ŠĻą”±į>ž’ FHž’’’E’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ģ„ĮM šæ¹#bjbjā=ā= )F€W€W¹’’’’’’lžžžžžžž²xxxxŒl²×LVXXXXXX$# C!Ŗ|ž|fžž‘fffFžžVfVfäfJžžJų š:ŖgŪɲĘxJvJJ §0×Jķ!Ą¦ķ!Jf²²žžžžŁPUBLIC HEALTH MEASURES General Public health measures are non-medical activities that may be used to reduce the spread of the influenza virus. These include individual public health measures and community public health measures. The type of public health measures used will depend on the characteristics of the new influenza virus. Measures directed toward community disease control have not been well studied or reported in scientific literature. However, there is broad agreement that when cases infected with a new virus first appear, aggressive measures will be valuable in delaying the impact or possibly containing an evolving pandemic.Infection Control - NOWWHATHOWWHOWHEREWHENAnnual Influenza Vaccination - Encourage all staff to get the annual flu vaccination. While this will not protect from the pandemic new virus strain, it will prevent other forms of influenza in 70% of the healthy population.Hand Washing – Encourage frequent hand washing with soap and water or hand sanitizers very effective in limiting the spread of infection. Effective handwashing involves wetting hands, applying liquid soap, scrubbing for 20 seconds, rinsing and drying with a paper towel. Effective use of sanitizers involves applying enough sanitizer for hands to stay wet for 15 seconds, spreading sanitizer over all surfaces of hands and rubbing hands together until dry. Sneeze/Cough Etiquette - Encourage Cough & sneeze etiquette Covering the mouth and nose while sneezing and coughing will help limit the spread of infection. Cover your mouth and nose with a tissue or cough/sneeze into your upper sleeve. Dispose of used tissue and wash your hands after coughing or sneezingStay at home if ill – Encourage employees to stay at home when ill It will help limit the spread of infection.Environmental Cleaning - Because the virus can survive on environmental surfaces (up to 48 hours on hard surfaces)Encourage frequent cleaning at workstations It can reduce the spread of the virus in the workplace. Cleaning should take place using common household disinfectants. . . Community Based Public Health Measures During a Pandemic During an influenza pandemic, infection control measures outlined above should be reinforced at all levels. Additional public health measures for community based disease control will be considered. The trigger for these measures will depend on the way in which the pandemic unfolds. Decisions on implementing these measures will be made by the World Health Organization, the Center for Disease Control (CDC) and the Massachusetts Department of Public Health. However, directions may also be forth coming from the State and local governments to ensure consistency. Some measures have been assessed as being effective as a community based strategy. However, all community based public health measures will be assessed and these include: Self Isolation - Individuals who are ill will be asked to stay home from public locations. Adults recommended for self isolation should remain home for a minimum of 5 days after onset of symptoms (7 days for young children) or until symptoms have resolved, unless they need to visit a health care provider. During this period people should avoid close contact with unexposed household members. A close contact is defined as face to face exposure within 3 feet of another individual. Frequent disinfection of household surfaces should be practiced. Quarantine - At the very early stages of a pandemic, contacts and individuals linked to exposure sites may be promptly identified and if this is the case, these individuals may be quarantined in an effort to slow transmission in the community. This measure would only be applied if there were sporadic infections or clusters in the Region and not if there was efficient virus spread in the general population. School/Daycare Closure - Children are known to be efficient transmitters of influenza. Closing schools and daycare facilities may reduce transmission or delay the spread of the disease, particularly if the pandemic was causing high attack rates in school aged children. This control measure will have an effect on the parents and caregivers and could divert essential workers to child-care responsibilities. School boards or daycare administrators may choose to independently close their facilities based on their own criteria for safe facility operation. Restriction of Large Gatherings - This would involve closing of indoor gathering places for people. Gatherings may include sporting events, theater, conferences as well as mass public transportation services. Because the effectiveness of this measure is not documented and the difficulty with sustainability of canceling or restricting indoor gatherings, this measure is not recommended in the United States pandemic plan as a broad public health measure. However, this measure remains an option for targeted events to reduce transmission. Social Distancing - Once a pandemic has arrived in a community, people should use “social distancing” as a way to reduce the risk of being exposed. The Health Department will provide advice. Some strategies for social distancing include: - Avoid close contact with individuals (i.e. within 3 feet). - Minimize visitors to homes. - Cancel family gatherings. - Avoid shaking hands, hugging, or kissing people as greetings. - Stock up on groceries and shop less frequently. - Work from home. - Minimize contact at work by teleconferencing. - Utilize means other than public transit. Use of Masks By Well Individuals - This measure is not recommended in the United States pandemic plan as a community based intervention. It is assessed that it is not likely to be effective in reducing disease spread in the general population. It is recognized that wearing a surgical mask properly at the time of an exposure may provide a barrier, if used with other infection control measures. If masks are used, they should only be used once and must be changed if wet (because they become ineffective when wet). Masks must be removed properly to avoid contaminating the wearer. It is not feasible to wear masks for the duration of a pandemic wave and there may be supply problems. Further advice will be provided by the localHealth Department. Hand Sanitizing Stations in Public Settings - Frequent handwashing is an effective infection control measure. However, the United States pandemic plan does not recommend establishing sanitizing stations in public settings such as public transit stations. It is assessed that this would not be effective in significantly reducing the spread of the disease in the general population. Compliance would not be assured and these stations would require human and financial resources to maintain. Handwashing must be encouraged and existing public washrooms should be appropriately stocked with supplies at all times. Increased Frequency of Cleaning Surfaces in Public Settings - The frequency of hand contact with various public surfaces would require constant cleaning to have any effect on reducing the virus on these surfaces. Realistically this measure cannot be implemented. However, individuals can reduce their risk of exposure to infectious droplets by more frequent cleaning of their own environments and limiting hand contact with public surfaces (e.g. elevator buttons, public telephones). These strategies will be included in public education messages. Screening at Critical Infrastructure Locations - passive screening of staff by use of a questionnaire at the entrances to critical infrastructure locations (e.g. a water treatment plant) may assist in limiting the spread of infection. If deemed appropriate, the Health Department will provide advice on the implementation of screening including questions to be asked. 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