Checklist gives protection from exposure to flu

Hand washing and masks are key for patients, staff

When caring for patients with respiratory symptoms, do you always require them to put on surgical masks and perform hand hygiene?

"It is vital to require patients to practice respiratory etiquette and for staff to use droplet precautions," urges Maryann Gierloff, RN, MSN, CIC, infection control facilitator at Northwest Community Hospital in Arlington Heights, IL.

At Northwest’s ED, "all avenues of communication" are being used to get this message out to staff, including newsletters, memos, formal inservices, e-mail, department meetings, corporate meetings and posters, says Gierloff. (See resources, below, to obtain patient education posters.)

To reduce exposure to flu, she recommends the following:

  • If patients have respiratory symptoms, give them respiratory hygiene kits consisting of a box of tissues, surgical mask, and instructions in Spanish and English. "We worked with marketing to make the instructions user-friendly, with the goal of taking some of the stigma off wearing a mask," says Gierloff.

The instructions read as follows: "Dear patient or visitor: Individuals visiting hospitals often carry colds or other viral infections that can easily be passed from one person to another. Medical studies have shown that covering the mouth and nose can dramatically reduce the spread of colds and viral infections. In order to provide you with the best possible care and to protect all individuals coming to the hospital, we kindly ask if you are coughing or sneezing, that you use the mask and tissues we are providing. Also remember to clean your hands after coughing or sneezing. Your cooperation is very much appreciated."

  • Ask any patient who is coughing or sneezing to wear a surgical mask. If a patient’s respiratory status is compromised to the point that they are unable to wear a surgical mask, staff use of droplet precautions, segregating the patient, and expediting care become even more important, notes Gierloff. "For patients who cannot wear a surgical mask, tissues are provided and patients are asked to use them when coughing, sneezing, or controlling nasal secretions," she adds.
  • Ask patients with respiratory symptoms to perform hand hygiene using an alcohol rub or soap and water.
  • Place patients with respiratory symptoms in a private room, cubicle, or waiting area as soon as possible, and expedite care.

In addition, ED staff members are instructed to use droplet precautions whenever caring for patients with any respiratory symptoms, as follows:

  • Do not allow patients to cough or sneeze in your face. Wear a surgical mask to protect yourself.
  • Use eye protection, gowns, and gloves as necessary.
  • Perform hand hygiene after providing care to patients with respiratory symptoms.
  • If close contact is not necessary, maintain a distance of three feet from individuals with respiratory symptoms.

Hand hygiene is essential

"We are now, more than ever, encouraging our staff to employ appropriate hand hygiene by inservices, properly stocked facilities, and convenience of location [of hand-washing stations]," says Steve R. Rasmussen, RN, CEN, clinical coordinator for the ED at Virginia Commonwealth University Medical Center in Richmond.

In addition to inservices, clinical coordinators and charge nurses routinely observe in clinical areas to see if staff members are performing hand hygiene. "Not only are we keeping existing conventional hand-washing areas stocked, but we have also added waterless hand stations in halls, triage areas, and high-traffic areas to encourage frequent use and convenience," he reports. "I have noticed increased use of the waterless products over conventional hand cleaning techniques."

At Edward Hospital in Naperville, IL, hand hygiene has been addressed at every staff meeting, with inservices given by the hospital’s infectious disease practitioner to provide current data on potential epidemics and encourage prevention, says Randy Schmidt, RN, charge nurse for the ED. There are sinks and soap dispensers in every patient room, and hand-sanitizer dispensers are mounted outside every patient room for staff and visitor use, he says.

"We added additional hand-sanitizer dispensers throughout the ED this year," he reports. "The inservices did help make staff more aware, and the hand sanitizers are used frequently."

There are about 40 hand dispensers throughout the ED currently, placed by patient rooms, nutrition areas, the staff lounge, stat laboratory, medication rooms, nursing stations, waiting areas, and triage. "Placement was chosen for visibility and ease of use," says Schmidt. "It is not necessary to enter any room to use a sanitizer. They are easily accessible to everyone."

If patients with respiratory symptoms can’t be brought back to a private treatment room immediately, masks are given, he adds.

"We also have signage in all the waiting areas regarding respiratory hygiene," says Schmidt. "Tissues, waste containers, and wall-mounted hand-sanitizer dispensers are located there as well."


For more information, contact:

  • Maryann Gierloff, Infection Control, Northwest Community Hospital, 800 W. Central Arlington Heights, IL 60187. Telephone: (847) 618-4370. E-mail: MGierloff@NCH.ORG.
  • Steve Rasmussen, RN, CEN, Clinical Coordinator, Emergency Department, Virginia Commonwealth University Medical Center, 401 N. 12th St., Richmond, VA 23298. Telephone: (804) 828-7330. E-mail:
  • Randy Schmidt, RN, Charge Nurse, Emergency Department, Edward Hospital, 801 S. Washington St., Naperville, IL 60450. Telephone: (630) 527-3936. Fax: (630) 527-5018. E-mail:

Patient education posters on respiratory etiquette can be downloaded free of charge at the New York State Department of Health web site ( Click on "Influenza," and under "Educational Posters," click on the poster title "Don’t Spread it Around," available in English, Spanish, Chinese, and Russian.

"Cover Your Cough" posters and fliers can be downloaded in English, Spanish, Vietnamese, Chinese, and Tagalog at the Centers for Disease Control and Prevention web site (