Influenza Infection Control

1
Influenza Infection Control

• Arjun Srinivasan, MD
• Division of Healthcare Quality Promotion
• National Center for Infectious Diseases

2
Influenza transmission

• Occurs primarily by large respiratory droplets
  that are expelled from the respiratory tract
  during coughing or sneezing.
  
• Close contact, within 3 feet, is usually
  required for transmission.

3
Influenza transmission
continued

• Theoretically could occur when hands, or other
  objects, become contaminated with respiratory
  droplets or secretions and then come into contact
  with the mucous membranes.
• Environmental transmission has not been
  demonstrated epidemiologically

4
Infection control should start at the point of
patient contact

• The Hospital Infection Control Practices
  Advisory Committee (HICPAC) recommends that
  healthcare facilities implement a Respiratory
  Hygiene/ Cough Etiquette strategy in clinics
  and at points of entry to the facility as part
  of Standard Precautions.

5
Respiratory hygiene/ Cough etiquette

• Post visual alerts at facility entrances
  instructing both patients and those who accompany
  them, to alert the staff if they have symptoms
  of a respiratory infection.
• Signs should instruct those with symptoms to
  follow recommendations for respiratory
  hygiene/cough etiquette.

6
Respiratory hygiene/ Cough etiquette
continued

• Signs should instruct patients to
• Cover the nose and mouth when coughing or
  sneezing.
  
• Use tissues to contain respiratory secretions.
• Dispose of tissues after use.
• Perform hand hygiene after contact with
  respiratory secretions or contaminated materials
  (e.g. tissues).

7
Respiratory hygiene/ Cough etiquette
continued

• Healthcare facilities should ensure that there
  are adequate supplies of
  
• Tissues
• No-touch waste receptacles
• Alcohol based hand rubs or hand washing supplies.

8
Respiratory hygiene/ Cough etiquette
continued

• During periods of increased community respiratory
  infection activity, facilities should offer
  procedure or surgical masks to persons who are
  coughing.
• When space permits, coughing patients should be
  encouraged to sit at least 3 feet away from other
  patients.
  
• These measures can be implemented year round.

9
Droplet precautions for influenza

• Healthcare personnel should observe Droplet
  Precautions in addition to Standard Precautions,
  when examining patients with symptoms of a
  respiratory infection, especially when fever is
  present.
• Droplet Precautions include the use of a surgical
  or procedure mask for close patient contact

10
Hospital admission of patients with known or
suspect influenza

• Place patient on Droplet Precautions
• Place the patient in a private room. Patient
  cohorting can be used if private rooms are not
  available.
  
• Wear a surgical mask and remove the mask when
  leaving the patients room.
  
• If patient movement outside the room is
  necessary, have the patient wear a mask, if
  possible.

11
When to initiate and discontinue Droplet
Precautions for influenza

• The decision to isolate patients for influenza
  should be made on clinical grounds.
  
• Rapid antigen diagnostic tests for influenza can
  be falsely negative in up to 30 of cases.
  
• In normal hosts, maintain Droplet Precautions for
  5 days from the onset of symptoms.
  
• In immunocompromised hosts, maintain Droplet
  Precautions for the duration of illness.

12
Other considerations

• Facilities should discourage persons with
  symptoms of a respiratory infection from visiting
  patients in the facility.
  
• Healthcare workers who develop respiratory
  illness should be instructed not to report to
  work.