Medical practices across the US will be well-advised to have processes in place for dealing with the certain outbreak of flu infections within their ranks, whether it is the Influenza virus or the H1N1 (Swine) Flu. It is not unrealistic to predict that a significant percentage of a practice’s employees could be affected – this could be further compounded by illness within the employee’s family, leading to further absence from the workplace. What follows is information we distributed to our staff (thanks to Bob Tilley and our administrative staff for the research).
Government Resources for Influenza Pandemic
Flu.gov This single source offers updates from the Centers for Disease Control and Prevention (CDC), Department of Human Services and Department of Homeland Security. We have found it to be quite helpful in collecting information on how employers can best prepare for the anticipated pandemic.
MyFluSafety The Florida Department of Health maintains this site to provide the latest information on the influenza pandemic in the Sunshine State.
Most of the information coming from the experts is consistent. But still it falls upon each employer to make its own decisions about how to best work with staff and to continue daily business operations.
In addition to the H1N1 virus, the CDC recommends that everyone receives the seasonal flu shot just as an additional precaution. Most adults will require just one dose but children may require a second injection – check with a pediatrician. In our practice, we purchase the seasonal flu vaccine and make it available to all staff members and their immediate family members. As I mentioned above, protecting the employee only could result in lost time if his or her children fall ill and they need time off anyway.
H1N1 (Swine) Flue Vaccination
The H1N1 flu vaccine is not for sale but, in most states, will be distributed by their Departments of Health. Practices should contact the Director of the Health Department and arrange for their employees to get the vaccine if possible. The CDC’s Advisory Committee on Immunization Practices, a panel made up of medical and public health experts, recommended who should receive the new H1N1 vaccine when it becomes available on a priority basis:
- Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated
- Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants less than 6 months old might help protect infants by “cocooning” them from the virus
- Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity
- Children from 6 months through 18 years of age because we have seen many cases of H1N1 influenza in children and they are in close contact with each other in school and day care settings, which increases the likelihood of disease spread
- Young adults 19 through 24 years of age because we have seen many cases of H1N1 influenza in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population
- Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.
CDC officials do not expect a shortage of H1N1 vaccine, but vaccine availability and demand can be unpredictable. Initial supplies may be available only in limited quantities. Once the demand for vaccine for the prioritized groups has been met at the local level, the CDC recommends vaccinating everyone from the ages of 25 through 64 years. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups.
Precautions Within the Office
Precautions for Patients:
We have placed hand sanitizer dispensers at key locations such as the check-in and check-out counters, and will ask patients to use them before they sign in. If staff members observe any patient displaying signs of a flu-like illness, they will report this to either their supervisor or a physician. These patients should be asked to reschedule if at all possible. In addition, employees should immediately use hand sanitizer or wash their hands if they come in contact with one of these patients.
Precautions for staff are more complex:
First, establish whether the employee has a cold or the flu. Public health officials differentiate between the two by defining the flu as a temperature of 100 degrees or higher, plus one or more of the following symptoms – cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue, diarrhea, and vomiting.
For those staff members who are experiencing flu-like symptoms, they should be told…
If you have a temperature of 100 degrees or higher plus one or more of the symptoms outlined above, you cannot continue to work and you will be sent home. You then have two options:
1) You can visit your primary care doctor and have a Rapid Test for the H1N1 virus. If the test is negative for H1N1, you may return to work and wear a mask to reduce exposure to patients and co-workers as long as you are symptomatic. If the test is positive for H1N1, you will need to follow the CDC advisory:
- The CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. Your supervisor will take the temperature of any employee returning to work after being out with either the H1N1 or seasonal flu virus. (Your fever should be gone without the use of a fever-reducing medicine)
- Keep away from others as much as possible to keep from making others sick
- Be prepared in case you get sick and need to stay home for a week or so. We recommend that you keep a small supply of items on hand, including over-the-counter medicines, alcohol-based hand rubs, tissues and other related items that could be useful and help avoid the need to make trips out in public while you are sick and contagious
2) If you decline the Rapid Test, we will have to assume you have the H1N1 virus and you will not be permitted to return to work for at least 7 days, or until your fever is gone for at least 24 hours, whichever is longer.
For those staff members who are sick but do not have the flu:
- The employee can elect to take a couple of days off, rest, and then return to work when feeling better
- If the staff member has no fever, but feels that he or she can return to work and perform the assigned duties, the employee with lingering cold symptoms should wear an N95 respirator mask at all times when in the office
What You Can Do to Stay Healthy
The CDC advises that influenza spreads mainly person-to-person through coughing or sneezing of infected people. It recommends the following everyday actions to stay healthy:
- Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you do not have a tissue, cough or sneeze into your sleeve
- Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective
- Avoid touching your eyes, nose or mouth – germs spread that way
- Stay home if you get sick – CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them
- Follow public health advice regarding school closures, avoiding crowds and other social distancing measures (keeping a minimum of six feet between people, whenever practical)
Understand that the N95 respirator or facemask is used primarily to prevent an infected person from spreading their infectious organisms to other healthy individuals. However, use of a facemask or N95 respirator may also be of benefit if used correctly and consistently when exposed to an ill person. The use of facemasks may be considered as an alternative to respirators, although they are not as effective as respirators in preventing inhalation of small particles, which is one potential route of influenza transmission.
For specific work activities that involve contact with people who have influenza-like illness, the CDC recommends the following:
- Workers should keep their interactions with the ill person as brief as possible
- The ill person should be asked to follow good cough etiquette and hand hygiene and to wear a facemask, if able, and one is available
- Workers at increased risk of severe illness from influenza infection should avoid people with influenza-like illness (possibly by temporary reassignment); and
- Where workers cannot avoid close contact with persons with influenza-like illness, some workers may choose to wear a facemask or N95 respirator on a voluntary basis
Family members who become ill
Employees who are well but who have an ill family member at home with H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including washing their hands often with soap and water, especially after they cough or sneeze.
If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs to prevent illness.
If you become ill and experience any of the following warning signs, the CDC recommends that you seek emergency medical care.
In adults, emergency warning signs that need urgent medical attention include:
- Difficulty breathing or shortness of breath
- Pain or pressure in the chest or abdomen
- Sudden dizziness
- Severe or persistent vomiting
- Flu-like symptoms improve but then return with fever and worse cough
In children, emergency warning signs that need urgent medical attention include:
- Fast breathing or trouble breathing
- Bluish or gray skin color
- Not drinking enough fluids
- Severe or persistent vomiting
- Not waking up or not interacting
- Being so irritable that the child does not want to be held
- Flu-like symptoms improve but then return with fever and worse cough
Public health officials state that they expect most people to recover from the H1N1 virus without needing medical care. If you have a severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed. Be aware that if the flu becomes widespread, less testing will be needed, so your health care provider may decide not to test for the flu virus.
Antiviral drugs can be given to treat those who become severely ill with influenza. These antiviral drugs are prescription medicines with activity against influenza viruses, including H1N1 flu virus. These medications must be prescribed by a health care professional.
The CDC recommends two influenza antiviral medications for use against H1N1 flu: oseltamivir (trade name Tamiflu ®) and zanamivir (Relenza ®). As the H1N1 flu spreads, these antiviral drugs may become in short supply. Therefore, the drugs may be given first to those people who have been hospitalized or are at high risk of severe illness from flu. The drugs work best if given within 2 days of becoming ill, but may be given later if illness is severe or for those at a high risk for complications.