These following guidelines listed for H1N1 Flu (Swine Flu) have been sanctioned by the Ministry Of Health in Barbados for use in various settings.

LISTED:

• General Hygiene Pre-Caution measures (Messages for Posters & Public announcements)
• Guidelines for Mass Gathering Events (Show Promoters & Persons attending Shows)
• Guidelines for Child Care (Parents & Care Providers)
• H1N1 Home Isolation Guidelines (Home Care)

Please share this information with friends, family, employers, employees, schools, community groups, sports organizations and visitors to the island.

Note:
These guidelines can also be accessed by visiting the following:

• Barbados Integrated Government Portal www.gov.bb
• Barbados Government Information Service website (GIS) www.gisbarbados.gov.bb

For more Global information

• Centre for Disease Control and Prevention (CDC) http://www.cdc.gov/h1n1flu/
• World Health Organization (WHO) http://www.who.int/csr/disease/swineflu/en/index.html   
  

CONTACT:
Ministry of Health - Health Promotion Officers
Jemmotts Lane
St. Michael
BARBADOS
Phone: (246) 426-6941

Ministry Of Health - HOTLINE
436 2444 / 436 2437

General Hygiene Measures

TO REDUCE SPREAD OF INFLUENZA - PRACTISE THESE GENERAL HYGIENE MEASURES

• Cover your mouth and nose with a disposable tissue when coughing or sneezing, and place the used tissue in a trash bin.

• Wash your hands often with soap and water, especially after coughing or sneezing. An alcohol based hand sanitizer gel can also be used.

• Avoid touching your eyes, nose and mouth, as the virus can enter your body this way

• If you are attending a public event and develop fever with cough or sore throat you should return home immediately.

• Seek medical advice if your symptoms become severe.

Respiratory Etiquette:

• Cover your nose and mouth with a tissue when you cough or sneeze.
• Throw the tissue in the bin after use.
• Wash your hands with soap and water

Hand Hygiene:

• Wash your hands often especially after coughing or sneezing with soap and water for at least 20 seconds.
• Alcohol-based hand sanitizers can also be used to clean hands.
• Avoid touching your eyes, nose or mouth.

Social Distancing

• Avoid close contact with persons who have flu like symptoms (fever, cough, sore throat etc).
• Keep at least six feet away from them.
• Limit personal contact like shaking hands, hugging and kissing at this time as these increases the risk of spreading bacteria and viruses from person to person.
• Do not spit on the ground.

A MESSAGE FROM THE MINISTRY OF HEALTH

Guidelines for Mass Gatherings during an Influenza Pandemic

A Mass Gathering refers to an assembly or grouping of people in one place either indoors or outdoors.

The following guidelines are issued for persons organizing or attending mass gatherings, to promote the safety and welfare of all persons, and reduce the spread of Influenza A/H1N1:

Patrons of Mass or Social Gatherings
In general persons who do not have flu like symptoms may freely participate in social and mass gatherings.  However those without symptoms but who have been in close contact with a confirmed case of Influenza A H1N1, should refrain from taking part in mass gatherings for a minimum of 7 days after exposure.

Persons with flu like symptoms which include fever plus cough or sore throat, should stay home from work, public places and mass gatherings for seven days after symptoms start, or until 24 hours after symptoms clear, whichever is longer, and seek medical advice

Persons, who are experiencing fever and other flu symptoms while at a mass gathering, should immediately return home

Seek medical attention if you experience worsening symptoms:

Emergency warning signs for adults:

•Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness and confusion
• Severe or persistent vomiting

Emergency warning signs for children:

• Fast breathing or trouble breathing
• Not drinking enough water or other fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Vomiting and diarrhea

The public is reminded that personal hygiene measures are the main strategies for preventing spread of Influenza A H1N1. Flu Prevention practices includes:

Respiratory Etiquette:

• Cover your nose and mouth with a tissue when you cough or sneeze.
• Throw the tissue in the bin after use.
• Wash your hands with soap and water

Hand Hygiene:

• Wash your hands often especially after coughing or sneezing with soap and water for at least 20 seconds.
• Alcohol-based hand sanitizers can also be used to clean hands.
• Avoid touching your eyes, nose or mouth.

 Social Distancing

• Avoid close contact with persons who have flu like symptoms (fever, cough, sore throat etc).
• Keep at least six feet away from them.
• Limit personal contact like shaking hands, hugging and kissing at this time as these increase the risk of spreading bacteria and viruses from person to person.
• Do not spit on the ground.

Organizers or hosts of Mass or Social Gatherings

Event organizers should communicate that attendees should remain home if they are ill and provide information and a supportive environment for good hygiene practices while at the event or gathering.

Other measures can be used by the event organizer depending on the type and setting of the event including:

• Ensure proper hand washing facilities (including water, soap, paper towels, bins (preferably pedal bins)), are available for patrons/persons attending the gathering. Make hand washing facilities/ stations available if the event is being held in an outdoor setting.

• Provide health education material on flu prevention and hand hygiene at points of entrance/exit, and place posters and or audiovisual displays in vantage positions and prominent areas to facilitate patron awareness.

• Make verbal announcements at the gathering regarding preventive measures for the reduction of spread of influenza

Ministry of Health – Barbados
July 2009 Update

Guidelines for Parents and Care Providers (Camps/Day Care/Home Care) 

CARE OF THE CHILD WITH INFLUENZA

General Symptoms include fever with cough or, sore throat.
Additional Signs in infants may include unusual fretfulness and crying, loss of appetite, loss of interest in play, reduced levels of activity and sleeping more than usual

Influenza is an illness that is caused by a virus much like the common cold. It can affect persons of any age and is spread by contact with secretions from the nose or mouth of the infected person.

Young children may be especially prone to infection as they often place their hands and other objects into their mouths.

Remember very young children and those with underlying chronic health conditions such as asthma, disorders of the immune system or developmental disorders may be at increased risk of severe illness, so you should seek prompt medical attention if they develop symptoms.

Parents of Children with Symptoms of Influenza Should Seek the Advice of their Health Care Provider. It is also important to note the following:

Keep the child with symptoms of influenza at home and away from school or day care until cleared for reentry by your health care provider. Notify the principal or head of the day care facility of the child’s condition.

• Have an alternative plan for care of your ill child.
• If possible, have the child sleep in a separate room away from others.
• Disinfect toys and frequently touched surfaces.
• Teach your child to wash his/hers hands frequently with soap and water.
• Give medication as prescribed by health care provider or use over the counter medicines (for older children) to relieve symptoms.
• If your child’s condition worsens seek prompt medical attention.

TIPS FOR HOME CARE OF CHILDREN WITH INFLUENZA

Persons who are at increased risk of severe illness from influenza should avoid close contact with the ill child. This includes women who are pregnant, persons with underlying chronic diseases, and those with conditions that may result in a weakened immune system.

Avoid Spreading the Influenza to Others

Four key measures for containing the disease are social distancing (keeping ill household members from those that are well), respiratory etiquette, hand-hygiene and ventilation
.

• Social Distancing

• Contact with the ill child should be limited to one or two persons (primary care givers) as much as possible.  Try not to entertain visitors in your home during periods when family members are ill.

• Respiratory Etiquette

• Teach your child to cover his/her mouth and nose with a tissue when he/she cough or sneeze.  If the child is too young to comply you may place a surgical mask on your face when you are in close contact with the child. (Note that your mask should be changed after four hours of use, or sooner if it becomes wet or soiled).
• Throw used tissues and masks in a covered garbage can with a plastic liner or place them in a plastic bag.  Bags should be tied before being put out for collection.

• Hand Hygiene

• Wash your hands with soap and water for 20 seconds before rinsing.
• Or use alcohol based gels; these should be rubbed on hand and allowed to air dry

• Ventilation

• Create good airflows through the house by opening your windows and doors. This helps to get rid of germs

If You Are the Caregiver

When you are holding small children who are sick, place their chin on your shoulder so that they will not cough in your face.
For the older child, have the child wear a surgical mask when you are in close contact with him or her.  Place a surgical mask on your own face if the child is too young to wear one.
Clean your hands with soap and water or use an alcohol-based hand rub after you touch the sick child or handle used tissues, or laundry

Get Medical Care Right Away if the sick Child:

• Has difficulty breathing or chest pain
• Has purple or blue discoloration of the lips
• Is vomiting and unable to keep liquids down
• Has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry
• Has seizures (for example, uncontrolled convulsions)
• Is less responsive than normal or becomes confused

GUIDELINES FOR THE DAY CARE SETTING OR HOME

Avoid exposing other children to a sick child.  Try to avoid activities as sharing toys, eating utensils, and linens during the period of illness.  Cleaning of the environment should include washing shared surfaces and clothes, bed linen and other items that have been in contact with the sick child’s respiratory secretions or stools.

Water and soap should be used for washing, and afterwards hands should be washed thoroughly with soap and water.

Caring for the Sick Child in the Day Care Setting
Issue reminders informing parents those children with influenza should not be brought to Day Care.  Observe child’s condition on entry to your facility.
Notify parent/guardian promptly if a child shows flu like symptoms during the course of the day but remember it is your duty to ensure continued care of the child until collected.
Separate the sick child from other children by keeping them at least six feet away
Wash your hands after caring for the sick child.

• Pay close attention to the condition of the sick child and seek immediate medical attention if the child’s condition warrants it.
• Wear a surgical mask when you are in close contact with the sick child.
• When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face.

General Health Tips

• Teach children to cover their coughs and sneezes with tissues and to wash their hands, staff should also model these behaviors.
• Observe children carefully and notify parent(s) if you detect signs of illness
• Sanitize/disinfect toys and common use   surfaces regularly

Remember! Get Medical Care Right Away if the sick Child:

• Has difficulty breathing or chest pain
• Has purple or blue discoloration of the lips
• Is vomiting and unable to keep liquids down
• Has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry
• Has seizures (for example, uncontrolled convulsions)
• Is less responsive than normal or becomes confused

Disinfect your Institution or Home at Least Once Daily 

Non absorbent surfaces should be disinfected with a solution that is made up by mixing 3/4 cup of chlorine bleach to one gallon of water. (1:10 chlorine bleach solution).

The solution must be mixed with cold tap water and kept at room temperature. A fresh batch must be made up every day. The bleach used must be of 5.25% to 6% strength.

You should check the manufacturer’s label for information on product strength. To prevent potentially dangerous chemical reactions no other cleaning agents should be added to the solution.

FLOORS AND FLOOR COVERINGS
Do not hang up and swat mats to clean as this will create aerosols.
The bucket used for mopping should have a wringer attached.
Mops should not be hand wrung as this may create aerosols

BEDDING
Cots, mattresses and pillows should be fitted with plastic covers and should be wiped over as for surface cleaning.
Use containers with close fitting lids or tied plastic bags to transport waste from the room of a sick child.

To Disinfect Surfaces or Items     

• Remove all organic materials such as secretions (any bodily fluid), mucus, vomitus and faeces and wash as normal.
• Disinfect by wiping with a cloth or mop that has been saturated with the 1:10 chlorine bleach solution. Small items may be immersed in the solution.
• Leave for at least 10 minutes then rinse or wipe dry as appropriate

Areas and Items that Require Frequent Disinfection Include:

• Door knobs/window handles/buttons/switches
• Surfaces (e.g. tables, telephones, computer keyboards)
• Children’s toys
• Floors and Walls
• Eating utensils
• Water taps/shower heads, bathtubs and washbasins
• Toilet - handles, seat and cover
• Dustbins

Adapted from WHO (Reducing excess mortality from common illnesses during an influenza pandemic) and CDC (Interim guidance for H1N1 flu (swine flu) taking care of your sick person at home)

Ministry of Health – Barbados
June 2009 Update

INSTRUCTIONS FOR SUMMER CAMPS

Camp Directors Should Consider the Following Suggestions for Coping with Pandemic Influenza:

• Ensure that you and your staff are familiar with the Ministry of Health’s Pandemic Influenza Guidelines for Child Care Providers

• Remind parents and guardians of the need to check their children daily for signs of illness.  If children are showing flu like symptoms that include fever with sore throat or cough they must be kept at home. 

• Staff should also observe children for flu like symptoms.

• Ensure that facilities are in place to adequately accommodate hand washing(including water, soap, paper towels, bins (preferably pedal bins). Provide alcohol based hand sanitizers for situations when hand washing facilities are not available

• Advise parents and guardians to provide campers with disposable tissue.  You should also encourage campers not to use wash cloths, handkerchiefs and bandanas to cover coughs and sneeze. These trap viruses and germs. Viruses on these items can contaminate or soil hands and hence spread germs to other surfaces and people. 

• Have daily talks reminding campers and staff of the need to consistently practice hand hygiene, cough etiquette and other general hygiene measures including not sharing water bottles, food utensils, towels and other personal items.

• Remind children  that if they feel ill during the day they should report this  to someone in charge

• Parents and guardians must be notified immediately if campers become ill with flu like symptoms during the day. Ensure that you have a valid  contact information for parents and guardians ( a working telephone number) 

• Campers who are ill with flu like symptoms should be kept in a well ventilated room away from others, and should be observed carefully for signs of worsening condition. If this occurs immediate medical attention should be sought. 

• Remind members of staff that they too should not report for duty if they are ill with influenza like symptoms that include fever with cough or sore throat.

• Consider having a back up plan for replacement of ill staff members

• Have a cleaning routine which includes regular cleaning of frequently handled objects and surfaces such as door knobs computer key boards, telephones and hand rails.

Ministry of Health – Barbados
June 2009 Update

Home Isolation Guidelines for People with Influenza

Infectious respiratory diseases like influenza can be spread by droplets which escape from the nose or mouth of the infected persons when they are talking, coughing or sneezing.

These droplets contain harmful germs and may travel in the air for a distance of about one or two meters before falling to a surface.

Other persons may become infected when they inhale these droplets from the air or by touching their eyes, nose or mouth with their hands that have touched a contaminated surface.

The main symptoms of influenza are fever with cough or sore throat. Persons may also experience runny nose, sneezing, muscle aches and pains, headache, tiredness, and sometimes vomiting and diarrhea.

Instructions to Lessen the Effects of Influenza in the Home

Persons being treated at home for influenza are instructed as follows:

• Do not leave home for the period indicated by the health care worker.
• Do not answer the door (arrange for other family members to do this).
• Do not have visitors to the house.

• If possible, sleep in a separate room away from others.

• Use separate utensils and dishes for meals, and wash these separately.
• Wear a mask when the in company of others and when using common areas of the  home
• Take medication as prescribed by health care workers or use over the counter medicines to relieve symptoms

• If your condition worsens seek medical advice

Caring for Sick Persons at Home

These guidelines describe simple measures that can be undertaken at the household level to prevent spreading the disease to other family members and to provide basic care for the ill person. These health practices do not require assistance from trained health staff and can be applied to a variety of illnesses.

Avoid Spreading the Influenza to Others

Four key measures for containing the disease are social distancing (keeping ill household members from those that are well), respiratory etiquette, hand-hygiene and ventilation.

      Social Distancing

• The ill person should keep at least six feet away from others
• Minimise gatherings (do not entertain visitors). The ill persons should confine themselves to a single room or area in the house and avoid those areas where others gather

Respiratory Etiquette

• Cover your coughs and sneezes with a tissue
• Throw used tissues in a covered garbage can with a plastic liner or place them in a plastic bag. 
• Bags should be tied before being put out for collection.

Hand Hygiene

• Wash your hands with soap and water for 20 seconds before rinsing.
• Or use alcohol based gels which should be rubbed on hands and allowed to air dry

Ventilation

• Create good airflows through the house by opening your windows and doors. This helps to  get rid of germs

If You Are the Caregiver
Avoid being face-to-face with the sick person. Stay at least an arm’s length away and have them wear a surgical mask.
When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face.
Clean your hands with soap and water or use an alcohol-based hand rub after you touch the sick person or handle used tissues, or laundry

Get Medical Care Right Away If The Sick Person At Home:

• Has difficulty breathing or chest pain
• Has purple or blue discoloration of the lips
• Is vomiting and unable to keep liquids down
• Has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry
• Has seizures (for example, uncontrolled convulsions)
• Is less responsive than normal or becomes confused

TIPS FOR HOME CARE OF PERSONS WITH INFLENZA

Persons at high risk of death and illness from disease should not be in close contact with the ill person. These persons include pregnant women, babies, elderly persons, and persons with severe or chronic diseases that include asthma, diabetes, heart disease, and those conditions that weaken the immune system

• Avoid other types of exposure to an ill person such as sharing toothbrushes,  eating utensils, drinks and linens

• Cleaning of the environment should include washing shared surfaces and clothes, bed linen and scarves that have been in contact with a patient's respiratory secretions or stools.

• Water and soap should be used for washing, and afterwards hands should be washed thoroughly with soap and water

GENERAL TIPS FOR CLEANING:
Areas Requiring Frequent Disinfection Include:

• Door knobs/window handles/buttons/switches
• Surfaces (e.g. tables, telephones, computer keyboards)
• Children’s toys
• Floors and Walls
• Eating utensils
• Water taps/shower heads, bathtubs and washbasins
• Toilet - handles, seat and cover
• Dustbins

General Health Advice for All Family Members

• Cover your nose and mouth when sneezing or coughing.
• Wash your hands after coughing, sneezing or wiping your nose.
• Wash your hands before touching your eyes, nose and mouth.
• Do not share towels.
• Do not share eating utensils-use serving spoons and cutlery.
• Maintain good indoor ventilation

General Cleaning Principles: Precautionary Notes

• Disinfectant should be applied using a damp cloth and the surface allowed to air dry.
• They should not be applied using a spray pack, as coverage is uncertain.
• Spraying may promote the production of aerosols. (Small airborne particles)

Clean and Disinfect Your Home at Least Once Daily 

Non absorbent surfaces should be disinfected with a solution that is made up by mixing 3/4 cup of chlorine bleach to one gallon of water. (1:10 chlorine bleach solution).

The solution must be mixed with cold tap water and kept at room temperature. A fresh batch must be made up every day. The bleach used must be of 5.25% to 6% strength.

You should check the manufacturer’s label for information on product strength. To prevent potentially dangerous chemical reactions no other cleaning agents should be added to the solution.
FLOORS AND FLOOR COVERINGS
Do not hang up and swat mats to clean as this will create aerosols.
The bucket used for mopping should have a wringer attached.
Mops should not be hand wrung as this may create aerosols

BEDDING
Cots, mattresses and pillows should be fitted with plastic covers and should be wiped over as for surface cleaning.
Use containers with close fitting lids or tied plastic bags to transport waste from the room of a sick child.

To Disinfect Surfaces or Items     

• Remove all organic materials such as secretions (any bodily fluid), mucus, vomitus and faeces and wash as normal.
• Disinfect by wiping with a cloth or mop that has been saturated with the 1:10 chlorine bleach solution. Small items may be immersed in the solution.
• Leave for at least 10 minutes then rinse or wipe dry as appropriate

Adapted from WHO
(Reducing excess mortality from common illnesses during an influenza pandemic) & CDC
(Interim guidance for H1N1 flu (swine flu) taking care of your sick person at home)

Ministry of Health – Barbados
June 2009 Update