CDC: Monitor HCWs for flu symptoms

Guidance stresses masks, vaccine

During last year's H1N1 influenza pandemic, health care workers inadvertently transmitted flu to their co-workers, in some cases triggering a hospital-based outbreak. That and other information about H1N1 transmission helped shape new guidelines from the Centers for Disease Control and Prevention that rely on vaccination, respiratory hygiene, and monitoring of ill employees by employee health professionals.

"When it's spreading in the community you have to be vigilant for symptoms," says John Jernigan, MD, MS, medical epidemiologist with CDC's Division of Healthcare Quality Promotion and an author of the guidelines. "More efficient recognition and handling of the ill health care workers can make a big difference in transmission."

The guidance, Prevention Strategies for Seasonal Influenza in Healthcare Settings, promotes a variety of measures to prevent transmission of influenza. As expected, it treats H1N1 as a seasonal rather than a pandemic strain, and it advises the use of droplet and contact precautions. Masks are sufficient protection, except when performing aerosol-generating procedures, CDC says.

"To effectively prevent transmission, it's going to take a multifaceted approach," says Jernigan.

The most important preventive measure is annual influenza vaccination, according to the guidance. "Achieving high influenza vaccination rates of HCP and patients is a critical step in preventing healthcare transmission of influenza from health care personnel to patients and from patients to health care personnel," it states.

CDC did not address the issue of mandatory influenza vaccination of health care workers. Infection control organizations such as the Society for Healthcare Epidemiology of America (SHEA) recently released position papers favoring mandatory vaccination. The Advisory Committee on Immunization Practices (ACIP), an expert panel that advises CDC, is considering the issue and will report at its June meeting, Jernigan noted. The National Vaccine Advisory Committee is also considering whether to recommend mandatory vaccination of health care workers.

CDC offers some guidance directed at employee health professionals. According to the guidance, they should establish procedures for:

  • tracking absences;
  • reviewing job tasks and ensuring that personnel known to be at higher risk for exposure to those with suspected or confirmed influenza are given priority for vaccination;
  • ensuring that employees have prompt access, including via telephone to medical consultation and, if necessary, early treatment;
  • and promptly identifying individuals with possible influenza.

"Health care personnel should self-assess for symptoms of febrile respiratory illness," CDC stated. "In most cases, decisions about work restrictions and assignments for personnel with respiratory illness should be guided by clinical signs and symptoms rather than by laboratory testing for influenza because laboratory testing may result in delays in diagnosis, false negative test results, or both."

CDC acknowledges that airborne transmission may occur with influenza, but notes that "the relative contribution of the different modes of influenza transmission is unclear." While previous H1N1 guidance advised health care workers to wear N95 respirators when caring for patients with suspected or confirmed influenza, the current guidance recommends donning a mask when entering a patient's room.

"Mask use and hand hygiene do actually reduce the transmission of influenza in health care settings," says Jernigan.

Vaccination and prompt treatment with anti-viral medications are even more important for health care workers at higher risk of complications from influenza — such as pregnant or morbidly obese workers or those with chronic health conditions. CDC does not recommend reassignment, but notes: "Work accommodations to avoid potentially high-risk exposure scenarios, such as performing or assisting with aerosol-generating procedures on patients with suspected or confirmed influenza, may be considered in some settings, particularly for health care personnel with more severe or unstable underlying disease."

[Note: A copy of the influenza guidance is available at www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm.]