The Centers for Disease Control (CDC) have updated their infection control guidance for seasonal influenza in healthcare settings. This new guidance supersedes previous CDC guidance for both seasonal influenza and 2009 H1N1 influenza. See www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm for the CDC’s detailed recommendations. Below is a summary of some key CDC recommendations. The application of the Cal/OSHA aerosol transmissible diseases (ATD) standard is also discussed.
The CDC believes that annual vaccination of both healthcare personal (HCP) and patients is the most important measure in preventing seasonal influenza infection. Cal/OSHA requires that the seasonal influenza vaccine be made available at no charge to potentially exposed employees in healthcare settings.
Respiratory hygiene and cough etiquette are measures designed to minimize potential exposures to all respiratory pathogens in healthcare settings, including influenza virus. These precautions are required by the ATD standard. Key elements include using facemasks or tissues to cover nose and mouth when coughing or sneezing, proper disposal of these contaminated items, and hand hygiene. Posting visual alerts, implementing procedures during patient registration to facilitate appropriate precautions, providing supplies, and separation of patients with symptoms when feasible are also very important. More detailed information is available at www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm.
HCP who develop fever and respiratory symptoms should not report to work and should be excluded from work for at least 24 hours after they no longer have a fever. HCP who develop acute respiratory symptoms without fever should be considered for evaluation by occupational health to determine if contact with patients is appropriate. Adherence to respiratory hygiene and cough etiquette upon retuning to work is always important. Temporary reassignment or exclusion from work may be appropriate for HCP that care for patients in a protective environment. Employers should develop appropriate nonpunitive sick leave policies for HCP.
Standard precautions are the foundation for preventing transmission of infectious agents in all healthcare settings, and all HCP should be well-trained in these precautions. Frequent hand hygiene and the use of gloves and gowns for any anticipated contact with potentially infectious material are elements of standard precautions that apply to patients with respiratory infections.
Droplet precautions should be implemented for patients with suspected or confirmed influenza. An important element of droplet precautions is donning a facemask when entering the room of a patient with suspected or confirmed influenza. Facemasks are loose-fitting and may be labeled as surgical, laser, isolation, dental, or medical procedure masks. The California Department of Public Health (CDPH) recommends that healthcare employers consider allowing HCP to use respiratory protection at least as effective as a fitted N95 filtering facepiece respirator during influenza patient care. Cal/OSHA only mandates the use of facemasks for droplet precautions.
For aerosol-generating procedures (such as bronchoscopy, sputum induction, and intubation) performed on suspected or confirmed cases of influenza, CDC recommends airborne precautions. Such procedures should be performed in an airborne infection isolation room, if feasible, and HCP in the room should wear respiratory protection at least as effective as a fitted N95 filtering facepiece. Consistent with CDC recommendations, Cal/OSHA will enforce the use of airborne precautions for aerosol-generating procedures (referred to as high hazard procedures in the ATD standard).
There is currently no shortage of N95 filtering facepieces. Therefore, CDPH recommends that facilities do not implement redonning, reuse, or extended use of filtering facepiece respirators because such policies increase the risk of contact transmission. (Redonning/reuse refers to removal of a disposable N95 respirator and putting it back on between patient encounters. Extended use refers to wearing a disposable N95 respirator for serial patient encounters where the respirator has not been removed between encounters.)
Other topics discussed within the CDC recommendations include managing visitor access within the facility, environmental infection control, engineering controls, employee training, antiviral treatment, and HCP at higher risk for complications of influenza.
This bulletin is a brief summary of key elements. Employers are encouraged to refer to the CDC, CDPH, and Cal/OSHA websites for comprehensive guidance. CDPH recommendations regarding this topic are available at http://www.cdph.ca.gov/programs/immunize/Documents/ CDPHGuidanceFluPreventionHCS20101105.pdf. Cal/OSHA guidance is available at http://www.dir.ca.gov/dosh/dosh1.html.
The above evaluations and/or recommendations are for general guidance only and should not be relied upon for legal compliance purposes. They are based solely on the information provided to us and relate only to those conditions specifically discussed. We do not make any warranty, expressed or implied, that your workplace is safe or healthful or that it complies with all laws, regulations or standards.