How to stop the spread of flu in your department

The Bethesda, MD-based National Foundation of Infectious Diseases recommends that EDs implement an aggressive year-round infection control program. To reduce exposure to flu in your ED, use these effective strategies:

  • Ask patients to put on masks at triage.

At St. Joseph Medical Center in Towson, MD, a "respiratory etiquette" policy was implemented in the ED. It includes signs asking coughing patients to wear a mask to control the spread of germs and placing antibacterial hand gel in the waiting room. 

"We instituted these precautions last year in response to a possible [severe acute respiratory syndrome] scenario, and we have continued it since," says Vicki Blucher, RN, BSN, CEN, ED clinical educator. "Patients do not seem to mind [wearing masks]."

Registration staff and volunteers have been educated about the policy, and they automatically give a mask to anyone with a cough, says Blucher.

At Carondolet St. Mary’s Hospital in Tucson, AZ, masks are at the triage desk for patients to take, with signs in English and Spanish telling patients to wear a mask and to wash their hands if they have a cough.

"There is also a sign to remind patients to notify us if they have been outside of the United States recently," says Mary G. Kelley, MS, ARNP, CEN, the ED’s triage coordinator. "We have a large immigrant population from Mexico, and we are getting more immigrants from Asia, so we are asking that population about recent travel also."

  • Offer to give flu shot to patients.

St. Joseph Medical Center recently instituted standing orders in which any admitted patient can be given the pneumococcal or flu vaccine if they want it and are eligible to receive it, says Blucher. "This program was designed for admitted patients, but we also can do if requested in the ED," she says. "We ask patients if they have had the flu/pneumonia shot on a routine basis."

  • Make the screening process automatic.

Carondolet St. Mary’s ED is customizing its ED Information System (EDIS, manufactured by Dallas-based T-System) to improve screening of flu patients, reports Kelley. "We are building the cough, tuberculosis, and travel questions into the system to help remind the nurses to ask them, and for some, we are making it a requirement that they are answered before the patient is discharged," she says.

  • Offer prophylaxis.

For last year’s flu season, which came early and was very severe, the antiviral drug amantadine was offered to all ED staff as a 30-60 day supply, says Blucher. "About 60% of ED staff took the drug, and we had very few call-outs," she says.


For more information on reducing exposure of flu, contact:

  • Vicki Blucher, RN, BSN, CEN, Clinical Educator, Emergency Department, St. Joseph Medical Center, 7601 Osler Drive, Towson, MD 21204. Telephone: (410) 337-1524. Fax: (410) 337-1118. E-mail:
  • Mary G. Kelley, MS, ARNP, CEN, Triage Coordinator, Emergency Department, Carondelet St. Mary’s Hospital, 1601 W. St. Mary’s Road, Tucson, AZ 85745. Telephone: (520) 872-2422. E-mail: