they are. Scoring is based on how independently a task can be performed and whether supervision or assistance is needed in performing the task.
Basic ADL versus Instrumental ADL

Basic activities of daily living are those skills needed in typical daily self care. An evaluation would, in part, consist of bathing, dressing, feeding, and toileting. The evaluator would examine various activities in each category to determine the patient's skill. Afterward it can be determined what, if any, changes will be necessary to allow the patient to function as independently as possible.

Instrumental activities of daily living refer to skills beyond basic self care that evaluate how individuals function within their homes, workplaces, and social environments. Instrumental ADLs may include typical domestic tasks, such as driving, cleaning, cooking, and shopping, as well as other less physically demanding tasks such as operating electronic appliances and handling budgets. In the work environment, an ADL evaluation assesses the qualities necessary to perform a job, such as strength, endurance, manual dexterity, and pain management.

If a person is being treated following an injury or disorder diagnosis, whether an intervention is needed depends upon how severe his or her functional ability has been affected. If an individual's ADL function is not restored, a health care professional will perform an intervention, which entails helping the individual adapt to permanent dysfunction or regain meaningful function. How well an individual must be able to perform these tasks depends upon the living setting he or she is returning to, whether it is a full custodial facility, assisted living community, or living at home on his or her own.
Complications

Returning a client to full meaningful function can be problematic for individuals who do not have the motivation to do so. A holistic approach to treatment is most important in cases such as these, and physical and occupation therapists are trained to evaluate not only the physical disability or dysfunction of an individual, but also the person's mental health and well-being. Occupational therapists can address mental health issues resulting from injury or disorder diagnosis, such as depression. However, in cases where a patient has sustained a permanent cognitive disability and is learning-impaired, it is more effective and appropriate for the occupational therapist to teach family members or a caretaker how to perform daily tasks for the patient.
Results

Interventions implemented to increase function include adaptations and home modification. Adaptations are devices that can enhance the usability of everyday items for individuals who have a limited range of motion. Home modification involves the process of making one's living environment more functional for ADL.
Adaptations

There are several ways that adaptations can be used to make common household items more functional. For example, patients commonly have a weakened grasp that is insufficient to hold heavy or small objects, so enhancements such as easily gripped handles could be added to small objects, such as eating utensils or personal grooming items. Other adaptations may involve the use of unique tools to facilitate tasks, such as using a long rod with a hook at one end, known as a dressing stick, to pull on pants or socks. Adaptations may involve altering the environment to aid in other tasks, such as providing adequate lighting or magnifying lenses to compensate for a vision impairment.
Home modifications

Home modification has become a major area for occupational therapists to practice. In order for patients to return home or go to a group setting, the physical environment of the house or facility may have to be altered to make ADL function better. Common examples of home modifications include the installation of grab bars in the shower, toilet area and hallways; lower kitchen counters for easier access to wheelchair-bound individuals; and the elimination of potential trip points, such as loose throw rugs and slight changes in floor elevation.
Health care team roles

Occupational therapists and physical therapists are the two primary disciplines most qualified to assess ADL function and recommend the appropriate intervention and modifications in one's home and work environment. Physical therapists might focus primarily on a patient's mobility and ambulation, while the occupational therapist might focus on more specific tasks described above.
KEY TERMS

Adaptation—Altering a tool used in performing a task so that the patient is better able to function independently or with minimal assistance.

Dressing stick—A long rod with a hook attached to the end that a patient uses in place of the hands. Typically a dressing rod would be used to pull on a pair of pants or socks.

Home modification—Altering the physical environment of the home so as to remove hazards and provide an environment that is more functional for the patient. Examples of home modification include installing grab bars and no-slip foot mats in the bathroom to prevent falls.

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Geriatrische fysiotherapie

Waarom deze specialisatie?

Het aantal ouderen neemt toe. Uit cijfers van het CBS blijkt dat het aantal 65-plussers in 1990 bijna 2 miljoen bedroeg. Er wordt geschat dat dit aantal in 2020 ca. 4 miljoen zal bedragen. Het aantal ouderen neemt percentagegewijs het sterkste toe. De verwachting is dat het aantal ouderen tot voorbij 2050 zal stijgen. Daarbij blijkt dat de provincie Noord-Brabant tweemaal zo sterk vergrijst als de rest van Nederland.

Binnen de beroepsvereniging voor fysiotherapie zag men de noodzaak in om hiertoe een groep collega’s aanvullend te scholen. Deze post HBO-opleiding kwam tot stand in samenwerking met het Nederlands Paramedisch Instituut (NPi) en het Centrum voor Niet Aangeboren Hersenletsel (NAH). Vanuit onze groepspraktijk nemen we hieraan deel in de persoon van collega C.A. van Leent.

Wat is geriatrische fysiotherapie?

Veroudering is een normaal multi-dimensionaal ontwikkelingsproces (oa. fysiologisch, psychologisch en emotioneel). Het aantal beperkingen en stoornissen ten gevolge van leeftijdsgerelateerde veranderingen neemt met de jaren toe. Meer dan 20% van de mensen boven de 65 geeft aan problemen met mobiliteit en functionaliteit te hebben. De overige 80% verdient evenwel zeker zoveel aandacht en biedt een uitdaging aan de preventieve gezondheidszorg. De belangrijkste oorzaak van versnelde veranderingen in het bewegingsapparaat bij ouderen is voortdurend verminderde lichamelijke activiteit, een te rustige levensstijl. Dit leidt tot adaptatie: een complex aan veranderingsprocessen waardoor de functie zo optimaal mogelijk blijft.

Kennis van adaptatieprocessen van biologische regelsystemen is onontbeerlijk om in te kunnen schatten of door het toedienen van prikkels de regelsystemen tot optimalisering van de aanpassingen kunnen worden gestimuleerd. De ouder wordende mens zal, door gezondheidsvoorlichting en begeleiding van functieherstel en functiebehoud, ondersteuning moeten krijgen, zodat hij een betekenisvol zelfstandig leven zal kunnen leiden. Daarmee levert hij indirect een bijdrage aan de betaalbaarheid van het zorgsysteem.

De fysiotherapeut is de meest voor de hand liggende deskundige om het functiebehoud en het functieherstel van ouderen te begeleiden. Fysiotherapeuten houden mensen in beweging.

De blik van de fysiotherapeut moet echter verder reiken dan spieren, kapsels banden en gewrichten. Oorzaken van hypokinesie kunnen namelijk gelegen zijn in motorische, maar ook in psychologische en sociaal-maatschappelijke factoren. Slechts constateren dat de motorische uitvoering is gestoord geeft onvoldoende informatie over de oorzaken van de gestoorde activiteit Deze oorzaken kunnen gelegen zijn op bv. existentieniveau, cognitief niveau, planningsniveau, uitvoeringsniveau of energievoorzieningniveau. Het fysiotherapeutisch onderzoek zal daarop moeten worden aangepast met specifieke meetinstrumenten.


Ouderen zijn 55-plussers

De volgende indeling wordt gebruikt:
* 55 –65 jaar: de senior; staat nog volop in het leven.
* 65 –75 jaar: de jongere oudere; heeft een actief bestaan: de actieve recreant.
* 75 –85 jaar: de oude oudere.
* 85 –plusser: deze zeer oude oudere; de kans op verminderde activiteit en afhankelijkheid is vergroot.

Het mag duidelijk zijn dat de ouder wordende mens centraal staat met zijn functionele mogelijkheden en onmogelijkheden (op beperkings- en participatieniveau).

Het benutten van mogelijkheden staat voorop: Positief denken ! Preventie !

In het kader van de gewijzigde fysieke en psychische belastbaarheid van ouderen vereisen behandeling en begeleiding specifieke deskundigheid, vaardigheid en attitude van de fysiotherapeut. De taak van de fysiotherapeut in de geriatrie bestrijkt alle geledingen binnen de gezondheidszorg: ziekenhuis, verpleeghuis, verzorgingshuis en thuissituatie, aanleunwoning. Bij de thuiswonende oudere wordt niet alleen gedacht aan thuiszorg, maar aan alle fysiotherapeutische zorg rondom een oudere die thuis woont. Dit kan dus ook dagbehandeling in een verpleeghuis betreffen of MBVO (= meer bewegen voor ouderen).

Uitgangspunt voor deze specialisatie vormt een “holistische sociaal model of management” en niet zozeer het medisch behandelmodel waarbij de nadruk ligt op stoornisniveau. Binnen dit model zijn belangrijk:
* Community-based health promotion.
* Preventie.
* Revalidatie.
* Multi-disciplinaire samenwerking

Naast de technische zijde van werkzaamheden wordt de nadruk gelegd op educatieaspecten. De geriatrisch fysiotherapeut probeert het gedrag van de mensen te beïnvloeden.

Verder wordt er aandacht besteed aan effectonderzoek en beleidsontwikkeling binnen de zorg voor ouderen en de preventieve gezondheidszorg. De geriatrisch fysiotherapeut vervult een voorhoedefunctie binnen het wetenschappelijk onderzoek naar veroudering. Doel van dit onderzoek is het voorkomen dat mensen met het stijgen der jaren beperkingen ontwikkelen. Met behulp van goede meetinstrumenten dienen deze multifactoriële oorzaken van het verminderd aanpassingsvermogen in kaart te worden gebracht.
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CANISIUS WILHELMINA ZIEKENHUIS

653 bedden

Het CWZ is een modern, algemeen ziekenhuis voor de regio met 653 bedden en 28 medisch specialismen. Er werken bijna 4000 medewerkers en vele vrijwilligers die hun werk met hoofd en handen doen, met hart en ziel.

Topklinisch ziekenhuis

Het CWZ is ook één van de 26 topklinische opleidings-ziekenhuizen in Nederland. Dit betekent dat het ziekenhuis topklinische voorzieningen heeft: veelal dure medische technieken die niet elk ziekenhuis aanbiedt. Het CWZ heeft drie topklinische functies: neurochirurgie, PCI (dotteren met het plaatsen van een stent) en ICD (Implanteerbare Cardio Defribrillator). Daarnaast loopt het CWZ in Nederland voorop op het gebied van onder meer kinderdiabetes, grote vaatchirurgie, traanwegchirurgie en kijkbuischirurgie.

Opleidingsziekenhuis

Het hoge niveau van deze kennis en kunde is te danken aan de opleidingsstatus van het CWZ. De opleiding van vele professionals per jaar houdt het ziekenhuis alert. En maakt dat de medische en verpleegkundige zorg elke dag beter wordt.
Het CWZ is het vierde opleidingsziekenhuis van Nederland.


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Questions & Answers Novel H1N1 Flu (Swine Flu) and You

Novel H1N1 Flu

What is novel H1N1 (swine flu)?
Novel H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. This virus is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization (WHO) signaled that a pandemic of novel H1N1 flu was underway.

Why is novel H1N1 virus sometimes called “swine flu”?
This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and bird (avian) genes and human genes. Scientists call this a "quadruple reassortant" virus.

Novel H1N1 Flu in Humans

Are there human infections with novel H1N1 virus in the U.S.?
Yes. Human infections with the new H1N1 virus are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment.
CDC routinely works with states to collect, compile and analyze information about influenza, and has done the same for the new H1N1 virus since the beginning of the outbreak. This information is presented in a weekly report, called FluView.

Is novel H1N1 virus contagious?
CDC has determined that novel H1N1 virus is contagious and is spreading from human to human.

How does novel H1N1 virus spread?
Spread of novel H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.
Photo of nurse and child

What are the signs and symptoms of this virus in people?
The symptoms of novel H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Severe illnesses and death has occurred as a result of illness associated with this virus.

How severe is illness associated with novel H1N1 flu virus?
Illness with the new H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.

In seasonal flu, certain people are at “high risk” of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this novel H1N1 virus have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease.

One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of novel H1N1-related complications thus far. CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to novel H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against novel H1N1 flu by any existing antibody.

How does novel H1N1 flu compare to seasonal flu in terms of its severity and infection rates?
With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.

When the novel H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the novel H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that novel H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this novel H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.

How long can an infected person spread this virus to others?
People infected with seasonal and novel H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.
Prevention & Treatment

What can I do to protect myself from getting sick?
There is no vaccine available right now to protect against novel H1N1 virus. However, a novel H1N1 vaccine is currently in production and may be ready for the public in the fall. As always, a vaccine will be available to protect against seasonal influenza
There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.

Take these everyday steps to protect your health:

* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners* are also effective.
* Avoid touching your eyes, nose or mouth. Germs spread this way.
* Try to avoid close contact with sick people.
* If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.

Other important actions that you can take are:

* Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
* Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs,* tissues and other related items might could be useful and help avoid the need to make trips out in public while you are sick and contagious

Photo of man sneezingWhat is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
Keep away from others as much as possible. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.

If I have a family member at home who is sick with novel H1N1 flu, should I go to work?
Employees who are well but who have an ill family member at home with novel H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including washing their hands often with soap and water, especially after they cough or sneeze. Alcohol-based hand cleaners are also effective.* If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs to prevent illness. For more information please see General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers.

What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner*. CDC recommends that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?
If you live in areas where people have been identified with novel H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people. CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.Staying at home means that you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings.

If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed.

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children, emergency warning signs that need urgent medical attention include:

* Fast breathing or trouble breathing
* Bluish or gray skin color
* Not drinking enough fluids
* Severe or persistent vomiting
* Not waking up or not interacting
* Being so irritable that the child does not want to be held
* Flu-like symptoms improve but then return with fever and worse cough

In adults, emergency warning signs that need urgent medical attention include:

* Difficulty breathing or shortness of breath
* Pain or pressure in the chest or abdomen
* Sudden dizziness
* Confusion
* Severe or persistent vomiting
* Flu-like symptoms improve but then return with fever and worse cough

Are there medicines to treat novel H1N1 infection?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with novel H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current pandemic, the priority use for influenza antiviral drugs is to treat severe influenza illness (for example hospitalized patients) and people who are sick who have a condition that places them at high risk for serious flu-related complications.

What is CDC’s recommendation regarding "swine flu parties"?
"Swine flu parties" are gatherings during which people have close contact with a person who has novel H1N1 flu in order to become infected with the virus. The intent of these parties is for a person to become infected with what for many people has been a mild disease, in the hope of having natural immunity novel H1N1 flu virus that might circulate later and cause more severe disease.

CDC does not recommend "swine flu parties" as a way to protect against novel H1N1 flu in the future. While the disease seen in the current novel H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.

CDC recommends that people with novel H1N1 flu avoid contact with others as much as possible. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.


Contamination & Cleaning

Photo of hands and soapHow long can influenza virus remain viable on objects (such as books and doorknobs)?
Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.

What kills influenza virus?
Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.

*What if soap and water are not available and alcohol-based products are not allowed in my facility?
Though the scientific evidence is not as extensive as that on hand washing and alcohol-based sanitizers, other hand sanitizers that do not contain alcohol may be useful for killing flu germs on hands.

What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.

How should waste disposal be handled to prevent the spread of influenza virus?
To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.

Photo of cleaning suppliesWhat household cleaning should be done to prevent the spread of influenza virus?
To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.

How should linens, eating utensils and dishes of persons infected with influenza virus be handled?
Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.
Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.

Eating utensils should be washed either in a dishwasher or by hand with water and soap.
Exposures Not Thought to Spread Novel H1N1 Flu

Can I get infected with novel H1N1 virus from eating or preparing pork?
No. Novel H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.

Is there a risk from drinking water?
Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of novel H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as novel H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.

Can novel H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?
Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of novel H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as novel H1N1 virus would also be similarly disinfected by chlorine.

Can novel H1N1 influenza virus be spread at recreational water venues outside of the water?

Yes, recreational water venues are no different than any other group setting. The spread of this novel H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.



Note: Much of the information in this document is based on studies and past experience with seasonal (human) influenza. CDC believes the information applies to novel H1N1 (swine) viruses as well, but studies on this virus are ongoing to learn more about its characteristics. This document will be updated as new information becomes available.

For general information about influenza in pigs (not novel H1N1 flu) see Background Information on Influenza in Pigs.

* Links to non-federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.

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CDC Guidance for State and Local Public Health Officials and School Administrators for School (K-12) Responses to Influenza during the 2009-2010 Schoo

This document provides guidance to help decrease the spread of flu among students and school staff during the 2009-2010 school year. This document expands upon earlier school guidance documents by providing a menu of tools that school and health officials can choose from based on conditions in their area. It recommends actions to take this school year and suggests strategies to use if CDC finds that the flu starts causing more severe disease. The guidance also provides a checklist for making decisions at the local level. Detailed information on the reasons for these strategies and suggestions on how to use them is included in the Technical Report. Based on the severity of 2009 H1N1 flu-related illness thus far, this guidance also recommends that students and staff with influenza-like illness remain home until 24 hours after resolution of fever without the use of fever-reducing medications.

For the purpose of this guidance, “schools” will refer to both public and private institutions providing grades K-12 education to children and adolescents in group settings. The guidance applies to such schools in their entirety, even if they provide services for younger or older students. Guidance for child care settings and institutions of higher education will be addressed in separate documents.

The guidance is designed to decrease exposure to regular seasonal flu and 2009 H1N1 flu while limiting the disruption of day-to-day activities and the vital learning that goes on in schools. CDC will continue to monitor the situation and update the current guidance as more information is obtained on 2009 H1N1.

About 55 million students and 7 million staff attend the more than 130,000 public and private schools in the United States each day. By implementing these recommendations, schools and health officials can help protect one-fifth of the country’s population from flu. Collaboration is essential: CDC, the U.S. Department of Education, state and local public health and education agencies, schools, students, staff, families, businesses, and communities all have active roles to play.

The decision to dismiss students should be made locally and should balance the goal of reducing the number of people who become seriously ill or die from influenza with the goal of minimizing social disruption and safety risks to children sometimes associated with school dismissal. Based on the experience and knowledge gained in jurisdictions that had large outbreaks in spring 2009, the potential benefits of preemptively dismissing students from school are often outweighed by negative consequences, including students being left home alone, health workers missing shifts when they must stay home with their children, students missing meals, and interruption of students’ education. Still, although the situation in fall 2009 is unpredictable, more communities may be affected, reflecting wider transmission. The overall impact of 2009 H1N1 should be greater than in the spring, and school dismissals may be warranted, depending on the disease burden and other conditions. (See the Technical Report for discussion of the kinds of circumstances that might warrant preemptive school dismissals.)
Recommended school responses for the 2009-2010 school year
Under conditions with similar severity as in spring 2009

* Stay home when sick:
Those with flu-like illness should stay home for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines. They should stay home even if they are using antiviral drugs. (For more information, see CDC Recommendations for the Amount of Time Persons with Influenza-Like Illness Should be Away from Others.)
See the Technical Report for more details about staying home when sick >>
* Separate ill students and staff:
Students and staff who appear to have flu-like illness should be sent to a room separate from others until they can be sent home. CDC recommends that they wear a surgical mask, if possible, and that those who care for ill students and staff wear protective gear such as a mask.
See the Technical Report for more details about separating ill students and staff >>
* Hand hygiene and respiratory etiquette:
The new recommendations emphasize the importance of the basic foundations of influenza prevention: stay home when sick, wash hands frequently with soap and water when possible, and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available).
See the Technical Report for more details about hand hygiene and respiratory etiquette >>
* Routine cleaning:
School staff should routinely clean areas that students and staff touch often with the cleaners they typically use. Special cleaning with bleach and other non-detergent-based cleaners is not necessary.
See the Technical Report for more details about routine cleaning >>
* Early treatment of high-risk students and staff:
People at high risk for influenza complications who become ill with influenza-like illness should speak with their health care provider as soon as possible. Early treatment with antiviral medications is very important for people at high risk because it can prevent hospitalizations and deaths. People at high risk include those who are pregnant, have asthma or diabetes, have compromised immune systems, or have neuromuscular diseases.
See the Technical Report for more details about early treatment >>
* Consideration of selective school dismissal:
Although there are not many schools where all or most students are at high risk (for example, schools for medically fragile children or for pregnant students) a community might decide to dismiss such a school to better protect these high-risk students.
See the Technical Report for more details about selective school dismissal >>

Under conditions of increased severity compared with spring 2009

CDC may recommend additional measures to help protect students and staff if global and national assessments indicate that influenza is causing more severe disease. In addition, local health and education officials may elect to implement some of these additional measures. Except for school dismissals, these strategies have not been scientifically tested. But CDC wants communities to have tools to use that may be the right measures for their community and circumstances.

* Active screening:
Schools should check students and staff for fever and other symptoms of flu when they get to school in the morning, separate those who are ill, and send them home as soon as possible. Throughout the day, staff should be vigilant in identifying students and other staff who appear ill.
See the Technical Report for more details about active screening >>
* High-risk students and staff members stay home:
People at high-risk of flu complications should talk to their doctor about staying home from school when a lot of flu is circulating in the community. Schools should plan now for ways to continue educating students who stay home through instructional phone calls, homework packets, internet lessons, and other approaches.
See the Technical Report for more details about high-risk students and staff members staying home
* Students with ill household members stay home:
Students who have an ill household member should stay home for five days from the day the first household member got sick. This is the time period they are most likely to get sick themselves.
See the Technical Report for more details about students with ill household members staying home >>
* Increase distance between people at schools:
CDC encourages schools to try innovative ways of separating students. These can be as simple as moving desks farther apart or canceling classes that bring together children from different classrooms.
See the Technical Report for more details about increasing distance between people at schools >>
* Extend the period for ill persons to stay home:
If influenza severity increases, people with flu-like illness should stay home for at least 7 days, even if they have no more symptoms. If people are still sick, they should stay home until 24 hours after they have no symptoms.
See the Technical Report for more details about extending the period for ill persons to stay home >>
* School dismissals:
School and health officials should work closely to balance the risks of flu in their community with the disruption dismissals will cause in both education and the wider community. The length of time schools should be dismissed will vary depending on the type of dismissal as well as the severity and extent of illness. Schools that dismiss students should do so for five to seven calendar days and should reassess whether or not to resume classes after that period. Schools that dismiss students should remain open to teachers and staff so they can continue to provide instruction through other means.
See the Technical Report for more details about school dismissals >>

Reactive dismissals might be appropriate when schools are not able to maintain normal functioning for example, when a significant number and proportion of students have documented fever while at school despite recommendations to keep ill children home.

Preemptive dismissals can be used proactively to decrease the spread of flu. CDC may recommend preemptive school dismissals if the flu starts to cause severe disease in a significantly larger proportion of those affected.
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Swine influenza

Swine influenza (also called H1N1 flu, swine flu, hog flu, and pig flu) is an infection by any one of several types of swine influenza virus. Swine influenza virus (SIV) is any strain of the influenza family of viruses that is endemic in pigs.[2] As of 2009, the known SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H3N1, H3N2, and H2N3.

Swine influenza virus is common throughout pig populations worldwide. Transmission of the virus from pigs to humans is not common and does not always lead to human influenza, often resulting only in the production of antibodies in the blood. If transmission does cause human influenza, it is called zoonotic swine flu. People with regular exposure to pigs are at increased risk of swine flu infection. The meat of an infected animal poses no risk of infection when properly cooked.

During the mid-20th century, identification of influenza subtypes became possible, allowing accurate diagnosis of transmission to humans. Since then, only 50 such transmissions have been confirmed. These strains of swine flu rarely pass from human to human. Symptoms of zoonotic swine flu in humans are similar to those of influenza and of influenza-like illness in general, namely chills, fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort.

Classification

Of the three genera of influenza viruses that cause human flu, two also cause influenza in pigs, with influenza A being common in pigs and influenza C being rare.[3] Influenza B has not been reported in pigs. Within influenza A and influenza C, the strains found in pigs and humans are largely distinct, although due to reassortment there have been transfers of genes among strains crossing swine, avian, and human species boundaries.

Influenza C

Influenza C viruses infect both humans and pigs, but do not infect birds.[4] Transmission between pigs and humans have occurred in the past.[5] For example, influenza C caused small outbreaks of a mild form of influenza amongst children in Japan[6] and California.[6] Due to its limited host range and the lack of genetic diversity in influenza C, this form of influenza does not cause pandemics in humans.[7]

Influenza A

Swine influenza is known to be caused by influenza A subtypes H1N1,[8] H1N2,[8] H3N1,[9] H3N2,[8] and H2N3.[10] In pigs, three influenza A virus subtypes (H1N1, H3N2, and H1N2) are the most common strains worldwide.[11] In the United States, the H1N1 subtype was exclusively prevalent among swine populations before 1998; however, since late August 1998, H3N2 subtypes have been isolated from pigs. As of 2004, H3N2 virus isolates in US swine and turkey stocks were triple reassortants, containing genes from human (HA, NA, and PB1), swine (NS, NP, and M), and avian (PB2 and PA) lineages.[12]

Surveillance

Although there is no formal national surveillance system in the United States to determine what viruses are circulating in pigs,[13] there is an informal surveillance network in the United States that is part of a world surveillance network.

Veterinary medical pathologist, Tracey McNamara, set up a national disease surveillance system in zoos because the zoos do active disease surveillance and many of the exotic animals housed there have broad susceptibilities. Many species fall below the radar of any federal agencies (including dogs, cats, pet prairie dogs, zoo animals, and urban wildlife), even though they may be important in the early detection of human disease outbreaks.[14] [15]

History

Swine influenza was first proposed to be a disease related to human influenza during the 1918 flu pandemic, when pigs became sick at the same time as humans.[16] The first identification of an influenza virus as a cause of disease in pigs occurred about ten years later, in 1930.[17] For the following 60 years, swine influenza strains were almost exclusively H1N1. Then, between 1997 and 2002, new strains of three different subtypes and five different genotypes emerged as causes of influenza among pigs in North America. In 1997-1998, H3N2 strains emerged. These strains, which include genes derived by reassortment from human, swine and avian viruses, have become a major cause of swine influenza in North America. Reassortment between H1N1 and H3N2 produced H1N2. In 1999 in Canada, a strain of H4N6 crossed the species barrier from birds to pigs, but was contained on a single farm.[17]

The H1N1 form of swine flu is one of the descendants of the strain that caused the 1918 flu pandemic.[18][19] As well as persisting in pigs, the descendants of the 1918 virus have also circulated in humans through the 20th century, contributing to the normal seasonal epidemics of influenza.[19] However, direct transmission from pigs to humans is rare, with only 12 cases in the U.S. since 2005.[20] Nevertheless, the retention of influenza strains in pigs after these strains have disappeared from the human population might make pigs a reservoir where influenza viruses could persist, later emerging to reinfect humans once human immunity to these strains has waned.[21]

Swine flu has been reported numerous times as a zoonosis in humans, usually with limited distribution, rarely with a widespread distribution. Outbreaks in swine are common and cause significant economic losses in industry, primarily by causing stunting and extended time to market. For example, this disease costs the British meat industry about £65 million every year.[22]

1918 pandemic in humans

The 1918 flu pandemic in humans was associated with H1N1 and influenza appearing in pigs;[19] this may reflect a zoonosis either from swine to humans, or from humans to swine. Although it is not certain in which direction the virus was transferred, some evidence suggests that, in this case, pigs caught the disease from humans.[16] For instance, swine influenza was only noted as a new disease of pigs in 1918, after the first large outbreaks of influenza amongst people.[16] Although a recent phylogenetic analysis of more recent strains of influenza in humans, birds, and swine suggests that the 1918 outbreak in humans followed a reassortment event within a mammal,[23] the exact origin of the 1918 strain remains elusive.[24] It is estimated that anywhere from 50 to 100 million people were killed worldwide.[19][25]

1976 U.S. outbreak
Main article: 1976 swine flu outbreak

On February 5, 1976, in the United States an army recruit at Fort Dix said he felt tired and weak. He died the next day and four of his fellow soldiers were later hospitalized. Two weeks after his death, health officials announced that the cause of death was a new strain of swine flu. The strain, a variant of H1N1, is known as A/New Jersey/1976 (H1N1). It was detected only from January 19 to February 9 and did not spread beyond Fort Dix.[26]

This new strain appeared to be closely related to the strain involved in the 1918 flu pandemic. Moreover, the ensuing increased surveillance uncovered another strain in circulation in the U.S.: A/Victoria/75 (H3N2) spread simultaneously, also caused illness, and persisted until March.[26] Alarmed public-health officials decided action must be taken to head off another major pandemic, and urged President Gerald Ford that every person in the U.S. be vaccinated for the disease.[27]

The vaccination program was plagued by delays and public relations problems.[28] On October 1, 1976, the immunization program began and by October 11, approximately 40 million people, or about 24% of the population, had received swine flu immunizations. That same day, three senior citizens died soon after receiving their swine flu shots and there was a media outcry linking the deaths to the immunizations, despite the lack of positive proof. According to science writer Patrick Di Justo, however, by the time the truth was known — that the deaths were not proven to be related to the vaccine — it was too late. "The government had long feared mass panic about swine flu — now they feared mass panic about the swine flu vaccinations." This became a strong setback to the program.[29]

There were reports of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, affecting some people who had received swine flu immunizations. This syndrome is a rare side-effect of modern influenza vaccines, with an incidence of about one case per million vaccinations.[30] As a result, Di Justo writes that "the public refused to trust a government-operated health program that killed old people and crippled young people." In total, less than 33% of the population had been immunized by the end of 1976. The National Influenza Immunization Program was effectively halted on December 16.

Overall, there were about 500 cases of Guillain-Barré syndrome (GBS), resulting in death from severe pulmonary complications for 25 people, which, according to Dr. P. Haber, were probably caused by an immunopathological reaction to the 1976 vaccine. Other influenza vaccines have not been linked to GBS, though caution is advised for certain individuals, particularly those with a history of GBS.[31][32] Still, as observed by a participant in the immunization program, the vaccine killed more Americans than the disease did.[33]

1988 zoonosis

In September 1988, a swine flu virus killed one woman and infected others. 32-year old Barbara Ann Wieners was eight months pregnant when she and her husband, Ed, became ill after visiting the hog barn at a county fair in Walworth County, Wisconsin. Barbara died eight days later, after developing pneumonia.[34] The only pathogen identified was an H1N1 strain of swine influenza virus.[35] Doctors were able to induce labor and deliver a healthy daughter before she died. Her husband recovered from his symptoms.

Influenza-like illness (ILI) was reportedly widespread among the pigs exhibited at the fair. 76% of 25 swine exhibitors aged 9 to 19 tested positive for antibody to SIV, but no serious illnesses were detected among this group. Additional studies suggested between one and three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection. However, there was no community outbreak.[36][37]

1998 US outbreak in swine

In 1998, swine flu was found in pigs in four U.S. states. Within a year, it had spread through pig populations across the United States. Scientists found that this virus had originated in pigs as a recombinant form of flu strains from birds and humans. This outbreak confirmed that pigs can serve as a crucible where novel influenza viruses emerge as a result of the reassortment of genes from different strains.[38][39][40]

2007 Philippine outbreak in swine
Please help improve this article by expanding it. Further information might be found on the talk page. (April 2009)

On August 20, 2007 Department of Agriculture officers investigated the outbreak (epizootic) of swine flu in Nueva Ecija and Central Luzon, Philippines. The mortality rate is less than 10% for swine flu, unless there are complications like hog cholera. On July 27, 2007, the Philippine National Meat Inspection Service (NMIS) raised a hog cholera "red alert" warning over Metro Manila and 5 regions of Luzon after the disease spread to backyard pig farms in Bulacan and Pampanga, even if these tested negative for the swine flu virus.[41][42]

2009 outbreak in humans
Main article: 2009 flu pandemic

The H1N1 viral strain implicated in the 2009 flu pandemic among humans often is called "swine flu" because initial testing showed many of the genes in the virus were similar to influenza viruses normally occurring in North American swine.[43] But further research has shown that the outbreak is due to a new strain of H1N1 not previously reported in pigs.

In late April, Margaret Chan, the World Health Organization's director-general, declared a "public health emergency of international concern" under the rules of the WHO's new International Health Regulations when the first cases of the H1N1 virus were reported in the United States.[44] [45] Following the outbreak, on May 2, 2009, it was reported in pigs at a farm in Alberta, Canada, with a link to the outbreak in Mexico. The pigs are suspected to have caught this new strain of virus from a farm worker who recently returned from Mexico, then showed symptoms of an influenza-like illness.[46] These are probable cases, pending confirmation by laboratory testing.

The new strain was initially described as an apparent reassortment of at least four strains of influenza A virus subtype H1N1, including one strain endemic in humans, one endemic in birds, and two endemic in swine.[43] Subsequent analysis suggested it was a reassortment of just two strains, both found in swine.[47] Although initial reports identified the new strain as swine influenza (i.e., a zoonosis originating in swine), its origin is unknown. Several countries took precautionary measures to reduce the chances for a global pandemic of the disease.[48] The Swine flu has been compared to other similar types of influenza virus in terms of mortality: "in the US it appears that for every 1000 people who get infected, about 40 people need admission to hospital and about one person dies".[49]. There are fears that swine flu will become a major global pandemic in the winter months, with many countries planning major vaccination campaigns. [50]

Transmission

Transmission between pigs

Influenza is quite common in pigs, with about half of breeding pigs having been exposed to the virus in the US.[51] Antibodies to the virus are also common in pigs in other countries.[51]

The main route of transmission is through direct contact between infected and uninfected animals.[11] These close contacts are particularly common during animal transport. Intensive farming may also increase the risk of transmission, as the pigs are raised in very close proximity to each other.[52][53] The direct transfer of the virus probably occurs either by pigs touching noses, or through dried mucus. Airborne transmission through the aerosols produced by pigs coughing or sneezing are also an important means of infection.[11] The virus usually spreads quickly through a herd, infecting all the pigs within just a few days.[2] Transmission may also occur through wild animals, such as wild boar, which can spread the disease between farms.[54]

Transmission to humans

People who work with poultry and swine, especially people with intense exposures, are at increased risk of zoonotic infection with influenza virus endemic in these animals, and constitute a population of human hosts in which zoonosis and reassortment can co-occur.[55] Vaccination of these workers against influenza and surveillance for new influenza strains among this population may therefore be an important public health measure.[56] Transmission of influenza from swine to humans who work with swine was documented in a small surveillance study performed in 2004 at the University of Iowa.[57] This study among others forms the basis of a recommendation that people whose jobs involve handling poultry and swine be the focus of increased public health surveillance.[55] Other professions at particular risk of infection are veterinarians and meat processing workers, although the risk of infection for both of these groups is lower than that of farm workers.[58]

Interaction with avian H5N1 in pigs

Pigs are unusual as they can be infected with influenza strains that usually infect three different species: pigs, birds and humans.[59] This makes pigs a host where influenza viruses might exchange genes, producing new and dangerous strains.[59] Avian influenza virus H3N2 is endemic in pigs in China and has been detected in pigs in Vietnam, increasing fears of the emergence of new variant strains.[60] H3N2 evolved from H2N2 by antigenic shift.[61] In August 2004, researchers in China found H5N1 in pigs.[62]
These H5N1 infections may be quite common: in a survey of 10 apparently healthy pigs housed near poultry farms in West Java, where avian flu had broken out, five of the pig samples contained the H5N1 virus. The Indonesian government has since found similar results in the same region. Additional tests of 150 pigs outside the area were negative.[63][64]

Signs and symptoms

In swine

In pigs influenza infection produces fever, lethargy, sneezing, coughing, difficulty breathing and decreased appetite.[11] In some cases the infection can cause abortion. Although mortality is usually low (around 1-4%),[2] the virus can produce weight loss and poor growth, causing economic loss to farmers.[11] Infected pigs can lose up to 12 pounds of body weight over a 3 to 4 week period.[11]

In humans

Direct transmission of a swine flu virus from pigs to humans is occasionally possible (called zoonotic swine flu). In all, 50 cases are known to have occurred since the first report in medical literature in 1958, which have resulted in a total of six deaths.[66] Of these six people, one was pregnant, one had leukemia, one had Hodgkin disease and two were known to be previously healthy.[66] Despite these apparently low numbers of infections, the true rate of infection may be higher, since most cases only cause a very mild disease, and will probably never be reported or diagnosed.[66]
According to the Centers for Disease Control and Prevention (CDC), in humans the symptoms of the 2009 "swine flu" H1N1 virus are similar to those of influenza and of influenza-like illness in general. Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. The 2009 outbreak has shown an increased percentage of patients reporting diarrhea and vomiting.[67] The 2009 H1N1 virus is not zoonotic swine flu, as it is not transmitted from pigs to humans, but from person to person.

Because these symptoms are not specific to swine flu, a differential diagnosis of probable swine flu requires not only symptoms but also a high likelihood of swine flu due to the person's recent history. For example, during the 2009 swine flu outbreak in the United States, CDC advised physicians to "consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed swine flu, or who were in one of the five U.S. states that have reported swine flu cases or in Mexico during the 7 days preceding their illness onset."[68] A diagnosis of confirmed swine flu requires laboratory testing of a respiratory sample (a simple nose and throat swab).[68]

The most common cause of death is respiratory failure, other causes of death are pneumonia (leading to sepsis)[69], high fever (leading to neurological problems), dehydration (from excessive vomiting and diarrhea) and electrolyte imbalance. Fatalities are more likely in young children and the elderly.

Prevention

Prevention of swine influenza has three components: prevention in swine, prevention of transmission to humans, and prevention of its spread among humans.

Prevention in swine

Methods of preventing the spread of influenza among swine include facility management, herd management, and vaccination (ATCvet code: QI09AA03). Because much of the illness and death associated with swine flu involves secondary infection by other pathogens, control strategies that rely on vaccination may be insufficient.

Control of swine influenza by vaccination has become more difficult in recent decades, as the evolution of the virus has resulted in inconsistent responses to traditional vaccines. Standard commercial swine flu vaccines are effective in controlling the infection when the virus strains match enough to have significant cross-protection, and custom (autogenous) vaccines made from the specific viruses isolated are created and used in the more difficult cases.[71][72] Present vaccination strategies for SIV control and prevention in swine farms typically include the use of one of several bivalent SIV vaccines commercially available in the United States. Of the 97 recent H3N2 isolates examined, only 41 isolates had strong serologic cross-reactions with antiserum to three commercial SIV vaccines. Since the protective ability of influenza vaccines depends primarily on the closeness of the match between the vaccine virus and the epidemic virus, the presence of nonreactive H3N2 SIV variants suggests that current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses.[73][74] The United States Department of Agriculture researchers say that while pig vaccination keeps pigs from getting sick, it does not block infection or shedding of the virus.[75]

Facility management includes using disinfectants and ambient temperature to control virus in the environment. The virus is unlikely to survive outside living cells for more than two weeks, except in cold (but above freezing) conditions, and it is readily inactivated by disinfectants.[2] Herd management includes not adding pigs carrying influenza to herds that have not been exposed to the virus. The virus survives in healthy carrier pigs for up to 3 months and can be recovered from them between outbreaks. Carrier pigs are usually responsible for the introduction of SIV into previously uninfected herds and countries, so new animals should be quarantined.[51] After an outbreak, as immunity in exposed pigs wanes, new outbreaks of the same strain can occur.[2]

Prevention in humans

Prevention of pig to human transmission

wine can be infected by both avian and human influenza strains of influenza, and therefore are hosts where the antigenic shifts can occur that create new influenza strains.

The transmission from swine to human is believed to occur mainly in swine farms where farmers are in close contact with live pigs. Although strains of swine influenza are usually not able to infect humans this may occasionally happen, so farmers and veterinarians are encouraged to use a face mask when dealing with infected animals. The use of vaccines on swine to prevent their infection is a major method of limiting swine to human transmission. Risk factors that may contribute to swine-to-human transmission include smoking and not wearing gloves when working with sick animals.[76]

Prevention of human to human transmission

Influenza spreads between humans through coughing or sneezing and people touching something with the virus on it and then touching their own nose or mouth.[77] Swine flu cannot be spread by pork products, since the virus is not transmitted through food.[77] The swine flu in humans is most contagious during the first five days of the illness although some people, most commonly children, can remain contagious for up to ten days. Diagnosis can be made by sending a specimen, collected during the first five days for analysis.[78]

Recommendations to prevent spread of the virus among humans include using standard infection control against influenza. This includes frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public.[79] Chance of transmission is also reduced by disinfecting household surfaces, which can be done effectively with a diluted chlorine bleach solution.[80]

Experts agree that hand-washing can help prevent viral infections, including ordinary influenza and the swine flu virus. Also avoiding touching eyes, nose and mouth with hands prevents flu. [3] Influenza can spread in coughs or sneezes, but an increasing body of evidence shows small droplets containing the virus can linger on tabletops, telephones and other surfaces and be transferred via the fingers to the mouth, nose or eyes. Alcohol-based gel or foam hand sanitizers work well to destroy viruses and bacteria. Anyone with flu-like symptoms such as a sudden fever, cough or muscle aches should stay away from work or public transportation and should contact a doctor for advice.

Social distancing is another tactic. It means staying away from other people who might be infected and can include avoiding large gatherings, spreading out a little at work, or perhaps staying home and lying low if an infection is spreading in a community. Public health and other responsible authorities have action plans which may request or require social distancing actions depending on the severity of the outbreak.

Vaccination

Vaccines are available for different kinds of Swine Flu. Although the current trivalent influenza vaccine is unlikely to provide protection against the new 2009 H1N1 strain,[81] vaccines against the new strain are being developed and could be ready as early as November 2009.[82]

Treatment

In swine

As swine influenza is rarely fatal to pigs, little treatment beyond rest and supportive care is required.[51] Instead veterinary efforts are focused on preventing the spread of the virus throughout the farm, or to other farms.[11] Vaccination and animal management techniques are most important in these efforts. Antibiotics are also used to treat this disease, which although they have no effect against the influenza virus, do help prevent bacterial pneumonia and other secondary infections in influenza-weakened herds.[51]

In humans

If a person becomes sick with swine flu, antiviral drugs can make the illness milder and make the patient feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms). Beside antivirals, supportive care at home or in hospital, focuses on controlling fevers, relieving pain and maintaining fluid balance, as well as identifying and treating any secondary infections or other medical problems. The U.S. Centers for Disease Control and Prevention recommends the use of Tamiflu (oseltamivir) or Relenza (zanamivir) for the treatment and/or prevention of infection with swine influenza viruses; however, the majority of people infected with the virus make a full recovery without requiring medical attention or antiviral drugs.[83] The virus isolates in the 2009 outbreak have been found resistant to amantadine and rimantadine.[84]

In the U.S., on April 27, 2009, the Food and Drug Administration (FDA) issued Emergency Use Authorizations to make available Relenza and Tamiflu antiviral drugs to treat the swine influenza virus in cases for which they are currently unapproved. The agency issued these EUAs to allow treatment of patients younger than the current approval allows and to allow the widespread distribution of the drugs, including by non-licensed volunteers.[85]


Notes

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3. ^ Heinen PP (15 September 2003). "Swine influenza: a zoonosis". Veterinary Sciences Tomorrow. ISSN 1569-0830. http://www.vetscite.org/publish/articles/000041/print.html. "Influenza B and C viruses are almost exclusively isolated from man, although influenza C virus has also been isolated from pigs and influenza B has recently been isolated from seals.".
4. ^ Bouvier NM, Palese P (September 2008). "The biology of influenza viruses". Vaccine 26 Suppl 4: D49–53. PMID 19230160.
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9. ^ Shin JY, Song MS, Lee EH, Lee YM, Kim SY, Kim HK, Choi JK, Kim CJ, Webby RJ, Choi YK (2006). "Isolation and characterization of novel H3N1 swine influenza viruses from pigs with respiratory diseases in Korea". Journal of Clinical Microbiology 44 (11): 3923–7. doi:10.1128/JCM.00904-06. PMID 16928961.
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18. ^ "Soft evidence and hard sell". New York Times. 5 September 1976. http://select.nytimes.com/gst/abstract.html?res=F10914FA3E5E14768FDDAC0894D1405B868BF1D3&scp=9&sq=Swine+Flu+epidemic&st=p.
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27. ^ Schmeck, Harold M. (March 25, 1976). "Ford Urges Flu Campaign To Inoculate Entire U.S.". The New York Times. http://select.nytimes.com/gst/abstract.html?res=F50A17FD3C5A167493C7AB1788D85F428785F9.
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