Interim Additional Guidance for Infection Control for Care of Patients with Confirmed, Probable, or Suspected Novel Influenza A (H1N1) Virus Infection in Outpatient Hemodialysis Settings

May 8, 2009 3:30 PM ET

These recommendations supplement the Centers for Disease Control and Prevention's Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting. This information is provided to clarify novel influenza A (H1N1) virus infection control recommendations that are specific to outpatient hemodialysis centers. This information complements, but does not replace the general infection control recommendations for novel influenza A (H1N1).

1. Hemodialysis patients meeting criteria for isolation precautions for novel H1N1 influenza (confirmed, probable, or suspected novel H1N1 infection – see guidance on case definition) may be dialyzed in outpatient dialysis centers if they would not normally be referred to a higher level of care based on their symptomatology. Patients should be triaged at or prior to arrival at the facility and symptomatic patients with febrile respiratory illness (defined as fever [greater than 37.8° Celsius] plus one or more of the following: rhinorrhea or nasal congestion; sore throat; cough) should be segregated from other patients as soon as possible.
2. Patients should wear a surgical mask and be placed in a separate room (if available) for dialysis with the door closed. Hepatitis B isolation rooms used to dialyze hepatitis B surface antigen positive patients should not be used for these patients unless: 1) the patient with suspected or confirmed novel H1N1 influenza virus is hepatitis B surface antigen positive or 2) the facility has no hepatitis B surface antigen positive patients who would require treatment in the isolation room.
3. If a separate room is not available, the patient should wear a surgical mask and should be treated at a corner or end-of-row station, away from the main flow of traffic if available. The patient should be separated by at least 6 feet from the nearest patient stations (in all directions). If a facility has more than one patient meeting criteria for novel H1N1 influenza isolation precautions, consideration should be given to cohorting these patients and the staff caring for them together in the unit and/or on the same shift.
4. Contact and Standard Precautions with eye protection (goggles or face shield) should be used by healthcare personnel when coming within 6 feet of patients meeting criteria for novel H1N1 influenza isolation precautions. This includes the use of a N95 respirator, nonsterile gloves and gown. Respirators, gowns and gloves should be removed and discarded and hand hygiene, with soap and water or alcohol based hand sanitizer, performed prior to leaving the dialysis station.
5. As with all hemodialysis patients, all supplies taken to the station should be reserved for that patient alone and either discarded after use or cleaned and disinfected prior to use by another patient (information available at the MMWR report: Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients).
6. Equipment such as chairside computers used for medical charting, should be utilized for that patient alone during the treatment of that patient and appropriately cleaned and disinfected before use for another patient
7. Environmental surfaces should also be cleaned and disinfected in accordance with standard facility protocols after the patient has vacated the station and before setting up the machine and arrival of a new patient into that station
8. Precautions should be kept in place for 7 days after the onset of the patient's symptoms or at least 24 hours after symptoms have resolved, whichever is longer.