What are the recommended precautions and management strategies for patients with influenza?

Flu Precautions for Patients with Influenza

Patients with confirmed or suspected influenza should be placed under droplet precautions, which includes isolation in a private room (or cohorting with other influenza patients), wearing surgical masks when within 3 feet of others, strict hand hygiene, and limiting movement outside the room to essential purposes only. 1

Patient Isolation and Room Placement

• Place patients with confirmed influenza in a private room or cohort them with other confirmed influenza patients unless medical contraindications exist 1
• For suspected influenza cases, place in a private room and perform rapid diagnostic testing promptly to facilitate appropriate downgrading of precautions 1
• Limit patient movement and transport from the room to essential purposes only 1
• When transport is necessary, have the patient wear a surgical mask to minimize droplet dispersal 1

Respiratory Hygiene and Cough Etiquette for Patients

• Patients must cover their nose and mouth when coughing or sneezing, preferably using tissues that are immediately disposed of in the nearest waste receptacle 1
• Alternatively, patients should cough or sneeze into their elbow rather than their hands 1
• If tolerated and feasible, provide a size-appropriate surgical mask for the patient to wear to prevent respiratory droplet dispersal, especially in common areas 1
• Patients should maintain at least 3 feet of separation from others when in common waiting areas 1

Hand Hygiene Requirements for Patients

• Patients must perform hand hygiene after having contact with respiratory secretions and contaminated objects or materials 1
• Hand hygiene options include alcohol-based hand rub, handwashing with soap and water, or use of antiseptic handwash 1
• Handwashing frequency of 5-10 times daily reduces hospitalization risk (adjusted OR 0.65), and >10 times daily provides even greater protection (adjusted OR 0.59) 2
• Handwashing after contact with contaminated surfaces is particularly protective (adjusted OR 0.65) and demonstrates a dose-response relationship 2

Healthcare Personnel Precautions When Caring for Influenza Patients

• Healthcare personnel must wear a surgical mask upon entering the patient's room or when working within 3 feet of the patient 1
• Decontaminate hands before and after giving care to or touching a patient, or after touching respiratory secretions, whether or not gloves are worn 1
• If hands are visibly soiled with blood, body fluids, or proteinaceous material, wash with soap and water; otherwise, alcohol-based hand rub is acceptable 1
• Wear gloves if hand contact with the patient's respiratory secretions is expected 1
• Wear a gown if soiling of clothes with the patient's respiratory secretions is expected 1

Personnel Restrictions and Sick Healthcare Workers

• Healthcare personnel with influenza-like illness must be evaluated by employee health services and removed from direct patient contact duties 1
• More stringent criteria should be applied for personnel working in high-risk areas including intensive care units, nurseries, and organ transplant units where patients are most susceptible to influenza complications 1

Unresolved Issues in Influenza Precautions

The following measures have insufficient evidence for routine recommendation:

• Eye protection when entering rooms or working within 3 feet of influenza patients - no definitive recommendation can be made 1
• Contact precautions in addition to droplet precautions - evidence is insufficient to mandate this routinely 1
• Negative air pressure rooms or independent air-supply systems for influenza patients - no recommendation can be made 1

Patient Education on Transmission Prevention

• Patients should stay home and avoid contact with others, especially high-risk individuals, until fever-free for 24 hours without antipyretics 3
• Patients remain off work while symptomatic to prevent transmission to colleagues 3
• Provide visual alerts and educational materials at facility entrances instructing patients to inform staff of respiratory symptoms when registering for care 1
• Make tissues and no-touch receptacles for disposal readily available in reception areas 1

Outbreak Control Measures

When a facility outbreak is suspected or recognized:

• Perform rapid influenza virus testing on nasopharyngeal swab or nasal-wash specimens from patients with recent symptom onset 1
• Obtain viral cultures from a subset of patients to determine the infecting virus type and subtype 1
• Administer current inactivated influenza vaccine to unvaccinated patients and healthcare personnel 1
• Consider antiviral prophylaxis for all patients without influenza illness in the involved unit for a minimum of 2 weeks or until approximately 1 week after outbreak end 1

Common Pitfalls to Avoid

• Do not delay implementation of droplet precautions while awaiting laboratory confirmation - initiate precautions based on clinical suspicion and downgrade once testing is complete 1
• Do not rely solely on alcohol-based hand sanitizers - while convenient and effective for influenza, handwashing with soap and water is superior when hands are visibly soiled 1
• Do not assume facemasks alone are sufficient - when implemented within 36 hours of symptom onset, the combination of facemasks plus hand hygiene is most effective (adjusted OR 0.33) compared to facemasks alone 4, 5
• Adherence is critical - interventions are only effective when implemented early (within 36 hours of index case symptom onset) and used diligently 4, 5