We're isolating everyone with respiratory symptoms. Period. Our infection control folks have modified our droplet precautions to include N95s and goggles for all aerosolizing activities on ALL such patients, but have decided that a surgical mask is adequate unless there is a risk of aerosolizing. We have a poster - http://www.albertahealthservices.ca/...ct-droplet.pdf
So the other night I was helping another PICU nurse bathe a patient with confirmed H1N1. I was wearing my fit-tested and designated N95 respirator, and I COULD SMELL THE SOAP. The day of my fit test, I could taste the Bittrex all the way through the test, and the tester told me that unless it was "really strong" I had a good fit. He also told me that the fogging I was seeing on my glasses wasn't a problem. Do I believe him?
Oh, and we're reusing the disposable goggles our unit is providing. We're to use the same pair for the whole shift and then put them in a bucket for cleaning.
As for discontinuation of isolation precautions, this is our current directive from Infection Prevention and Control:
Admitted suspect Influenza A H1N1 patient or resident:
Only on receipt of a negative Respiratory Viral Panel Nucleic Acid Test (PCR) result from Nasopharyngeal
Swab/Aspirate or Bronchial Alveolar Lavage specimen.
Confirmed Influenza A H1N1 patient or resident (except those listed below)
When all symptoms have resolved and not before 7 days from the start of symptoms*. If in doubt, contact IPC.
Patient admitted to Critical Care / Intensive Care Units:
Not before 10 days from beginning of symptoms* and with consultation of IPC.
Child under 5 years of age:
Not before 10 days from beginning of symptoms* and with approval of IPC.
Severely Immunocompromised Patient (e.g. bone marrow and other transplant recipients, oncology
Only with approval of IPC.
* Repeat Respiratory Viral Panel for Influenza A is not required to discontinue precautions.
This Directive is subject to change as more information becomes available about Influenza A H1N1.
So far we've only had three confirmed cases on our unit... the thin edge of the wedge.