The Haryana Health Department has issued guidelines and taken steps to prevent the spread of H1N1 swine flu as 31 cases have so far been reported from the state during the current year. A spokesman of the department said here today that nine cases had been reported from Karnal district, followed by four each from Kurukshetra and Fatehabad, three each from Hisar and Sirsa, two each from Yamunanagar, Kaithal and Panchkula and one each from Rohtak and Ambala districts. Till yesterday, nine deaths had been reported from five districts-- three in Kurukshetra, two each in Karnal and Sirsa and one each in Hisar and Gurgaon. He said Civil Surgeons had been issued guidelines for making separate isolation wards or rooms in hospitals and ensure that linen, blood pressure apparatus and thermometer were separately available in the isolation room. Also, dedicated physician, nurses, and paramedical staff should be available for this isolation area. Large oxygen cylinders, pulse oxymeter and portable x-ray machine should be available in the isolation ward. All Civil Surgeons had been directed to identify the nearest government or private heath institution with ventilator facilities. As ventilator facilities were available at Rohtak, Agroha, Sonepat and Gurgaon, the Civil Surgeons had been directed to tie up even with private health institutions for providing ventilator facilities for the patients referred by government institutions. All district units had been provided with adequate quantities of personal protection equipment kits and virus transfer medium kits, N 95 masks, triple layer masks, medicines like oseltamivir, antibiotics and other medicines. Instructions had also been issued to rapid response teams for investigation of H1N1 positive cases. These had been directed that if there was any suspected or positive case, the information should be given telephonically immediately to the state surveillance unit. They should visit that particular area and conduct house to house survey immediately. During survey, if any suspected case is detected, they should take a throat and nasal sample and give Tamiflu tablets.The follow-up of such patients and their contacts should be done till double the seven-day incubation time of swine flu.