H1N1 Flu - Swine Flu Information for California Dental Practices

The Centers for Disease Control has updated its recommendations for preventing transmission of H1N1 virus in dental practices. These recommendations are provided below.

Be aware of outbreaks of illnesses in your community by checking the news or visiting the Web site of your county public health departments. For statewide data and information, refer to the California Department of Public Health which updates its information weekly.

Prevention of 2009 H1N1 Influenza Transmission in the Dental Health Care Settings – November 23, 2009
Source: http://www.cdc.gov/OralHealth/infectioncontrol/factsheets/2009_h1n1.htm

Transmission of 2009 H1N1 Influenza

Exposure to 2009 H1N1 influenza virus occurs in household, community, and occupational settings, and transmission is thought to occur through droplet exposure of mucosal surfaces; through indirect contact, usually via the hands, with respiratory secretions from an infectious patient or contaminated surface; and through inhalation of small particle aerosols in the vicinity of the infectious individual.

Symptoms of Influenza

Persons with influenza, including 2009 H1N1 influenza, may have some or all of these symptoms:

fever*
cough
sore throat
runny or stuffy nose
body aches
headache
chills
fatigue
sometimes diarrhea and vomiting

*It's important to note that not everyone with influenza will have a fever.

Control of 2009 H1N1 Influenza

A hierarchy of control measures should be applied to prevent transmission of 2009 H1N1 influenza in all health care settings. To apply the hierarchy of controls, facilities should take the following steps, ranked according to their likely effectiveness:

Elimination of potential exposures (e.g., deferral of ill patients and source control by masking coughing individuals).
Engineering controls that reduce or eliminate exposure at the source without placing primary responsibility of implementation on individual employees.
Administrative controls including sick-leave policies and vaccination that depend on consistent implementation by management and employees.
Personal protective equipment (PPE) for exposures that cannot otherwise be eliminated or controlled. PPE includes gloves, surgical facemasks, respirators, protective eyewear, and protective clothing (e.g., gowns).

Vaccination, an administrative control, is one of the most important interventions for preventing transmission of influenza to health care personnel. For more information on this hierarchy of controls, see CDC's Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel.

Specific Recommendations for Dental Health Care

Encourage all dental health care personnel to receive seasonal influenza and 2009 H1N1 influenza vaccinations.

Use patient-reminder calls to identify patients reporting influenza-like illness and reschedule non-urgent visits until 24 hours after the patient is free of fever, without the use of fever-reducing medicine.

Identify patients with influenza-like illness at check-in; offer a facemask or tissues to symptomatic patients; follow respiratory hygiene/cough etiquette; and reschedule non-urgent care. Separate ill patients from others whenever possible if evaluating for urgent care.

Urgent dental treatment can be performed without the use of an airborne infection isolation (AII) room because transmission of 2009 H1N1 influenza is thought not to occur over longer distances through the air, such as from one patient room to another.

Use a treatment room with a closed door, if available. If not, use one that is farthest from other patients and personnel.

Wear recommended PPE before entering the treatment room.

Dental health care personnel should wear a NIOSH fit-tested, disposable N95 respirator when entering the patient room and when performing dental procedures on patients with suspected or confirmed 2009 H1N1 influenza.

If N95 respirators and/or fit-testing is not available despite reasonable attempts to obtain, the dental office should transition to a prioritized use mode (i.e., non-fit-tested disposable N95 respirators or surgical facemasks can be considered as a lower level of protection for personnel at lower risk of exposure or lower risk of complication from influenza until fit-tested N95 respirators are available). Detailed information can be found in CDC's Interim Guidance on Infection Control Measures for H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel. Additional guidance, including recommendations regarding fit-testing issues, can be found on Questions and Answers Regarding Respiratory Protection for Infection Control Measures for 2009 H1N1 Influenza Among Healthcare Personnel.

As customary, minimize spray and spatter (e.g., use a dental dam and high-volume evacuator).

Dental Health Care Personnel

Dental health care personnel should self-assess daily for symptoms of febrile respiratory illness (fever plus one or more of the following: nasal congestion/runny nose, sore throat, or cough).

Personnel who develop fever and respiratory symptoms should promptly notify their supervisor and should not report to work.

Personnel should remain at home until at least 24 hours after they are free of fever (100°F/37.8°C), or signs of a fever, without the use of fever-reducing medications.

Personnel having a family member who is diagnosed with 2009 H1N1 influenza can still go to work but should monitor themselves for symptoms so that any illness is recognized promptly.

Additional Resources

For comprehensive information on CDC 2009 H1N1 influenza infection control guidelines, visit Infection Control and Clinician Guidance on H1N1 Flu Clinical and Public Health Guidance: