HHS flu pandemic infection control recommendations

Droplet isolation, cohorting

A new draft pandemic influenza plan issued by the U.S. Department of Health and Human Services calls for a combination of standard precautions and droplet isolation measures and an overall atmosphere of respiratory etiquette in hospitals caring for flu patients.

During the care of a patient with suspected or confirmed influenza the plan recommends:

Wear gloves if hand contact with respiratory secretions or potentially contaminated surfaces is expected.

Wear a gown if soiling of clothes with patient’s respiratory secretions is expected.

Change gloves and gowns after each patient encounter and before touching any noncontaminated items or touching another patient, and perform hand hygiene.

Decontaminate hands before and after touching the patient, after touching the patient’s environment, or after touching the patient’s respiratory secretions, whether or not gloves are worn.

When hands are visibly soiled or contaminated with respiratory secretions, wash hands with either a nonantimicrobial or an antimicrobial soap and water. Hand hygiene with plain soap or detergent for at least 10 to 15 seconds under running water is an effective method of removing soil and transient microorganisms. If sinks for hand hygiene are not readily available, alcohol-based agents can be used.

If hands are not visibly soiled and after glove removal, use an alcohol-based hand rub for routinely decontaminating hands in clinical situations. Alternatively, wash hands with an antimicrobial soap and water.

Droplet precautions

Droplet precautions should be a primary focus of planning as respiratory droplets represent the major route of influenza transmission.

Droplets are expelled from the respiratory tract primarily during coughing, sneezing, and talking, and during the performance of certain procedures such as suctioning and bronchoscopy.

Particles do not remain suspended in the air, and close contact (less than 3 feet) usually is required for transmission. Transmission occurs when droplets containing microorganisms generated from the infected person are deposited on the host’s conjunctivae, nasal mucosa, or mouth or when there is direct contact of hands with respiratory droplets or secretions followed by touching the mouth, nose, or conjunctiva. Because droplets do not remain suspended in the air, special air handling and ventilation are not required to prevent droplet transmission; that is, droplet transmission must not be confused with airborne transmission.

Components of droplet precautions include:

Place patient in a private room. When a private room is not available, place the patient in a room with a patient or patients who have active infection with the same microorganism but no other infection (cohorting). In a pandemic it is likely that most patients with suspected influenza will not have a specific laboratory confirmed diagnosis; such patients should be cohorted with other patients who have or may have influenza. If for some reason cohorting is not achievable, at least 3 feet spatial separation should be maintained between the infected patient and other patients and visitors. Special air handling and ventilation are not necessary, and the door may remain open.

Wear a surgical mask upon entering patient’s room or when working within 3 feet of patient. Remove the mask when leaving the patient’s room and dispose of the mask in a waste container. N95 respirators, which would be recommended for infections with airborne spread such as tuberculosis, are not required for influenza. Logistically, some hospitals may want to implement policy for the wearing of a mask to enter the room.

Limit the movement and transport of patient from the room to essential purposes only. If transport or movement is necessary, minimize patient dispersal of droplets by having the patient wear a surgical mask.


1. Department of Health and Human Services. Pandemic Influenza Response and Preparedness Plan. Web site: www.hhs.gov/nvpo/pandemicplan.