What are the recommended isolation precautions and treatments for a patient with influenza (flu)?

Isolation Precautions for Influenza

Patients with confirmed or suspected influenza require droplet precautions with standard precautions, including placement in a private room (or cohorting with other influenza patients), surgical mask use by healthcare personnel within 3 feet of the patient, and meticulous hand hygiene. 1

Patient Placement and Room Assignment

• Place confirmed influenza patients in a private room or cohort them with other confirmed influenza patients unless medical contraindications exist 2, 1
• For suspected influenza cases, place the patient in a private room immediately and perform rapid diagnostic testing promptly to facilitate appropriate downgrading of precautions once results are available 2, 1
• Limit patient movement and transport from the room to essential purposes only 2, 1
• When transport is necessary, have the patient wear a surgical mask to minimize droplet dispersal 2, 1

Healthcare Personnel Protection Requirements

Surgical mask use is mandatory - not N95 respirators for routine influenza care:

• Wear a surgical mask upon entering the patient's room or when working within 3 feet of the patient 2, 1
• Decontaminate hands before and after patient contact or after touching respiratory secretions, whether or not gloves are worn 2, 1
• Use alcohol-based hand rub when hands are not visibly soiled; wash with soap and water when hands are visibly dirty, contaminated with proteinaceous material, or soiled with blood or body fluids 2, 1
• Wear gloves if hand contact with the patient's respiratory secretions is expected 2, 1
• Wear a gown if soiling of clothes with the patient's respiratory secretions is anticipated 2, 1

Important caveat: Eye protection has no formal recommendation - the evidence remains unresolved regarding routine use of eye-protective devices for influenza 2

Patient Respiratory Hygiene Requirements

• Patients must cover their nose and mouth when coughing or sneezing, preferably using tissues that are immediately disposed of 1
• Alternatively, patients should cough or sneeze into their elbow rather than their hands 1
• If tolerated and feasible, patients should wear a surgical mask to prevent respiratory droplet dispersal, especially in common areas 1
• Patients must perform hand hygiene after contact with respiratory secretions using alcohol-based hand rub, soap and water, or antiseptic handwash 1
• Maintain at least 3 feet of separation from others when in common waiting areas 1

Healthcare Personnel Restrictions

• Healthcare personnel with influenza-like illness must be evaluated by employee health services and removed from direct patient contact duties 2, 1
• Apply more stringent criteria for personnel working in high-risk areas including intensive care units, nurseries, and organ transplant units (especially hematopoietic stem cell transplant) 2, 1

What Is NOT Required for Routine Influenza

Contact precautions: No recommendation exists for adding contact precautions beyond droplet precautions for influenza - the evidence is unresolved 2

Negative pressure rooms: No recommendation exists for maintaining negative air pressure in rooms of patients with influenza or placing influenza patients in areas with independent air-supply and exhaust systems - this remains an unresolved issue 2

Duration of Precautions

• Patients should remain isolated until fever-free for 24 hours without antipyretics 1, 3
• Common pitfall: Hospitalized patients with severe influenza may have persistently high viral loads and prolonged viral shedding, requiring extended isolation periods beyond the standard fever-free criterion 4

Outbreak Control Measures

When an influenza outbreak is identified:

• Perform rapid influenza virus testing on nasopharyngeal swab or nasal-wash specimens from patients with recent symptom onset 2, 1
• Obtain viral cultures from a subset of patients to determine the infecting virus type and subtype 2, 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

Critical Implementation Points

Do not delay precautions: Initiate droplet precautions based on clinical suspicion and downgrade once testing is complete - waiting for laboratory confirmation increases transmission risk 1

Hand hygiene superiority: While alcohol-based hand sanitizers are acceptable for non-visibly soiled hands, handwashing with soap and water is superior when hands are visibly soiled 1

High-risk patient considerations: More stringent infection control measures, including strict droplet precautions and preferably isolation for an extended period, may be necessary for hospitalized patients with severe influenza owing to prolonged viral shedding 4