Quick Safety Issue 46: Protecting patients and others from influenza in the health care setting
Health care workers who usually skip a flu shot need to take a harder look at who they may be harming the most — their patients and co-workers. According to the Centers for Disease Control and Prevention (CDC), the number of cases of influenza-associated illness that occurred last season was the highest since the 2009 H1N1 pandemic, when an estimated 60 million people were sick with influenza. During the 2017-2018 flu season, an estimated 48.8 million became ill with influenza, 22.7 million went to a health care provider, 959,000 were hospitalized, and 79,400 died from influenza.
Not every flu season is the same. Flu seasons range in severity from low to very high. Severity is assessed by the CDC based on key flu indicators, such as visits to the hospital or clinics, or deaths related to the flu. Overall hospitalization rates for all age groups during the 2017-2018 flu season were the highest ever recorded in the national surveillance system, breaking the previously recorded hospitalizations during the 2014-2015 flu season. Alarmingly, a total of 185 pediatric deaths related to the flu were reported to the CDC during the 2017-2018 season. Approximately 80 percent of these deaths occurred in unvaccinated children.
Last year, cases of influenza in the United States began to increase in November, and remained at high levels during January and February, according to the CDC.
Flu versus common cold
Influenza is a contagious respiratory illness caused by influenza viruses, which are spread through the droplets of infected people when they cough, sneeze or talk. Inhaling these droplets is how the flu spreads from person to person. Also, droplets can land on surfaces and spread to others who touch those contaminated surfaces. A person with the flu can be contagious the day BEFORE symptoms start, and remain contagious for up to seven days; the person is most contagious the first three-to-four days of symptoms starting.
Many people confuse symptoms of the common cold with those of the flu. While these two infections share some of the same symptoms, flu symptoms come on suddenly and are generally much worse than those of a cold. Some key difference between the cold and flu are:
- Flu symptoms come on abruptly, compared to the gradual onset of cold symptoms.
- The flu is usually associated with a fever, headache, chills, aches and fatigue/weakness, while these symptoms are uncommon in the common cold.
- The common cold is usually associated with sneezing, stuffy nose and sore throat. These symptoms may or may not be associated with the flu.
Protecting yourself and others from the flu
Prevention is the best way to avoid getting the flu. There are several ways that you can protect yourself, your family, patients and co-workers this flu season.
Get vaccinated! The best way to prevent seasonal flu is to get vaccinated every year.
- The flu vaccine is recommended for everyone 6 months of age or older. Vaccination is particularly important for people who are at high risk for complications related to the flu, such as the very young, the elderly and pregnant women. While it’s best to get vaccinated as early as possible, the vaccine still can be effective even if you get it later in the season.
- The CDC, the Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S. health care workers get vaccinated annually against influenza.
- Since health care workers may care for or live with people at high risk for influenza-related complications, it is especially important for them to get vaccinated annually.
- The flu vaccine cannot cause flu illness. The flu shot contains inactivated virus which is not infectious. The nasal spray vaccine which is appropriate for some individuals contains live flu virus, however these viruses are weakened to the point that they will not cause flu illness either. Vaccination has shown to have many benefits including decreasing the risk for getting the flu, reducing the number of hospitalizations related to the flu, and reducing the risk of flu-related death in children.
- Clean your hands frequently with soap and water or alcohol-based hand rub to help protect yourself from germs.
- Avoid touching your eyes, nose and mouth, as these are openings for germs to enter your body after your hands have touched a contaminated surface.
- Practice good health habits, especially during flu season, like frequently cleaning and disinfecting surfaces that you touch.
- If you feel ill with flu symptoms, help protect others:
--Stay home from work or school if you are sick. You can spread the flu virus up to one day after symptoms subside; for this reason it’s important to stay home for at least 24 hours after your fever is gone without the use of fever-reducing medication.
--When you cough and sneeze, cover your mouth and nose with tissue — or your elbow when a tissue is not available. Always remember to clean your hands with alcohol-based hand rub or soap and water after handling tissue.
Safety actions to consider:
Joint Commission-accredited organizations are required to offer a flu vaccination to licensed independent practitioners and staff (see Infection Prevention and Control standard IC.02.04.01). Health care organizations can help health care workers understand their responsibility to protect themselves and their patients from influenza, as well as support and encourage staff to take precautions to prevent the spread of viruses, including influenza viruses. In addition, the following actions can be taken by health care organizations:
- Put in place supportive, non-punitive time-off policies to encourage sick employees to not come into work.
- Make flu vaccine available to employees working all shifts to encourage compliance.
- Place cover-your-cough signs at the entrances of your facility to remind visitors about cough etiquette. Additionally, offer tissue, masks and hand sanitizers at the entrances of your facility.
The Centers for Disease Control. Seasonal Influenza. 2018.
Note: This is not an all-inclusive list.