Transcript Management of Influenza in the Perinatal Populationx

Management of Influenza
in the Perinatal Population
New Policy
Pam Sanders, MSN, RNC-NIC, CENP
Vice President, Women & Children’s Services
Purpose:
 To provide guidelines for staff when a pregnant woman
with respiratory symptoms presents to our facility for
labor and delivery.
 This policy is designed to minimize the potential for
infant exposure to influenza viruses when a pregnant
woman with respiratory symptoms that may be due to
the flu, delivers a baby at TGH.
 Infants that become infected with the influenza virus are
at higher risk for severe complications.
Respiratory Symptoms include:
Fever
Cough
Runny nose
Sore throat
body/muscle aches
fatigue
Actions:
 Pregnant women who
present with flu-like
symptoms are:
 Given a surgical
mask
 Put on Droplet
precautions
 Instructed on
respiratory hygiene
& cough etiquette
 Given an Influenza
PCR screen on
admission
(consider starting
antivirals while
results pending)
 Visitors will be
screened for flu-like
symptoms by Security
by completing a
questionnaire.
 Visitors will not be
allowed to visit in the
event of illness.
After Delivery of the infant:
 Separate the baby in the Delivery Room by a
distance of 6 feet or greater.
 Stable infants may remain in the Delivery
Room.
 Unstable infants will transfer to the
appropriate Level of Care.
Postpartum:
 To reduce the risk of exposure to the infant,
the CDC recommends separating the infant
from the mother in a separate room or by a
distance of 6 feet or greater until:
 The ill mother has received anti-viral
medications for greater than 48 hours
 The ill mother is afebrile without the aid of
antipyretics for greater than 24 hours
 The ill mother has control over her cough &
respiratory secretions
Maternal Refusal of Separation:
 If the mother refuses separation or other
circumstances are present that inhibit separation,
the following measures should be implemented to
reduce influenza exposure to the infant by
minimizing contact.
 Utilize physical barriers such as privacy screens and
curtains
 Keep the newborn at least 6 feet away from the
mother
 Ensure a healthy adult support person is present &
available to care for the infant
 Teach the mother and significant other the
importance of respiratory etiquette
 Document all interventions & education.
Breastfeeding:
 Breastfeeding is important.
 Breast milk has antibodies that babies need to fight
infection.
 Encourage & assist the ill mother with expressing her
breast milk.
 Infant feeding of expressed breast milk should be done
by a healthy care giver.
 In the event no other caregiver is present and/or the
mother chooses to put the infant to breast, the mother
should be instructed to:
 Wash her hands
 Put on a clean gown
 Wear a surgical mask
 Follow strict respiratory etiquette
Infant Care:
 Unless clinically indicated by the need for a higher level
of care or the mother’s refusal of separation, newborns
of influenza-infected mother’s will be cared for in the
term newborn nursery.
 Symptomatic mothers & exposed family members are
not allowed to enter the nursery.
 All infants of ill mothers, regardless of separation status,
will be observed for signs & symptoms of influenza.
 Any newborn that develops symptoms will be cared for
in a private room in the NICU on Droplet Precautions.
Respiratory Etiquette:
Frequent hand washing
No touching or rubbing the face
Cover mouth & nose when sneezing
Discard used tissues in the trash
Visitors:
 Visitors should be limited to individuals necessary for the
patient’s emotional well-being & care.
 All unvaccinated family members & care givers who will
be in contact with the infant should be encouraged to
get an influenza vaccination.
 Visitors who have been in contact with the patient during
the symptomatic period ( 1 day before the onset of
symptoms until 7 days after the development of
symptoms) may be contagious & should be encouraged
not to visit.
 Visitors should be instructed to:
 Limit movement throughout the hospital.
 Avoid common areas: Starbucks, McDonald’s the cafeteria
 Use good infection prevention practices: hand hygiene, PPE,
respiratory etiquette
 Limit surfaces touched in the room
Patient Education:
 It is important to teach the mother & significant others the
importance of minimizing risk to the infant through:
 Hand hygiene
 Respiratory etiquette
 Frequently cleaning touched surfaces
 Do not allow contact with ill persons, until they have been without
fever for 24 (hours without medication) or until 7 days after the
onset of symptoms, whichever is longer.
 Encourage vaccination among other caregivers & family members
that will have contact with the baby
 Contact your pediatrician immediately if the infant develops
symptoms that suggest the flu: sneezing, coughing, runny nose,
fever
Recommendations adapted from the CDC Guideline for the Prevention
and Control of Influenza in the Intrapartum and Postpartum Hospital
Settings, March 7, 2011.