Notice: Interim recommendations for infection prevention and control of avian influenza in healthcare settings

On this page

• Preamble
• Background
• Interim recommendations for infection prevention and control of avian influenza in healthcare settings
• References

Preamble

Outbreaks of avian influenza, such as A(H5N1), in domestic and wild birds and some mammals, have become widespread globally. There has also been evidence of sporadic transmission of avian influenza to humans. Transmission of avian influenza from human to human is extremely rare and there has not been evidence of sustained transmission. Although the risk of avian influenza infection remains low in humans in Canada, the potential risk of human cases may be higher in those individuals with occupational or recreational exposures to infected animals or contaminated environments. Given the pandemic potential of avian influenza, infection prevention and control (IPC) recommendations for avian influenza in the Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings (RPAP) guideline have been updated.

Background

Avian influenza is a viral infection that mainly causes disease and mortality in birds but can sometimes infect humans and other mammals. There are many types of avian influenza, which are all caused by various subtypes of type A influenza virus (e.g., H5N1, H7N3, H9N2).

Avian influenza viruses can be broadly classified into two types, based on the severity of illness caused in birds:

• low pathogenic avian influenza (LPAI), which causes little or no signs of illness in infected birds, and
• highly pathogenic avian influenza (HPAI), which can cause severe illness and death in birds

It is important to note that there is no correlation between the pathogenicity of avian influenza viruses in birds and the infectious and pathogenic potential in humans and other mammals. Both HPAI and LPAI viruses have caused mild to severe illness and death in humans and non-human mammals, and precautions are therefore warranted regardless of pathogenicity in birds.

Avian influenza infections in humans are rare events and the likelihood of human infection with avian influenza virus is low. Transmission of the virus from animal to human occurs via inhalation or contact with mucus membranes. Exposure may occur through various sources including secretions (mucus, saliva), unpasteurized (raw) milk, blood, feathers, and feces of infected animals or contaminated environments such as animal farms or live animal markets. The primary risk factor for human infection appears to be exposure to infected live or dead animals or contaminated environments. There has been no evidence of sustained transmission between humans.

Since late 2021, Canada has been responding to cases of avian influenza A(H5N1) in poultry and wild birds and other wildlife across the country. Avian influenza A(H5N1) is widespread in wild birds globally and has caused outbreaks in poultry in many countries and outbreaks in dairy cattle across the United States. There has been evidence of transmission from mammal to mammal between cattle, however the exact mode of transmission is still being investigated. Avian influenza A(H5N1) virus has also been detected in unpasteurized (raw) milk and raw or undercooked meat from infected dairy cattle in the United States.^{Footnote 1} There have been documented human cases of A(H5N1) reported globally, including in the United States, which were all following exposure to dairy cows or poultry.^{Footnote 2} Recent human cases of other subtypes of avian influenza [A(H5N6), A(H5N2), A(H9N2)] have also been identified globally.^{Footnote 3}

The purpose of this document is to provide updated guidance on IPC measures in healthcare settings in the event that a person under investigation, with probable or confirmed avian influenza is identified within a Canadian healthcare facility.

These recommendations were developed with technical expertise from the National Advisory Committee on Infection Prevention and Control (NAC-IPC) and by adopting a precautionary approach.^{Footnote 4Footnote 5} This guidance will be updated as new information becomes available.

The target audiences for this document are IPC professionals, Occupational Health and Safety professionals, healthcare organizations, and healthcare providers responsible for educating healthcare workers (HCWs) on IPC.

For the purposes of this guidance, the term "patient" will be used to include those receiving healthcare who are traditionally and routinely referred to as patients, clients, or residents.

Recommendations for non-healthcare settings are beyond the scope of this document. For public health guidance for these settings, refer to Guidance on human health issues related to avian influenza in Canada (HHAI). For non-subtype or strain-specific guidance for case and contact management of avian influenza, which includes recommendations for public health measures in community settings, refer to Public health management of human cases of avian influenza and associated human contacts.

Interim recommendations for avian influenza infection prevention and control in healthcare settings

• In addition to routine practices, patients under investigation and patients with probable or confirmed avian influenza should be placed on airborne, droplet, and contact precautions.
• If a case of avian influenza is suspected, immediately notify local public health authorities.
• A patient under investigation or with probable or confirmed avian influenza should preferably be placed in an airborne infection isolation room (AIIR).
• If an AIIR is not available:
  • the patient may be placed in a single, enclosed room with a dedicated toilet and hand hygiene facilities designated for their use
  • the door should be kept closed
  • portable HEPA filters may be considered by IPC and facilities personnel to supplement existing ventilation strategies, especially in areas where ventilation does not meet Canadian Standards Association (CSA) standards
• Cohorting of patients with known exposures to avian influenza is not recommended. If required, it should only be considered in consultation with the local IPC and public health teams.
• Recommended personal protective equipment (PPE) when caring for patients under investigation, with probable or confirmed avian influenza includes:
  • a fit-tested N95 (or an equivalent or higher protection) respirator
  • eye protection (i.e., goggles or face shield)
  • gown
  • gloves
• A medical mask (if tolerated) should be worn by the patient when outside their room or care area and the patient should perform hand hygiene prior to masking and after touching or removing a mask.
• A medical mask worn by the patient (if tolerated) may be considered while HCWs are providing patient-facing care.

The duration and discontinuation of additional precautions for an individual patient should be determined in consultation with the IPC program and in accordance with local, provincial or territorial public health guidance and organizational policies. All other guidance as per RPAP remains unchanged.

Related links

• Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings
• Hand Hygiene Practices in Healthcare Settings