Influenza Infection Control

1. Influenza Infection Control Arjun Srinivasan, MD Division of Healthcare Quality Promotion National Center for Infectious Diseases

2. Influenza transmission Occurs primarily by large respiratory droplets that are expelled from the respiratory tract during coughing or sneezing. Close contact, within 3 feet, is usually required for transmission.

3. Influenza transmission Theoretically could occur when hands, or other objects, become contaminated with respiratory droplets or secretions and then come into contact with the mucous membranes. Environmental transmission has not been demonstrated epidemiologically

4. Infection control should start at the point of patient contact The Hospital Infection Control Practices Advisory Committee (HICPAC) recommends that healthcare facilities implement a “Respiratory Hygiene/ Cough Etiquette” strategy in clinics and at points of entry to the facility as part of Standard Precautions.

5. Respiratory hygiene/ Cough etiquette Post visual alerts at facility entrances instructing both patients and those who accompany them, to alert the staff if they have symptoms of a respiratory infection. Signs should instruct those with symptoms to follow recommendations for respiratory hygiene/cough etiquette.

6. Respiratory hygiene/ Cough etiquette Signs should instruct patients to: Cover the nose and mouth when coughing or sneezing. Use tissues to contain respiratory secretions. Dispose of tissues after use. Perform hand hygiene after contact with respiratory secretions or contaminated materials (e.g. tissues).

7. Respiratory hygiene/ Cough etiquette Healthcare facilities should ensure that there are adequate supplies of: Tissues No-touch waste receptacles Alcohol based hand rubs or hand washing supplies.

8. Respiratory hygiene/ Cough etiquette During periods of increased community respiratory infection activity, facilities should offer procedure or surgical masks to persons who are coughing. When space permits, coughing patients should be encouraged to sit at least 3 feet away from other patients. These measures can be implemented year round.

9. Droplet precautions for influenza Healthcare personnel should observe Droplet Precautions in addition to Standard Precautions, when examining patients with symptoms of a respiratory infection, especially when fever is present. Droplet Precautions include the use of a surgical or procedure mask for close patient contact

10. Hospital admission of patients with known or suspect influenza Place patient on Droplet Precautions Place the patient in a private room. Patient cohorting can be used if private rooms are not available. Wear a surgical mask and remove the mask when leaving the patient’s room. If patient movement outside the room is necessary, have the patient wear a mask, if possible.

11. When to initiate and discontinue Droplet Precautions for influenza The decision to isolate patients for influenza should be made on clinical grounds. Rapid antigen diagnostic tests for influenza can be falsely negative in up to 30% of cases. In normal hosts, maintain Droplet Precautions for 5 days from the onset of symptoms. In immunocompromised hosts, maintain Droplet Precautions for the duration of illness.

12. Other considerations Facilities should discourage persons with symptoms of a respiratory infection from visiting patients in the facility. Healthcare workers who develop respiratory illness should be instructed not to report to work.