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Pandemic Influenza – 1 Contact Hour
Non-pharmaceutical Measures
The fallback position for slowing the spread of infection, experts say, is mitigation, the use of non-pharmaceutical measures. These include personal ones like washing hands and wearing a mask, occupational ones like working from home or arranging care for children who are sick or whose schools close, neighborhood-level ones like closing theaters, museums or restaurants, and metropolitan-wide ones like shutting a school system or canceling a major league ballgame.
In the 1918 Spanish flu, American cities that reacted quickly had fewer deaths than those that acted slowly and used fewer precautions, according to a 2007 study of 43 cities by researchers from the University of Michigan and the Centers for Disease Control. The outbreak in St. Louis was mild, because the authorities closed schools, churches and theaters, while Philadelphia, which had one of the highest death rates, held a war bond parade at the start of the outbreak. The most common combination of preventive measures was school closings and bans on public gatherings, which in 34 cities lasted for a median of four weeks.
The World Health Organization does not recommend closing borders or restricting international travel, although it is considered prudent for people who are ill to delay international travel and for those who develop symptoms following international travel to seek medical attention.
Mitigation measures include:
- Social distance. By travelling less, working from home, closing schools and otherwise maintaining distance from other people, there is less opportunity for the virus to spread.
- Respiratory hygiene. Populations should be repeatedly informed of the need for “respiratory hygiene” (covering mouth when coughing or sneezing, careful disposal of soiled tissues or other materials). Standard Precautions plus Droplet Precautions are recommended for the care of patients infected with human flu.
- Masks. No mask can provide a perfect barrier but products that meet or exceed the NIOSH N95 standard
recommended by the World Health Organization are thought to provide good protection. WHO recommends that health-care workers wear N95 masks and that patients wear surgical masks (which may prevent respiratory secretions from becoming airborne). Although masks are not particularly effective against the spread of influenza, they may be useful in encouraging social distancing and in reminding the wearer not to touch the face. This can reduce infection due to contact with contaminated surfaces, especially in crowded public places where coughing or sneezing people have no way of washing their hands. The mask itself can become contaminated and must be handled as medical waste when removed. - Hygiene. Frequent handwashing, especially when there has been contact with other people or
with potentially contaminated surfaces can be very helpful. Alcohol-based hand sanitizers also kill both bacteria and viruses.
Role of the Healthcare Provider
Healthcare providers should keep respiratory patients separate from other patients, and should reassign pregnant staff members as well as other personnel with a high risk of complications from influenza to non-patient care areas of the facility. Elective admissions and surgeries should be curtailed during a pandemic.
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 three 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 healthcare facility engineer to assist or use portable HEPA filters 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 face piece (i.e., disposable) respirator, when entering the room.
Monitoring of Healthcare Workers
Healthcare workers need to be vigilant for the development of fever, respiratory symptoms, and/or conjunctivitis for one week after their last exposure to influenza–infected patients. Healthcare workers who become ill should seek medical care and, prior to arrival, notify their healthcare provider that they may have been exposed to flu. In addition, employees should notify occupational health and infection control personnel at their facility.
With the exception of visiting a healthcare provider, healthcare workers who become ill should be advised to stay home until twenty-four 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.
Pandemic Preparation
The United States has been working closely with other countries and the World Health Organization to strengthen systems to detect outbreaks of influenza that might cause a pandemic. The effects of a pandemic can be lessened 
if preparations are made in advance. The Department of Health and Human Services and other federal agencies are providing funding, advice, and other support to states to assist with pandemic planning and preparation. Information on international as well as state/federal planning and cooperation, including links to state pandemic plans, is available at http://www.pandemicflu.gov.
Education and outreach are critical to preparing for a pandemic. Understanding what a pandemic is, what needs to be done at all levels to prepare for pandemic influenza, and what could happen during a pandemic helps people to make informed decisions. Well-informed healthcare professionals may be able to help others in their communities in this endeavor.
