Infection control and prevention guidelines for influenza in clinics and other outpatient healthcare settings.

              Infection Control and Prevention Guidelines
for Influenza in Clinics and
Other Outpatient Healthcare Settings
Public Health
Fact Sheet
Public Health
Fact Sheet
Modes of Influenza Transmission:
The spread of influenza virus occurs through droplet transmission, when respiratory droplets from infected persons directly fall within 3–6 feet (may be up to 10 feet) from the infected person after coughing, sneezing, or talking. These droplets infect the mucus membranes (eyes, nose, or mouth) of others, or contaminate surfaces and items in the infected person’s environment. The droplets can be picked up from surfaces and indirectly spread to mucus membranes after touching contaminated surfaces.
Droplet transmission differs from airborne transmission, which is the ability of tiny respiratory droplets to float in the air and travel further distances. Airborne transmission of influenza viruses is unknown. Therefore airborne precautions should be followed during aerosol-generating procedures such as bronchoscopy, intubation, cardiopulmonary resuscitation (CPR), open airway suctioning, and sputum induction.
Control and Prevention of Influenza Viruses:
1. Early recognition of patients with influenza-like symptoms at first entry into the healthcare system. Prevent spread from the source by the following actions:
a. Place a surgical or procedure mask on any client with influenza-like illness. If wearing a mask would compromise the client’s ability to breathe easily, have them cover their mouth and nose with a tissue when coughing or sneezing.
b. Separate symptomatic persons from others by at least 3-6 feet as quickly as possible. Place patient into a separate room (such as an exam room) with the door closed.
c. Instruct clients to follow respiratory hygiene, cough etiquette, and hand hygiene: Cover mouth and nose with a tissue when coughing or sneezing, OR cough or sneeze into the upper sleeve, NOT into one’s hands. Put used tissues in the waste basket. Wash hands with soap and water or use alcohol-based hand cleaner afterwards.
d. Provide supplies: Tissues, waste containers, and hand hygiene materials.
2. Use standard precautions when caring for all persons including those with influenza-like illness:
a. Perform hand hygiene with soap and water or alcohol-based hand product after contact with the patient or potentially contaminated environmental surfaces. Only use alcohol-based hand rubs when hands are NOT visibly soiled. Perform hand hygiene: Before having direct contact with patients. After contact with blood, body fluids or excretions, mucus membranes, nonintact skin, and wound dressings. After contact with a patient’s intact skin such as checking vital signs or positioning a patient. If hands will be moving from a contaminated body site to a clean body site during patient care. After contact with inanimate objects in the immediate vicinity of the patient. After removing personal protective equipment such as gloves, gowns, or masks.
b. Follow respiratory hygiene and cough etiquette (see 1.c. above).
c. Use gloves if hand contact with secretions or contaminated surfaces is anticipated. Change gloves between patients. Failure to do so is an infection control hazard! Put on clean gloves just before touching a patient's mucous membranes, non-intact skin, or contaminated items. Gloves do not replace the need for hand hygiene because gloves may be torn during use, and hands can become contaminated during removal of gloves. Remove gloves and perform hand hygiene when exiting the room.
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Influenza-like-illness (ILI) is defined as fever* and cough and/or a sore throat in the absence of another KNOWN cause of illness.
*temperature of 100°F (37.8°C) or greater