Tips for Physicians on Infection Control During Flu Season
As a physician, you can take critical steps to reduce the risk of transmitting flu within your work facilities. Infections associated with health care settings including hospitals, long-term care facilities, physician offices, and emergency departments are more common when flu is circulating in the community.
In investigations of outbreaks of respiratory viruses including influenza, these infection control measures were identified as among the most important for preventing transmission in health care facilities:
Communicate with patients. Especially during flu season, post signs and visual alerts at the entry to your office, clinic, or facility to remind patients how to observe respiratory hygiene, cough etiquette, and hand hygiene. During patient registration and triage, instruct staff to ask patients and those who accompany them if they have any symptoms of respiratory infection, so that facemasks can be provided as soon as possible. Download patient education fliers from the Centers for Disease Control and Prevention website.
Encourage respiratory hygiene and cough etiquette. Physicians have an essential role in promoting basic infection control measures at first point of contact with a potentially infected person.
- Separate symptomatic patients from asymptomatic patients as much as feasible, ideally by three feet;
- Provide a mask for any patient who has a respiratory tract illness AND for any symptomatic people accompanying the patient;
- Provide tissues, covered receptacles for the used tissues, and hand hygiene materials; and
- Schedule frequent cleaning and disinfection of surfaces and emptying of trash.
Observe recommended isolation precautions. Use Standard Precautions, especially hand hygiene, for ALL patient contacts. Use Droplet Precautions when in contact with patients who have a respiratory illness. Use gowns and gloves if exposure to respiratory tract secretions on clothing is likely — especially when examining young infants and toddlers who are not likely to be able to contain their secretions and who may be infected with RSV, for which Contact Precautions are recommended to prevent transmission. Don a mask and observe hand hygiene upon entry into a patient’s room even if your intention is not to touch the patient. When you anticipate needing gowns and gloves, it’s best to put them on when you enter the room.
Isolation should continue seven days from symptom onset, or 24 hours after having no fever without antipyretics and resolving respiratory signs, whichever is longer.
Minimize exposure from visitors. During weeks of peak flu activity, limit the number of visitors to inpatient facilities. Limit the number of people who are not patients or necessary healthcare personnel in the emergency department. Also, visitors should be instructed to limit their movement in the health care facility and avoid gathering in public areas. Health care facilities should perform active screening of visitors for acute respiratory illness.
Whenever possible, assign patients with respiratory illness to single-patient rooms. Limit the use of aerosol- generating procedures to those that are absolutely necessary, and use N95 respirators or powered air-purifying respirators when performing such procedures.
Vaccinate all health care personnel for flu. Health care personnel should be vaccinated. Staff with influenza symptoms should be excluded from work until at least 24 hours after fever has resolved.Consider temporarily reassigning staff who would be returning to work in protected environments (e.g., oncology, intensive care units, or transplant units) to non-patient-care activities, or exclude them from work for seven days from symptom onset, or until resolution of all symptoms, whichever is longer.
Report possible institutional outbreaks of flu to state and local health departments, including any clusters of two or more cases of acute respiratory illness occurring in long term care facilities, where at least one case has a positive test for influenza.
Do you have a question for the TMA Flu Fighters? Contact the TMA Knowledge Center with your question at (800) 880-7955 or email knowledge[at]texmed[dot]org.
The Flu Fighters are Wendy Chung, MD, SM, Dallas County Health and Human Services’ chief epidemiologist and chair of TMA’s Committee on Infectious Diseases (CID); Lisa Cornelius, MD, MPH, infectious diseases, medical officer, Texas Department of State Health Services; Bruno P. Granwehr, MD, MS, The University of Texas MD Anderson Cancer Center, Houston; Gilberto Handal, MD, pediatrics, Texas Tech University Health Science Center, El Paso; Philip P. Huang, MD, MPH, medical director, Austin/Travis County Health and Human Services; Charles J. Lerner, MD, infectious disease consultant to CID, San Antonio; Donald Murphey, MD, medical director, pediatric infectious diseases, Cook Children’s Medical Center, Fort Worth; Seema Shah, MD, MPH, Department of Medicine, The Methodist Hospital, Houston; and Jane Siegel, MD, pediatric infectious diseases, Children’s Medical Center, Dallas.