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H1N1 Prevention at the Terry Fox Canadian Youth Centre

The pandemic (H1N1) 2009 influenza virus has rapidly spread across the world. While influenza activity would normally be expected to wane during the summer months, the pandemic (H1N1) 2009 influenza virus has not done this, and surveillance data suggest that the spread has continued unabated.

Symptoms

To date, infection with the pandemic (H1N1) 2009 influenza virus has resulted in influenza-like-illness (ILI), similar to seasonal influenza.
• ILI is defined as the acute onset of respiratory symptoms with fever and cough and one or more of the following symptoms: sore throat, muscle/body aches, joint pain or weakness.
• Gastrointestinal symptoms may also be present.
• Fever may not be prominent.
• Other symptoms may include: a runny nose, fatigue and loss of appetite.

Infection Prevention and Control Practices

According to the Public Health Agency of Canada, the most important factors in the control of the spread of the pandemic (H1N1) 2009 influenza virus in postsecondary, boarding schools settings, and the like are:
• Early identification of ill students and staff exhibiting symptoms of influenza-like-illness (ILI).
• Exclusion/isolation from the setting of anyone ill with symptoms of ILI.
• Practising cough/sneeze etiquette and frequent hand cleaning.

Prevention Measures at the Centre

To reduce the spread of the H1N1 influenza virus at the Terry Fox Canadian Youth Centre, routine infection prevention and control (IPAC) strategies are emphasized with both Encounters with Canada (EWC) staff, participants and teacher-monitors. In accordance with the directives of the Public Health Agency of Canada and the Ontario Ministry of Health and Long-Term Care, the following measures have also been implemented.

Environmental Cleaning

Influenza viruses can survive on some surfaces for several hours to days, but are rapidly destroyed by cleaning. Accordingly, at the Centre:
• EWC maintenance staff are doing extra cleaning and disinfecting, ensuring soap and alcohol hand rub dispensers are filled at all times.
• Objects and surfaces that are commonly touched by multiple people ("high-touch") - doorknobs, faucets handles, shared items like musical instruments, computer keyboards, telephones - are cleaned and disinfected daily with special disinfectant to prevent the transmission of viruses from person to person through contaminated hands.
• Waste receptacles are plentiful, distributed around the Centre, and are frequently emptied.

Physical Layout & Supplies

• Alcohol-based hand rub (ABHR) with 60-90% alcohol in locked dispensers and facilities for hand washing (running water, supply of soap in a dispenser, hot-air hand-dryers, waste receptacles) are located at multiple sites throughout the Centre - and, in particular, in the cafeteria and other common areas where participants congregate.
• Participants are distanced from one another while sleeping. They sleep in bunk beds, with physical separations between each set of beds.
• The Centre has a designated health-care centre (an infirmary), where participants, teacher-monitors and staff can be quickly isolated should they become ill.
• The infirmary has necessary supplies on hand, such as surgical masks, gloves, nasal swabs for testing purposes, tissues and disinfectants to ensure routine infection prevention and control (IPAC) practices are followed.
• Extra supplies of special disinfectant, soap, alcohol-based hand rub and so on are readily in stock to facilitate the increased cleaning and disinfecting at the Centre.

Hand Hygiene and Respiratory (Cough) Etiquette

The Public Health Agency of Canada states that hand hygiene and covering coughs and sneezes are the most important means of prevention of transmission of influenza. Further, hand washing with plain soap and water is the preferred method of hand hygiene in schools and public institutions. It recommends that when hand-washing sinks are not available, use of alcohol-based hand rubs is a good alternative. Accordingly, the following actions have been taken at Encounters with Canada.
• EWC staff, teacher-monitors and participants are instructed on how to correctly perform hand hygiene - wash their hands often for at least 15 seconds with soap and water, or clean their hands with alcohol-based hand rub - before meals, after sneezing or coughing or nose-blowing, before and after preparing food, after recreational activities, after going to the washroom, after riding on public transit, after using shared items, before and after visiting people who are sick, after handling animals or their waste, and so on.
• EWC staff and teacher-monitors continually model correct hand hygiene practices and frequently remind participants to consistently use good hand hygiene practices.
• EWC staff and teacher-monitors regularly check participants' use of alcohol-based hand rub to ensure it is appropriately used.
• EWC staff, teacher-monitors and participants are encouraged to sneeze and cough into a tissue, or to use their forearm/shoulders - NOT their hands. (This minimizes the potential to pass droplet contaminants from person-to-person more effectively than covering sneezes with hands.)
• EWC staff, teacher-monitors and participants are encouraged to avoid sharing food, drinks and other personal items.

Monitoring

• Infectious disease specialist, Dr. Permjit Suri, MD, FRCP(c), is on retainer for the Centre and Connie Brock, RPN (Registered Practical Nurse), from the Community Nursing Registry of Ottawa, is on-site daily.
• EWC employees have the opportunity to get both regular flu and H1N1 shots, free of the charge.
• Should a participant, teacher-monitor or staff member show any signs of influenza-like-illness (ILI), a nasal swab will be administered by the nurse and taken to Dr. Suri's office immediately for processing. Results will be available within 24 to 48 hours.
• Other precautions include placing basic information on how to recognize symptoms of ILI online for parents, and EWC participants, teacher-monitors and staff.
• EWC participants, teacher-monitors and staff are encouraged to monitor their health daily for symptoms of ILI.
• EWC staff and teacher-monitors observe participants for any signs of ILI.
• Participants are encouraged to immediately notify EWC staff, teacher-monitors or the on-staff nurse for assessment if they feel unwell.
• EWC staff and teacher-monitors are asked not to come to work while ill.
• Contact information for parents is readily available should a participant become unwell.
• EWC participants and staff are provided with personal dispensers of hand sanitizer while at the Centre.

Education

• Posters on H1N1 precautions are posted around the Centre, as well as ones on how to wash one's hands correctly.
• This document and other health and safety information is posted online for reference by EWC participants, their parents and teacher-monitors.
• EWC's on-site nurse trains the staff who, in turn, instruct the teacher-monitors on how to monitor participants for flu-like symptoms.
• Each week, EWC staff instruct participants and teacher-monitors on good hygiene practices, which include hand hygiene, coughing/sneezing etiquette and not sharing personal items or eating utensils.
• EWC's nurse also provides current information and updates with respect to flu symptoms and specific responsibilities for staff who are directly involved with the day-to-day activities of participants related to reducing spread of infection, such as encouraging hand washing.

Travel Considerations

• Participants who are ill should not travel to the Centre. They are encouraged to visit a physician and get a doctor's note to validate a week change.
• Should parents cancel the participation of their child after 12 p.m. EST on the Thursday prior to the selected week at Encounters and/or just not show up, the entire registration fee of $625 will be forfeited unless a written doctor's note is provided to Encounters with Canada management.
• The Centre has a plan in place in case participants are too ill to return home.

Outbreak Recommendations

To ensure appropriate measures are implemented to mitigate the impact and spread of the illness to EWC staff, teacher-monitors and participants, EWC has developed a strategy to recognize an outbreak of pandemic (H1N1) 2009 influenza virus and/or other triggers that warrant consultation with local public health officials.

Adapted from:
Guidelines for the Prevention and Management of Pandemic (H1N1) 2009 in Elementary and Secondary Schools, Ministry of Health and Long-Term Care, Government of Ontario, issued August 28, 2009 at: http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro/docs/school_guidelines_20090828.pdf

H1N1 Influenza & Schools, Ministry of Health and Long-Term Care, Government of Ontario, September 2009, at: http://www.health.gov.on.ca/en/ccom/flu/h1n1/public/docs/factsheets/schools/h1n1_fs_schools_en.pdf

Public Health Guidance for Post Secondary and Boarding Schools regarding the Prevention and Management of Influenza-like-illness (ILI), Including the Pandemic (H1N1) 2009 influenza Virus, Public Health Agency of Canada, August 19, 2009, at: http://www.phac-aspc.gc.ca/alert-alerte/h1n1/hp-ps/psili-eng.php

Guidelines for the Prevention and Management of Novel H1N1 Influenza Virus in Summer Camps, Ministry of Health and Long-Term Care, Government of Ontario, issued July 30, 2009 at: http://www.health.gov.on.ca/english/providers/program/emu/health_notices/summer_camps/sc_guidelines_20090730.pdf

FightFlu.ca: www.fightflu.ca