What to do in the workplace?

This article presents information about pandemic diseases (and more specifically H1N1) spreading throughout your place of business. Here are 15 simple points gathered from the nation’s leading sources on pandemic preparedness:

1 — Cover your cough – If you have to cough, show some manners, and consideration for the health of others… You may already be ill and not know it. Think about others, too. Are your co-workers coughing? Have them cover their mouths. If you want to be really safe, prepare your workplace with masks. Many do not understand the difference in masks, but it is really quite simple: N95 and other “rated” and form fitting masks are to protect the well from inhaling airborne pathogens. Procedural masks (like what a surgeon wears) are for the ill, to help them cover their mouths and noses to avoid expelling pathogens towards the Well. You can find both at any quality first aid supplier. (Avoid new “miracle masks” claiming unheard of protection and germ-killing properties… If it sounds too good to be true, it probably is.)

2 — Wash your hands frequently – Cooties! Think about all the things you touch every day. Think about how many others touch them and breathe on them. Are they ill? Now… think about how often you touch your face. Try counting for 5-10 minutes… you would be surprised. Wash your hands. Hot soap and water are great. Hand sanitizers are handy when hot water is not available. Other great options are benzalkonium chloride (BZK) wipes — those nice clean towellettes — that are so handy to have around. Benzalkonium chloride solutions are rapidly acting biocidal agents with a moderately long duration of action. They are active against bacteria and some viruses, fungi, and protozoa.4 You can pick these up from your favorite first aid product company for about 3¢ each… usually in boxes of 100. Pass them around to co-workers, stash them in your pocket, wallet, purse, glove box, lunch box, briefcase, wherever.

3 — If you think you have been exposed – You do not need to stay home yet, but monitor your symptoms, and avoid touching your eyes, nose, or mouth - germs spread this way.

4 — If you have a fever, stay home for at least 24 hours after the fever has ended.5

5 — Get a vaccine when it becomes available – Rest assured that the regulatory procedures in place for the licensing of pandemic vaccines, including procedures for expediting regulatory approval, are rigorous and do not compromise safety or quality controls.6

6 — Wipe it, sanitize it, keep it clean – Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.6 Wipe it down. Provide your staff or cleaning crew with germicidal disinfecting solutions for cleaning desks, phones, common areas, etc (with gloves or other appropriated personal protective equipment donned, first, of course). These can be easily acquired through your janitorial supply or first aid store.

7 — Keep a special eye on expecting mothers – Pregnant women are known to be at higher risk for seasonal influenza complications. Recent studies show they might also be at higher risk for novel H1N1 influenza complications.

8 — Is it safe to eat pork and pork products? – Yes. Influenza A(H1N1) has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The influenza A(H1N1) virus is killed by cooking temperatures of 160°F/70°C, corresponding to the general guidance for the preparation of pork and other meat.6

9 — If you think you are sick – You probably will not be able to tell the difference between seasonal flu and influenza A(H1N1) without medical help. Typical symptoms to watch for are similar to seasonal viruses and include fever, cough, headache, body aches, sore throat and runny nose. Only your medical practitioner and local health authority can confirm a case of influenza A(H1N1).

10 — Treatment – If you feel unwell, have high fever, cough or sore throat:

• stay at home and keep away from work, school or crowds;
• rest and take plenty of fluids;
• cover your nose and mouth when coughing and sneezing and, if using tissues, make sure you dispose of them carefully;
• clean your hands immediately after with soap and water or cleanse them with an alcohol-based hand rub;
• if you do not have a tissue close by when you cough or sneeze, cover your mouth as much as possible with the crook of your elbow;
• use a mask to help you contain the spread of droplets when you are around others, but be sure to do so correctly;
• inform family and friends about your illness and try to avoid contact with other people;
• if possible, contact a health professional before traveling to a health facility to discuss whether a medical examination is necessary.

11 — Don’t panic – According to the World Health Organization (WHO), this H1N1 pandemic is currently of “moderate” severity, with the overwhelming majority of patients recovering, even without medical treatment, within a week of the onset of symptoms.6

12 — Isolation – While it may be difficult to enforce sick leave or isolation of an employee you suspect has either be exposed to H1N1, or may have contracted H1N1, try to get the employee to voluntarily separate or isolate themselves.

13 — Antiviral drugs – The Centers for Disease Control and Prevention (CDC) recommends the use of oseltamivir (brand name Tamiflu ®) or zanamivir (brand name Relenza ®) for the treatment and/or prevention of infection with swine influenza viruses. These are prescription drugs, so consult your physician.4

14 — Educate – As an employer, you should provide written guidance (email, etc.) on novel influenza A (H1N1) flu appropriate for the language and literacy levels of everyone in the workplace.4 As an individual, teach your family, friends and co-workers these simple points.

15 — Don’t be fooled – Retailers and manufacturers prey on a fearful public. As noted in point one, “If it sounds too good to be true…” check out the fraudulent product listings at the FDA.7

Make wise decisions, study your environment, and PREPARE. Pandemic flu exposure can be easily minimized.

Special thanks to:
1. Ready.gov
2. FirstAidStore.com
3. Fema.gov
4. CDC.gov
5. Flu.gov
6. WHO.org
7. United States Food & Drug Administration (http://www.accessdata.fda.gov/scripts/h1n1flu/ )
8. PandemicFlu.gov

SIDEBAR: Flu Terms Defined

Seasonal (or common) flu is a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available.

Novel H1N1 flu is a new influenza virus causing illness in people. This new virus was first detected in the U.S. in April 2009, and has spread to many countries around the world.

Bird flu is commonly used to refer to Avian flu (see below). Bird flu viruses infect birds, including chickens, other poultry and wild birds such as ducks.

Avian flu (AI) is caused by influenza viruses that occur naturally among wild birds. Low pathogenic AI is common in birds and causes few problems. Highly pathogenic H5N1 is deadly to domestic fowl, can be transmitted from birds to humans, and is deadly to humans. There is virtually no human immunity and human vaccine availability is very limited.

Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person.

What You Should Know

• Key Facts Dec 28
• Infection in Humans
• Questions & Answers
• WHO Avian Flu FAQ
  (From World Health Organization)

Specific Topics

• The Virus & Its Spread
  Flu viruses, avian flu viruses, spread among birds, spread to people
• Prevention
  Infection control, vaccine development

• Outbreaks
  North America, Asia & Europe Jan 5 , Bird Embargo Dec 29, Quarantine Executive Order…

Information for Specific Groups

• Health Professionals
• State Health Departments
• Poultry Industry
• Persons Involved in Eradication Activities
• Travelers
• U.S. Citizens Living Abroad
• Airline Industry
• Persons with Possible Exposure

Interim Recommendations for Infection Control in Health-Care Facilities Caring for Patients with Known or Suspected Avian Influenza

• PDF formatted for print
  (119 KB/3 pages)
• Prevention of Avian Flu
• Infection Control in Health-Care Facilities
• Avian Flu Vaccines

Note: CDC is revising its interim guidance for infection control precautions for avian influenza. The revised recommendations will be posted on this website as soon as they are finalized.

Objective

This document provides interim guidance for protection of health-care workers involved in the care of patients in the United States with known or suspected avian influenza. Depending upon where avian influenza is active in the world, such patients may be recently returning travelers entering U.S. health-care facilities or individuals who have had close contact with domestic poultry infected with avian influenza in the United States. For information regarding the clinical and epidemiologic criteria to be used in screening patients for possible avian influenza, see the “Update on Influenza A(H5N1) and SARS: Interim Recommendations for Enhanced U.S. Surveillance, Testing, and Infection Control” and “Interim Recommendations for Persons with Possible Exposure to Avian Influenza During Outbreaks Among Poultry in the United States .”

Background

Influenza viruses that infect primarily birds are called “avian influenza viruses.” These type A influenza viruses are genetically distinguishable from influenza viruses that usually infect people. There are many subtypes of avian influenza A viruses, including H7 and H5. Avian influenza viruses can be distinguished as “low pathogenic” and “highly pathogenic” forms based on genetic features of the virus and the severity of the illness they cause in poultry.

Avian influenza viruses do not usually infect humans; however, several instances of human infections and outbreaks of avian influenza have been reported since 1997 (for more information, see “ Basic Information About Avian Influenza” ). In 2003, influenza A (H7N7) infections occurred in the Netherlands among persons who handled infected poultry and among their families during an outbreak of avian flu among poultry. More than 80 cases of H7N7 illness were confirmed by testing (the symptoms were mostly confined to eye infections, with some respiratory symptoms), and one patient died (a veterinarian who had visited an H7N7 influenza-affected farm). Although there was evidence of limited person-to-person spread of infection, sustained human-to-human transmission did not occur in this or other outbreaks of avian influenza. It is believed that most cases of avian influenza infection in humans have resulted from contact with infected poultry or contaminated surfaces. However, other means of transmission are also possible, such as the virus becoming aerosolized and landing on exposed surfaces of the mouth, nose, or eyes, or being inhaled into the lungs.

Infection and disease in people caused by highly pathogenic avian influenza H5N1 infection have been identified recently in Vietnam and Thailand. On February 1, 2004, the World Health Organization (WHO) reported that laboratory test results had confirmed two fatal cases of human H5N1 infection in Vietnam in which human-to-human transmission may have occurred. The cases occurred in two sisters who were part of a cluster of four cases of severe respiratory illness in a single family. According to WHO, a detailed investigation of this cluster concluded that limited human-to-human transmission was one possible explanation, but direct poultry-to-human transmission could not be ruled out.

The following interim recommendations are based on what are deemed optimal precautions for protecting individuals involved in the care of patients with highly pathogenic avian influenza from illness and for reducing the risk of viral reassortment (i.e., mixing of genes from human and avian viruses). The ability of low pathogenic avian influenza viruses to cause infection and serious disease is less well established, but appears to be lower than that of highly pathogenic viruses based on available information. Nonetheless, it is considered prudent to take all possible precautions to the extent feasible when caring for patients with known or possible avian influenza.

Rationale for Enhanced Precautions

Human influenza is thought to transmit primarily via large respiratory droplets. Standard Precautions plus Droplet Precautions are recommended for the care of patients infected with human influenza. However, given the uncertainty about the exact modes by which avian influenza may first transmit between humans additional precautions for health-care workers involved in the care of patients with documented or suspected avian influenza may be prudent. The rationale for the use of additional precautions for avian influenza as compared with human influenza include the following:

• The risk of serious disease and increased mortality from highly pathogenic avian influenza may be significantly higher than from infection by human influenza viruses.
• Each human infection represents an important opportunity for avian influenza to further adapt to humans and gain the ability to transmit more easily among people.
• Although rare, human-to-human transmission of avian influenza may be associated with the possible emergence of a pandemic strain.

Recommendations for Avian Influenza

All patients who present to a health-care setting with fever and respiratory symptoms should be managed according to recommendations for Respiratory Hygiene and Cough Etiquette and questioned regarding their recent travel history.

Patients with a history of travel within 10 days to a country with avian influenza activity and are hospitalized with a severe febrile respiratory illness, or are otherwise under evaluation for avian influenza, should be managed using isolation precautions identical to those recommended for patients with known Severe Acute Respiratory Syndrome (SARS). These include:

• Standard Precautions
  • Pay careful attention to hand hygiene before and after all patient contact or contact with items potentially contaminated with respiratory secretions.
• Contact Precautions
  • Use gloves and gown for all patient contact.
  • Use dedicated equipment such as stethoscopes, disposable blood pressure cuffs, disposable thermometers, etc.
• Eye protection (i.e., goggles or face shields)
  • Wear when within 3 feet of the patient.
• Airborne Precautions
  • Place the patient in an airborne isolation room (AIR). Such rooms should have monitored negative air pressure in relation to corridor, with 6 to 12 air changes per hour (ACH), and exhaust air directly outside or have recirculated air filtered by a high efficiency particulate air (HEPA) filter. If an AIR is unavailable, contact the health-care facility engineer to assist or use portable HEPA filters (see Environmental Infection Control Guidelines) to augment the number of ACH.
  • Use a fit-tested respirator, at least as protective as a National Institute of Occupational Safety and Health (NIOSH)-approved N-95 filtering facepiece (i.e., disposable) respirator, when entering the room.

For additional information regarding these and other health-care isolation precautions, see the Guidelines for Isolation Precautions in Hospitals. These precautions should be continued for 14 days after onset of symptoms or until either an alternative diagnosis is established or diagnostic test results indicate that the patient is not infected with influenza A virus. Patients managed as outpatients or hospitalized patients discharged before 14 days with suspected avian influenza should be isolated in the home setting on the basis of principles outlined for the home isolation of SARS patients (see http://www.cdc.gov/ncidod/sars/guidance/i/pdf/i.pdf).

Vaccination of Health-Care Workers against Human Influenza

health-care workers involved in the care of patients with documented or suspected avian influenza should be vaccinated with the most recent seasonal human influenza vaccine. In addition to providing protection against the predominant circulating influenza strain, this measure is intended to reduce the likelihood of a health-care worker’s being co-infected with human and avian strains, where genetic rearrangement could take place, leading to the emergence of potential pandemic strain.

Surveillance and Monitoring of Health-Care Workers

• Instruct health-care workers to be vigilant for the development of fever, respiratory symptoms, and/or conjunctivitis (i.e., eye infections) for 1 week after last exposure to avian influenza-infected patients.
• Health-care workers who become ill should seek medical care and, prior to arrival, notify their health-care provider that they may have been exposed to avian influenza. In addition, employees should notify occupational health and infection control personnel at their facility.
• With the exception of visiting a health-care provider, health-care workers who become ill should be advised to stay home until 24 hours after resolution of fever, unless an alternative diagnosis is established or diagnostic tests are negative for influenza A virus.
• While at home, ill persons should practice good Respiratory Hygiene and Cough Etiquette to lower the risk of transmission of virus to others.

Respirators should be used in the context of a complete respiratory protection program as required by the Occupational Safety and Health Administration (OSHA). This includes training, fit-testing, and fit-checking to ensure appropriate respirator selection and use. To be effective, respirators must provide a proper sealing surface on the wearer's face. Detailed information on a respiratory protection program is provided at this OSHA web page.

This CDC Page last modified May 21, 2004