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H1N1 Flu Watch 

H1N1 Influenza Update

H1N1 influenza is now circulating everywhere throughout the province and is affecting many OPSEU members where they work, at home and in the community. Many members are turning to their union for information and assistance to address work-related concerns about influenza. Following are some of the most commonly raised concerns and some useful sources of additional information:

I work in a Correctional or Youth Justice facility where H1N1 influenza vaccine is being offered to inmates or youth but not to staff. Is that the right approach?

OPSEU says this is the wrong approach. Correctional Officers, Youth Service Officers and other staff work in the same environment where inmates and youth live, and their duties often require them to be in close proximity to inmates or youth. Many inmates and youth are at high risk of contracting influenza and other infectious illnesses because their underlying health status is poor, hygiene conditions in the facilities are often not optimal, and their living environments are often very crowded. These same conditions also put staff at risk. It is OPSEU’s position that Correctional facilities and Youth Justice facilities should be offering H1N1 influenza vaccine to staff at the same time as vaccine is being offered to inmates or youth.

OPSEU members, through their Joint Health and Safety Committees, should strongly encourage their employers to request the Ministry of Health and Public Health Units to release vaccine that can be offered to employees at risk.

I work in a Correction or Youth Justice facility where we have a local pandemic influenza plan, but there is a lot of confusion about how to implement it. What should I do?

OPSEU members in these facilities should request that their Joint Health and Safety Committee have an urgent meeting to review their pandemic flu plan in light of the current influenza situation in the province and their facility. Local Infection Prevention and Control Committees should also be involved in this discussion. Areas to be considered are: screening of new admissions for Influenza-Like Illness (ILI); screening of other inmates/youth for ILI if an inmate/youth develops flu symptoms; staff self-screening for flu symptoms; encouraging staff to stay home when ill with no reprisals from employers; where inmates/youth will be housed while awaiting medical assessment and when they are diagnosed with flu; issues around personal protective equipment such as availability, accessibility, respirator fit-testing and training; and, communication to staff about health and safety measures and changes to measures.

The Ministry of Health and Long Term Care (MOHLTC) has released two new guidance documents for Corrections and Youth Justice Centres which provide useful information. Links to these documents are below.

I work in a Developmental Services home where two of our residents have been diagnosed with influenza. Although one has been transferred to hospital, we are caring for the other resident in the home. What should staff do?

OPSEU members in Developmental Services workplaces should be requesting that their JHSC or Health and Safety Representative have an urgent meeting to discuss measures and procedures to protect staff from influenza in the workplace. If employers refuse to meet or say that pandemic planning is not a health and safety issue, remind them that their obligations under Sections 8 and 9 of the Regulation for Health Care and Residential Facilities require employers to consult with the JHSC or Health and Safety rep when developing measures and procedures to protect staff from infectious illnesses.

Some workplaces have pandemic influenza plans or emergency plans while others do not. Plans should address issues such as: screening of residents for ILI; screening of staff for ILI; encouraging staff to stay home when ill with no reprisals from employer; where sick residents will be housed; additional hygiene measures to reduce risk of exposure to influenza; issues around personal protective equipment such as availability, accessibility, respirator fit-testing and training; and, communication to staff about health and safety measures and changes to measures.

Although the MOHLTC has not developed guidance specifically for Developmental Services workplaces, it has released guidance for Long Term Care and for Home Care workers which will provide useful tips relevant to DSS workplaces. Links are below.

Additionally, the MOHLTC has adopted the following definition of health care worker from the Canadian Immunization Committee for the purposes of priority access to H1N1 vaccine: “Healthcare workers including hospital employees, other staff who work or study in hospitals (e.g. students in health care disciplines and contract workers), other health care personnel (e.g. those working in clinical laboratories, nursing homes, and home care agencies), and child care workers are at risk of exposure to communicable diseases because of their contact with patients or material from individuals with infections, both diagnosed and undiagnosed.” The definition includes “regulated and unregulated professionals” and those who “provide direct/indirect patient care.” Health care workers are considered to be a priority group to receive vaccine before the general public. OPSEU believes this definition should include DSS workers as well and encourages members in this sector to insist that they are offered the vaccine as a priority group.

I work in an office and one of my co-workers in the next cubicle went home sick today with influenza symptoms. What should I do?

Wherever you work, your employer should have developed a pandemic influenza or emergency management plan. JHSCs and Health and Safety reps should have had input into the measures and procedures in the plan to protect workers. JHSCs and Health and Safety reps should strongly encourage a meeting with employer representatives to either review the existing plan or to develop a plan with measures and procedures including an effective communication strategy to protect and inform workers.

It is believed that influenza is primarily spread through large droplets that directly contact a person’s nose, mouth or eyes. These droplets are produced when an infected person coughs, sneezes or talks sending infectious droplets into the air. Influenza may also be spread when a person touches an area contaminated with influenza viruses and then touches their nose, mouth or eyes. In a workplace where a worker has been working with H1N1, it would be advisable to wipe down commonly used areas with disinfectant wipes to reduce the risk of contact transmission. It is a good practice in general, even if no one is ill, to implement good cleaning practices to ensure that commonly touched items such as door handles, telephones, and counters are cleaned regularly. Workers should be encouraged to practice frequent hand hygiene using soap and water or alcohol-based hand cleanser.

In an office setting where a worker has contracted influenza, it would be advisable to alert staff to be vigilant about their own health since they may have been exposed to the virus. Staff who develop flu symptoms should be encouraged to stay home with no reprisals from the employer.

The MOHLTC has useful guidance on how to stay healthy and how to do a self-assessment for influenza symptoms. Additionally, the U.S. Department of Labour has published a valuable document to assist workplaces prepare for an influenza pandemic which contains guidance for office settings as well as other higher risk workplaces. See links below.

I am pregnant (or have a serious underlying health condition) and my doctor has advised me to try to avoid exposure to people with H1N1 until I can be vaccinated. What should I do?

If you have a medical reason supported by a doctor’s note to request a workplace accommodation you should follow the regular procedure used by OPSEU members in your workplace when they request an accommodation. Different OPSEU locals follow different processes when assisting members with accommodation issues. Some locals have an Accommodation Committee to assist members while in others, stewards, a member of the Local Executive or an OPSEU member of the JHSC may assist. Advise your supervisor that you will be requesting an accommodation and contact your Local steward, executive member or health and safety representative to discuss how a safe accommodation could be arranged and to schedule a meeting with your employer.

I’ve heard that doctors’ offices are too busy to book appointments for people who need a doctor’s note before returning to work after having the flu. Is that true and if so, what should I do when my employer demands that I provide a doctor’s note?

Some employers have decided to relax the requirement for workers to provide doctors’ notes during this time. In a recent press release, the Ontario Medical Association encouraged employers to reconsider asking their employees for a sick note from a physician because of an absence from work. “In order to help reduce the transmission of H1N1 and other illnesses, Ontario’s doctors believe it is wise for patients to stay home when they have flu-like symptoms,” said Dr. Suzanne Strasberg, President of the OMA. “Employers need to recognize that by requiring a sick note, they are encouraging those who are experiencing their worst symptoms and are most infectious to go out, when they should just be home in bed.”

The OMA statement goes on to note that people with mild flu symptoms who do not need medical care may place others at risk if they come to the doctor’s office just to get a note. Additionally, the OMA states that during this time, doctors’ resources are better spent focusing on patients who need their care, rather than producing notes to satisfy employer policies.

Locals and individual OPSEU members should inquire whether their employers will relax current requirements to produce doctors’ notes while the pandemic is creating huge demands on our health care system.

H1N1 Resources

October 23, 2009 H1N1 Influenza Update

The Ministry of Health and Long-Term Care (MOHLTC) has released updated clinical guidelines for Long-Term Care Settings, Ambulatory Care and Emergency Departments.

In all three guidance documents, occupational health and safety and infection prevention and control advice continues to take a precautionary approach recommending ongoing screening for influenza like illnesses (ILI), good hand hygiene, and appropriate use of personal protective equipment, including N95 respirators where necessary. Section five of each document contains the updated Infection Prevention and Control/Occupational Health and Safety guidance.

Long-Term Care settings

Key health and safety/infection prevention and control measures recommended are:

  • Passive screening (signage at the entrance) should continue; advising persons not to enter if they have ILI symptoms.
  • Daily screening of residents for ILI.
  • Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
  • Healthcare providers caring for or assessing patients/residents with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
  • Coughing residents should be instructed to wash their hands, cover mouth and nose with a surgical mask if possible and be placed in a separate room or stay 2 metres away from others while awaiting assessment.

Ambulatory Care settings

Key health and safety/infection prevention and control measures recommended are:

  • Encourage patients to self-screen at home for ILI and screen patients by phone when making appointments.
  • Screen patients for ILI at reception using either signage or by receptionist.
  • Patients with ILI symptoms should be asked to wear a surgical mask and, if possible, stay at least 2 metres away from others or in a separate room while awaiting assessment.
  • Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
  • Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
  • Coughing patients should be instructed to wash their hands and cover mouth and nose with a surgical mask

Emergency Departments

Key health and safety/infection prevention and control measures recommended are:

  • Active screening (screening by a person) of patients for ILI symptoms using Febrile Respiratory Illness screening tool.
  • Patients with fever or other ILI symptoms to be advised to wear a surgical mask and to be placed in separate room or remain at least 2 metres away from others while awaiting assessment.
  • Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
  • All Emergency room staff within 2 meters of ILI patients should wear fit-tested N95 respirators and eye protection.
  • Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns, eye protection, and fit-tested N95 respirators.

New October 14, 2009 Important Health Notice:

http://www.health.gov.on.ca/english/providers/
program/emu/health_notices/ihn_20091014.pdf

New Long Term Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/
pro/docs/ltc_guidance.pdf

New Ambulatory Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/
pro/docs/ambulatory_guidance.pdf

New Emergency Department guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro
/docs/emergency_guidance.pdf
 

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

  • People with chronic medical conditions under age 65
  • Pregnant women
  • Healthy children from 6 months to 5 years old
  • Persons living in remote and isolated settings or communities
  • Health care workers involved in pandemic response or the delivery of essential health care services
  • Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza.  Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

OPSEU continues to advise local JHSCs and Health and Safety Reps to review your employer’s pandemic influenza or emergency plan to ensure that it is adequate to meet workplace needs in this oncoming influenza season. Whether you work in a health care workplace, a correctional facility, an office, a store, a college, a group home, with the public or in isolation, your workplace should have a pandemic influenza plan that addresses health and safety concerns of workers.

In each type of workplace, different measures and procedures may be appropriate. Hand-washing stations, maintaining social distancing, not coming to work ill and good cough and cold etiquette may be all that’s needed in one workplace, while other workplaces may consider erecting barriers between public and staff. Other workplaces where patients with influenza are cared for may need much more protective precautions as well as staff training. There are numerous excellent resources you and your JHSC or your Health and Safety Rep can turn to. Here are a few:

June 12, 2009 H1N1 Influenza Update

On June 11, 2009, the World Health Organization (WHO) raised the global pandemic level from Phase 5 to Phase 6 signalling that a global pandemic is underway with sustained human to human transmission in several WHO countries.  To countries with no H1N1 cases yet, this means that spread to their country is imminent, but to Canada, the influenza has already been spreading for some time.  As of June 11, 2009 there were 1 638 confirmed cases of H1N1 Influenza in Ontario.  Ten people who have the H1N1 flu virus were in hospital as of June 9, a number of whom have underlying medical conditions.    

The WHO decision is based upon geography rather than severity of the illness, therefore the decision does not mean anything new in Ontario at this point.  Following the WHO announcement on June 11, 2009, Ontario MOHLTC issued a new health notice explaining impact of the announcement in Ontario, that existing guidelines and reduction to lab testing for non-high risk individuals will continue unchanged. 

Since most cases in Ontario remain mild and are being considered equivalent to the regular flu, Ontario is attempting to turn its focus from identifying mild cases (and focusing on counts) to focusing on prevention of spread and monitoring for severity and ensuring that those individuals under 2, over 65, or with underlying medical conditions receive priority for lab testing and obtain appropriate care.  This approach will ensure that Ontario remains ready to respond with its ready pandemic plan should the H1N1 become more severe and it also means that severe cases receive faster attention and treatment. 

OPSEU members should continue to be vigilant in their workplaces to ensure that precautions are in place to prevent spread of H1N1 and that the guidelines for Emergency Departments, Ambulatory Care, and Long-Term Facilities are being adhered to.  The changing focus in lab testing means that many mild cases of H1N1 will no longer be specifically diganosed, therefore we need to assume that the numbers will be under-estimated and use precautions wherever we go, and ensure that workplaces adopt precautions that prevent spread.  While basic precautions include hand-washing, disinfectant, staying home if sick, signage, passive monitoring, and good housekeeping, there are other recommendations that OPSEU Joint Health and Safety Committees or health and safety representatives might make to enhance prevention.  Examples include suggesting ways to change the work process to prevent spread, such as conference calling instead of meeting, or re-defining work priorities in ways that make sense in particular workplaces.  

Below are the most current documents:   

NEW! June 11, 2009  Important Health Notice 

Guidance for Management of Patients with Influenza-like Illness (ILI) in Ambulatory Settings   

Guidance for Management of Patients with Influenza-like Illness (ILI) in Emergency Departments 

Important Health Notice

Quick Reference: May 19th Updates to H1N1 Flu Virus Guidance Documents (these are now replaced for ambulatory and emergency management in the above two documents, but is still useful for guidance in long term care settings) 

Guidance for Influenza-like-illness (ILI) Management in Long Term Care (LTC) 

Screening Tool for Influenza-like-illness (ILI) in Health Care Settings (both ambulatory and emergency)    

Signage for Ambulatory Settings

Occupational Health and Safety Requirements for the Health Care Sector

Information on the use and fit-testing of N95 Respirators 

Ministry of Health and Long Term Care H1N1 Flu Virus (Human Swine Flu) site has regular updates and links to other useful sites 

Ontario’s Agency for Health Protection and Promotion provides regularly updated information on H1N1 Flu (Human Swine Flu)

OPSEU’s “A Healthcare Workers Guide to Pandemic Influenza”

June 9, 2009 H1N1 Influenza Update

As of June 5, Ontario has confirmed a total of 1078 cases of H1N1 influenza, with 184 of those occurring since June 3, 2009.  While most cases in Ontario remain mild, six people with the virus are currently hospitalized, and two others with chronic medical conditions who contracted H1N1 virus have died.   

On June 2, the MOHLTC released “Quick Reference: May 19th Updates to H1N1 Flu Virus Guidance Documents” to highlight the changes and updates made May 19th in the directives for emergency ambulatory settings, emergency departments, and long term care facilities.  The quick reference guide clarifies what procedures changed and why the changes were made.       

On June 4, Ontario Ministry of Health and Long Term Care (MOHLTC) issued a health notice announcing the release of new versions of both Emergency Ambulatory settings and Emergency Departments’ guidance documents.  It appears that there are no changes being made and no replacement of the Guidance for Influenza-like-illness (ILI) Management in Long Term Care.  The MOHLTC notice also announces that hours of operation for the Health Care Provider hotline will be reduced.

Changes in ambulatory and emergency settings call for a reduction in laboratory testing for H1N1 Influenza due to the fact that H1N1 is the predominant circulating strain of influenza in many communities at this time, with most cases being mild.  Specifically, the documents state that health care providers in ambulatory care settings and emergency departments should only submit laboratory specimens in cases where lab results are required for clinical management of hospitalized cases of influenza-like-illness (ILI) or where patients are at high risk for complications from influenza (ie immunocompromised, pregnant, persons under the age of 2 years and over 65 years of age). 

New June 2, 2009 May 19th Updates to H1N1 Flu Virus Guidance Documents (these are now replaced for ambulatory and emergency management in the above two documents, but is still useful for guidance in long term care settings) 

Ministry of Health and Long Term Care H1N1 Flu Virus (Human Swine Flu) site has regular updates and links to other useful sites 

Ontario’s Agency for Health Protection and Promotion provides regularly updated information on H1N1 Flu (Human Swine Flu)

Wednesday May 27, 2009 H1N1 Influenza Update

As of May 26, 2009, the total number of H1N1 flu cases in Ontario is 371. A 44-year old Toronto man with a chronic pre-existing medical condition passed away on May 23rd. On May 24th laboratory testing confirmed a positive test for H1N1 in this individual. It is not clear what role the H1N1 virus played in the fatality which is now under investigation by the Office of the Chief Coroner.

No new guidance or Important Health Notices have been issued by the MOHLTC this week. However, the MOHLTC reported that today it plans to post a clarification document explaining existing guidance for Ambulatory care, Emergency departments and Long Term Care.  This document is being developed in response to numerous requests by stakeholders to interpret guidance documents and to explain the rationale behind them. At today’s teleconference with MOHLTC, the Ministry advised that new guidance is also being developed for community and home care settings. Additionally, it may revise existing guidance as more information about the spread and virulence of H1N1 influenza is gathered.

Please continue to watch the OPSEU website and the links below for updates on H1N1 Influenza:

Ministry of Health and Long Term Care H1N1 Flu Virus (Human Swine Flu) site has regular updates and links to other useful sites 

Ontario’s Agency for Health Protection and Promotion provides regularly updated information on H1N1 Flu (Human Swine Flu)

Wednesday May 20, 2009 H1N1 Influenza Update

Ontario currently has 272 confirmed cases of N1N1, only 57 of which have a travel history to Mexico or other affected regions.  While a few individuals have been hospitalized, all cases remain mild and most people have fully recovered. 

Due to the increased person-to-person transmission and the declining link to travel to Mexico or other affected regions, a number of guidance documents have been changed to remove links to Mexico in screening and care, and other processes are either heightened or remain the same.  Highlights include:  

  • Since travel to an affected area is no longer an appropriate predictor of H1N1influenza infection, a fit-tested N95 respirator, in addition to droplet and contact precautions should be used by health care workers when within 2 metres of caring for all patients with influenza-like-illness (ILI) in emergency departments, ambulatory settings and NOW long term care settings.  This is a new development for Long Term Care settings, as the May 19, 2009 guidance upgrades precautions in these settings, upgrading from using routine contact and droplet precautions to using fit-tested N95 respirators when caring for patients with ILI 
  • Triage staff in emergency departments should wear both eye protection (new) and fit-tested N95 respirators when conducting active surveillance of patients presenting with respiratory symptoms     
  • In emergency and ambulatory settings, (and now long-term care settings), fit-tested N95 respirators shall be worn when providing care to all patients with ILI, now regardless of any link to Mexico or any other affected area   
  • All patients presenting to Emergency departments, receiving care in ambulatory settings, and attending at long term care facilities should continue to be actively screened using the updated May 19, 2009 screening form
  • Passive surveillance continues; signage shall be posted in ambulatory settings and emergency departments asking people to self-report symptoms and in long-term care settings asking them not to enter if exhibiting symptoms of ILI
  • The requirement in ambulatory settings for a physical barrier remains (ie. Window or plexi-glass barrier) or the receptionist should maintain a 2 metre (6 foot) distance from all patients if possible.  New in updated guidelines; if no barrier exists and a 2 metre distance is not possible, a fit-tested respirator and eye protection should be worn

For complete information, review the new documents below:

New May 19, 2009, Important Health Notice—Information for Health Care Professionals

New May 19, 2009, Guidance for Management of Patients with Influenza-like-illness (ILI) in Emergency Departments

New May 19, 2009, Clinical Guidance for Management of Patients with Influenza-like-illness (ILI) in Ambulatory Settings 

New May 19, 2009, Signage for Ambulatory Settings 

Other useful sites: 

Ministry of Health and Long Term Care H1N1 Flu Virus (Human Swine Flu) site has regular updates and links to other useful sites 

Ontario’s Agency for Health Protection and Promotion provides regularly updated information on H1N1 Flu (Human Swine Flu)

Friday May 15, 2009 H1N1 Influenza Update

As of May 14, 2009, the total number of H1N1flu cases in Ontario is 155. All of the cases are mild; one person with H1N1 flu has been hospitalized for other medical reasons.

MOHLTC has released a new fact sheet "Occupational Health and Safety Requirements for the Health Care Sector" which describes duties and responsibilities [MORE] of employers, supervisors and workers under the Occupational Health and Safety Act and its regulations. All of these obligations continue during the current influenza outbreak.    The Occupational Health and Safety Act is available at the following link: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90o01_e.htm

A worker who is required by his or her employer or by the Regulation for Health Care and Residential Facilities (http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_930067_e.htm ) to wear or use any protective clothing, equipment or device shall be instructed and trained in its care, use and limitations before wearing or using it for the first time and at regular intervals.  Employers are encouraged to document that workers are trained, dates when training was conducted and materials covered during training.  A worker must work in compliance with the Act and its regulations and use or wear any equipment, protective devices or clothing required by the employer.

The other new document, "Information on the use and fit-testing of N95 Respirators" is specifically aimed at the healthcare sector, but provides useful guidance to any workplace where N95 respirators may be required. N95 respirators filter out tiny airborne particles when the respirator fits and is properly used.  Individuals who are required to wear N95 respirators must be fit tested at least every two years to ensure a proper fit. 

Please continue to watch the OPSEU website and the links below for updates on H1N1 Influenza:

Ministry of Health and Long Term Care H1N1 Flu Virus (Human Swine Flu) site has regular updates and links to other useful sites 

Ontario’s Agency for Health Protection and Promotion provides regularly updated information on H1N1 Flu (Human Swine Flu)

Friday May 8, 2009 H1N1 Influenza Update

As of May 7, 2009, there were 56 lab-confirmed cases of H1N1 Influenza A in Ontario. Travel to Mexico accounts for 37 of the cases and an additional 12 cases had close contact with a confirmed case. Seven cases are still being investigated. All cases are mild and no one in Ontario has been hospitalized.

The MOHLTC has released a new document, “Information on the Novel H1N1 Influenza Virus for Primary Care Practitioners.” Although most of the information on the document is useful, the Ministry, apparently in an attempt to reduce anxiety among primary care practitioners, included the following point: “Health care professionals including family physicians and other primary care practitioners are more susceptible to infection with influenza viruses at home and in the community than in the work place.” This is a confusing and potentially misleading statement. It is incorrect to say in general that there is a greater risk of exposure to influenza in the community than in health care workplaces.

The risks to health care practitioners of exposure to influenza must be assessed in each workplace and within different workplace areas. For example, there are probably greater risks of exposure in a busy emergency department than in a grocery store. There may also be greater risks in a family physician’s office than in a long term care setting. Both OPSEU and the representative from the Ontario Medical Association requested the Ministry to either remove or revise the statement to reflect these points. The Ministry agreed to review it, but made no commitment to change it.

OPSEU continues to advise its members to request meetings of their Joint Health and Safety Committees to review and update their pandemic influenza or emergency plans. This is particularly important in the health care sector and workplaces where employers have been requested to stockpile 4 weeks worth of personal protective equipment and other emergency supplies. OPSEU has received numerous reports of health care workplaces that do not have their 4-week supplies, especially N95 respirators. We have also received reports of some workplaces that have stockpiles where some items are outdated or degraded. For example, the elastic on N95 respirators may have begun to break down over time. JHSCs should ensure that respirator fit-testing is current and that functioning N95 respirators are available.

It appears that this influenza outbreak is relatively mild. However, it is possible that the virus will emerge again in our regular ‘flu season’ in the fall and it is possible that a second wave of H1N1 influenza will be more virulent. It is prudent to take advantage of the opportunity of this mild outbreak to review and revise your pandemic influenza or emergency plans as well as to ensure that everyone has received education on the plans so that everyone is prepared in the event of a more serious outbreak.

The MOHLTC has decided, based on the reduced volume of calls, to reduce the hours of operation of its Health Care Providers Hotline starting this weekend. The hotline will operate on Saturday, May 9 from 0800 to 1600; it will be closed on Sunday; and, starting on Monday, May 11, it will be open from 0900 to 1700. The hotline number is: 1-866-212-2272.

The daily 3 p.m. updates by the Chief Medical Officer of Health (CMOH) will be scaled down from a press conference to a daily press release starting next week.

Please continue to watch the OPSEU website and the links below for updates on H1N1 Influenza (Human Swine Flu).

New nformation on the Novel H1N1 Influenza Virus for Primary Care Practitioners 

New Important Health Notice May 7, 2009 

Guidance for Clinical Care of Patients: Ambulatory Settings – provides important infection prevention and health and safety information 

Ministry of Health and Long Term Care H1N1 Flu Virus (Human Swine Flu) site has regular updates and links to other useful sites 

Ontario’s Agency for Health Protection and Promotion provides regularly updated information on H1N1 Flu (Human Swine Flu)

Wednesday May 6, 2009 H1N1 Influenza Update

As of May 6, there are 49 lab-confirmed cases of H1N1 influenza in Ontario. Travel to Mexico or contact with a person who has H1N1 and who traveled to Mexico remains the most frequent source of the illness. Because laboratory testing capacity has been increased, cases of H1N1 are now being confirmed faster.

New guidance has been released for the management of influenza-like-illness (ILI) in Long Term Care facilities. Unfortunately, the health and safety/infection prevention and control guidance for workers is not as protective as OPSEU believes it should be. OPSEU takes the position that the precautionary principle, which states that action to reduce risk need not await scientific certainty, should be applied as we establish protective measures against this new virus.

The three main weaknesses in the document are as follows:

  • There is no recommendation that persons entering a LTC facility be screened by a person (active screening) for ILI before entering the home. The guidance note advises that signs be posted reminding people not to enter if they have ILI symptoms. This is known as passive screening or self-screening. Self-screening may not be effective if people are determined to enter despite having ILI symptoms or if they do not understand the questions on the sign. Advice: OPSEU takes the position that active screening of people entering the facility is more protective of worker health and safety.
  • Healthcare workers are advised to wear an N95 respirator when directly caring for a resident with ILI symptoms who has had contact with a person with a confirmed case of H1N1 flu. OPSEU does not believe that this advice is protective enough. If a visitor with ILI enters the facility, they may not know if they have H1N1. If the visitor later is diagnosed with a confirmed case of H1N1, this information may not be communicated to the LTC facility and workers may not be protected adequately. Advice: OPSEU believes it would be prudent for healthcare workers to wear an N95 respirator when in direct contact with residents with ILI who have been in contact with a person with confirmed or possible H1N1 influenza.
  • Healthcare workers are advised to wear a surgical mask to care for residents with ILI and a fit-tested N95 respirator during aerosol-generating procedures such as tracheal or oral suctioning. This is confusing advice and does not reflect the application of the precautionary principle. It is reasonable to advise the use of an N95 respirator during aerosol-generating procedures. However, requiring workers to wear a surgical mask when caring for residents with ILI in some circumstances and to wear an N95 respirator when caring for residents with ILI who have had contact with a confirmed case of H1N1 will confuse workers and may not be protective enough. Advice: OPSEU believes it would be prudent for healthcare workers to wear an N95 respirator when in direct contact with residents with ILI who have been in contact with a person with confirmed or possible H1N1 influenza.

OPSEU continues to advise its members on Joint Health and Safety Committees, and Health and Safety Representatives, to meet to review and update their pandemic influenza plans. In particular, JHSCs in LTC facilities should meet to review this new guidance and to determine what precautions to implement. 

Please continue to watch the OPSEU website and the links below for updates on H1N1 Influenza (Human Swine Flu).

Monday May 4, 2009 H1N1 Influenza Update

All but three of these cases have a travel history to Mexico. The three cases without Mexican travel history had close household contact with someone who had a confirmed case. These three cases indicate that human-to-human transmission has happened in Ontario. All 16 cases are mild and all are recovering at home. OPSEU will continue to participate in these teleconferences now scheduled three times weekly.

The World Health Organization pandemic threat level remains unchanged at Phase Five.

A new Important Health Notice (IHN) released on May 3 contains no new health and safety advice for healthcare workers. OPSEU members are advised to continue to follow the health and safety advice contained in the April 30, 2009 document, “Guidance for Clinical Care of Patients: Ambulatory Setting” which states that those providing direct care  to patients with an Influenza Like Illness (ILI) and a history of travel to Mexico within the previous 7 days practice hand hygiene, wear fit-tested N95 respirators and eye protection, wear gowns and gloves where there is a risk of contamination with respiratory secretions, and that surfaces potentially contaminated with respiratory secretions be cleaned with hospital-grade disinfectant.

The May 3, 2009 Important Health Notice focuses on guidelines for laboratory testing for patients with ILI and recommendations for the use of antivirals. Treatment with antiviral drugs is recommended only in very specific circumstances, all associated with symptoms of ILI and travel to Mexico or close contact with someone who traveled from Mexico.

Please continue to watch the OPSEU website and the links below for updates on H1N1 Flu (Human Swine Flu).

Helpful links and documents:

 Friday May 1, 2009 H1N1 Influenza Update

OPSEU President Warren (Smokey) Thomas yesterday communicated with OPSEU members in every sector about the Swine Flu outbreak, now being called Influenza H1N1

Sisters and Brothers,

This is an important message from your union regarding a possible influenza pandemic. As you know, Ontario is in an "enhanced state" of readiness and we need to remain proactive and vigilant in all OPSEU workplaces to reduce the chance of illness and further spread of H1N1 flu (previously called Swine Flu).

The attached memo from our Health and Safety Unit contains important advice to worker members of joint health and safety committees and health and safety representatives in all OPSEU workplaces.

As president, leader, or highest ranking member of your local, please ensure that this information is forwarded to your OPSEU representatives on joint health and safety committees and/or to all health and safety representatives at all workplaces in your local.

I encourage you and your local leadership to work in tandem with your worker safety representatives as they move forward with this important work.

All OPSEU members should check for updates about the H1N1 flu situation on the OPSEU website at http://opseu.org/hands/respiratory-illness-mexico-2009.htm

In solidarity,

Warren ( Smokey ) Thomas
President

Thursday April 30, 2009 Update

Ontario today is reporting eight cases of swine flu in Ontario. All cases are considered mild and no one has been hospitalized. Ontario remains at an enhanced state of vigilance, but an emergency has not been declared.

The World Health Organization, yesterday upgraded its Influenza Alert from Phase 4 to Phase 5, indicating that there is now evidence of human-to-human transmission of this novel virus in at least two countries. WHO is advising that all countries activate their pandemic preparedness plans. In response to the WHO announcement, Ontario is advising local authorities to begin activating local pandemic plans, is providing enhance monitoring of flu-like illnesses and is stepping up its communications to the healthcare system and the public.

OPSEU continues to advise it members in every sector who act as Health and Safety Representatives or who sit on Joint Health and Safety Committees (JHSC) to request an urgent meeting with their employer to review and update, if necessary, their pandemic influenza/emergency plans. A memo is being sent out by President Warren (Smokey) Thomas to all OPSEU locals advising them to initiate JHSC meetings and offering JHSC members and Health and Safety Representatives health and safety advice.

The Ministry of Health and Long Term Care today released a new Important Health Notice which increases Public Health reporting requirements of cases of Influenza Like Illness (ILI), as well as changes to Laboratory Guidelines. Additionally, the MOHLTC has released updated guidance for Clinical Care of Patients in Ambulatory Settings which provides health care workers with important infection prevention and control information. Healthcare workers providing direct care to patients with a travel history to Mexico and symptoms of ILI are advised to wear fit-tested N-95 respirators, eye protection, gloves and gowns where there is a risk of contamination with respiratory secretions. Good cleaning with hospital-grade disinfectant is recommended for any surfaces that may have been contaminated with respiratory secretions.

Please continue to watch the OPSEU website and the links below for updates on the swine flu situation as it continues to change.

Helpful links and documents:

NEW Important Health Notice, April 30, 2009 Information for Healthcare Providers 

NEW Guidance for Clinical Care of Patients: Ambulatory settingss – provides important infection prevention and health and safety information  

NEW April 30, 2009  MOHLTC news release 

NEW World Health Organization April 30, 2009 update 

Ministry of Health and Long Term Care Swine Flu site has regular updates and links  

Ontario Agency for Health Protection and Promotion provides regular swine flu updates

Wednesday April 29, 2009 Update

Ontario is now reporting seven laboratory confirmed cases of swine flu. Six of the cases are known to involve travel to Mexico and the seventh case is still being investigated. All are considered mild and the individuals are recovering at home. Ontario remains at an enhanced state of vigilance, but no emergency declaration has been made.

The provincial government has issued a new Important Health Notice which provides the latest guidelines and links to information.

Although no emergency declaration has been made, the Emergency Management Unit of the Ministry of Health and Long Term Care (MOHLTC) today convened its first teleconference of health care sector stakeholders to review the current situation and to establish working communication links. OPSEU participated and will take part in any future teleconferences. No new information was provided, other than the guidance contained on the April 29, 2009 Important Health Notice. Participants were reminded that health care workers have access to the Healthcare Providers Hotline (1-866-212-2272) for questions on Important Health Notices.

OPSEU advises its members in every sector who act as Health and Safety Representatives (in workplaces with fewer than 20 employees) or who sit on Joint Health and Safety Committees (in workplaces with 20 or more employees) to request an urgent meeting with their employer or a JHSC meeting to review their pandemic influenza plans. Employers, supervisors, Health and Safety Representatives and JHSCs should consider whether their plans are adequate to protect worker health and safety if the swine flu outbreak continues to spread.

All workplaces, particularly healthcare sector and other sectors with frequent close public contact should perform risk assessments to determine which workers are at risk of close contact with potentially infected individuals. In workplaces where it is determined that workers will be expected to be in close contact (2 meters or less) with people potentially ill with swine flu, appropriate personal protective equipment such as fit-tested NIOSH-approved N-95 respirators must be available. Additionally, adequate supplies such as gloves, gowns and face shields must be available where workers work with potentially ill patients, residents or clients. In healthcare facilities, access to the facility should be limited to a few entrances and screening of potentially ill visitors and clients/patients should be done. All workplaces should consider whether their communication networks within the workplace and from outside the workplace are up-to-date and working. All workplaces with public contact should ensure that adequate hand-wash solution is available. All workplaces should review their pandemic plans with all staff to ensure that everyone understands their roles, their duties and their rights.

Please continue to watch the OPSEU website and the links below for updates on the swine flu situation as it continues to change.

Helpful links and documents:

Tuesday April 28, 2009 Update

The World Health Organization (WHO) has moved the Mexican swine flu outbreak to Phase 4 (of 6) to indicate human to human transmission, however, no cases have been confirmed in Ontario.  Ontario remains at an “enhanced state” of vigilance—one level up from “routine.”  Declaration of Enhanced Conditions means that a potential emergency is developing at a local level. Under these conditions, surveillance and monitoring activities are enhanced.  The situation is fluid.  OPSEU members should keep updated by watching the website.  Note that—along with the signage for ambulatory locations released yesterday, today a new sign for patients needs to be posted in patient areas.     

Monday April 27, 2009 Update

Cases of Mexican Swine flu have been identified in Mexico, the U.S. and now Canada.  Four cases were found among school children in Nova Scotia, and two cases in British Columbia.  The two adult cases in BC are reported to have had minor symptoms and have recovered.  All six of these cases were linked to Mexican travel.  So far, no cases have been identified in Ontario.      

At this time Ontario remains on alert; Ontario remains in a state of enhanced surveillance.  Today’s Ontario Health notice explains that ambulatory care settings may experience an increase in visits and provides guidance in the management of ambulatory patients.  Clinical symptoms include high fever, headache, ocular pain, shortness of breath and extreme fatigue. 

For updates on the Mexican Swine Flu outbreak click here to check the Ontario Agency for Health Protection and Promotion.  This site also links to the Centre for Disease Control (CDC) and the World Health Organization (WHO).    

Severe Respiratory Illness in Mexico

April 24, 2009 

On April 21, 2009, Ontario"s Chief Medical Officer of Health announced an outbreak of Severe Respiratory Illness (SRI) in Mexico.

There have been no reported cases of the illness in Canada. However, the Ministry of Health has released an Important Health Notice  which describes symptoms of the illness, screening questions to use in hospital emergency departments and precautions for healthcare workers to take. If cases of SRI are discovered in Ontario, healthcare workers providing direct care (in the same room or in close contact) to SRI patients are advised to wear properly fit-tested N-95 respirators. All other healthcare workers are to follow Routine Practices. Patients who meet the definition of SRI  are to be cared for in a single room.

For more details, follow the link to the April 23, 2009 Important Health Notice and Appendix.

Appendix:  Sample Case Finding/Surveillance Form

For more information:

Lisa McCaskell, Senior Health & Safety Officer 416-443-8888, ext 8772

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