WHO Guidelines

1 Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care WHO Guidelines PANDEMIC AND. EPIDEMIC DISEASES. WHO Library Cataloguing-in-Publication Data Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. Health Organization. ISBN 978 92 4 150713 4. Subject headings are available from WHO institutional repository World Health Organization 2014. All rights reserved. Publications of the World Health Organization are available on the WHO web site ( ) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857;. e-mail: Requests for permission to reproduce or translate WHO publications whether for sale or for non- commercial distribution should be addressed to WHO Press through the WHO website ( ).)

2 The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

3 All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections ii Contents Contents Foreword .. ix xi Abbreviations and acronyms .. xiii Glossary .. xiv Executive summary .. 1. 1 Introduction and scope of the Guidelines .. 5. Acute respiratory infections in health care .. 5. Scope of the current Guidelines .

4 5. ARIs that may constitute a public health emergency of international concern covered in the current document .. 6. Severe acute respiratory 6. New influenza virus causing human infection .. 6. Novel acute respiratory infections with potential for a high public health impact .. 7. Infection prevention and control guiding principles .. 8. Early recognition and source 8. Administrative controls .. 8. Environmental and engineering controls .. 8. Personal protective equipment .. 9. Guideline development process .. 9. 2 Infection prevention and control recommendations .. 11. Recommendations for early recognition and source control .. 11. Recommendations for health-care facilities and public health authorities .. 11. Recommendations for administrative control strategies for health- care facilities.

5 16. Isolation precautions .. 17. Cohorting and special measures .. 18. Transport of patients inside and outside health-care facilities .. 18. Duration of infection prevention and control precautions and patient discharge .. 20. Family member and 21. Specimen collection, transport and handling within health- care facilities .. 22. Health-care worker vaccination and occupational health .. 22. Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections iii Recommendations for engineering and environmental control for acute respiratory infection .. 24. Placement of patients and spatial separation .. 24. Design of triage and waiting areas .. 24. Environmental controls for aerosol-generating procedures .. 25. Corridors.

6 25. Ultraviolet germicidal irradiation in health-care 25. Recommendations for use of personal protective equipment .. 25. Rational use of personal protective equipment .. 26. Recommendations for care of the 27. Removal of the body from the isolation room or area .. 27. Mortuary care .. 27. Postmortem examination .. 28. Engineering and environmental controls for autopsy .. 28. 3 Health-care facility preparedness planning for acute respiratory infection epidemics .. 31. Components of health-care facility pandemic acute respiratory infection preparedness plans .. 31. Access .. 33. 4 Research gaps .. 35. Aerosol-generating procedures .. 35. Epidemiology of 35. Duration of IPC precautions .. 35. Cohorting and special measures .. 35. Other interventions.

7 36. Annex A Respiratory 37. High-risk aerosol-generating procedures .. 37. Selection of respiratory protection equipment .. 37. Annex B Isolation precautions .. 43. Standard 43. Hand hygiene .. 44. Selection of personal protective equipment based on risk 44. Respiratory hygiene .. 45. Environmental controls cleaning and disinfection .. 45. Waste management .. 47. Packing and transporting patient-care equipment, linen and laundry, and waste from isolation areas .. 48. Prevention of needle-stick or sharps injuries .. 48. iv Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections Contents Droplet Precautions .. 48. Contact Precautions .. 49. Airborne Precautions .. 50. Infection prevention and control precautions for airborne diseases.

8 50. Infection prevention and control precautions for diseases that may be opportunistically transmitted through droplet 51. Annex C Sample checklist assessment of environmental conditions for home care of patients with ARIs of potential concern .. 53. Annex D Sample health-care worker influenza-like illness monitoring form for workers exposed to patients with ARIs of potential 55. Annex E Isolation rooms or areas .. 57. Preparation of the isolation room or area .. 57. Wearing and removing personal protective equipment .. 57. Leaving the isolation room or area .. 58. Checklist for isolation room or area trolley or table .. 61. Annex F Mortuary care and postmortem examination .. 63. Packing and transport of a dead body to a mortuary, crematorium or burial.

9 63. Personal protective equipment for handling dead bodies .. 63. Personal protective equipment during autopsy .. 63. Suggested methods to reduce aerosol generation during autopsy .. 64. Annex G Use of disinfectants: alcohol and bleach .. 65. Alcohol .. 65. 65. Annex H Surge capacity: personal protective equipment needs of health- care facilities during epidemics or pandemics .. 67. Annex I Cleaning and disinfection of respiratory equipment .. 71. Steps for cleaning and disinfection of plastic pieces of respiratory 71. Cleaning and disinfection of mechanical ventilators .. 72. Annex J Infection prevention and control across the continuum of health care .. 75. Emergency and outpatient care .. 75. Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections v Paediatric acute care.

10 76. Home care for acute respiratory infection patients .. 76. Annex K Strength of infection prevention and control recommendations based on GRADE .. 79. Annex L Summaries of relevant systematic reviews of the literature .. 91. Summary of Aerosol-generating procedures and risk of transmission of acute respiratory diseases: A systematic review .. 91. Summary of Physical interventions to interrupt or reduce the spread of respiratory viruses .. 96. Summary of Physical interventions to interrupt or reduce the transmission of respiratory viruses resource use implications: A. systematic review .. 102. Summary of The effectiveness of vaccination of healthcare workers for the protection of patients at higher risk of acute respiratory disease: A systematic review.