Guidance for workers on avian flu patients

The Occupational Safety and Health Administration (OSHA) has issued this guidance related to avian influenza. Its recommendations are based on Centers for Disease Control and Prevention (CDC) guidelines. All patients who present to a health care setting with fever and respiratory symptoms should be managed according to the CDC’s recommendations for respiratory hygiene and cough etiquette and questioned regarding their recent travel history. (Go to:

It has not yet been determined that avian flu can be spread from person to person. However, due to the potential risks of human-to-human infection, isolation precautions identical to those recommended for severe acute respiratory syndrome (SARS) should be implemented for all hospitalized patients diagnosed with or under evaluation for influenza A (H5N1) as follows:

  • Standard precautions. Pay careful attention to hand hygiene before and after all patient contact.
  • Contact precautions. Use gloves and gown for all patient contact.
  • Eye protection. Wear within 3 feet of patient.
  • Airborne precautions. Place the patient in an airborne isolation room (i.e., monitored negative air pressure in relation to the surrounding areas with six to 12 air changes per hour).

The CDC has recommended that the minimum requirement is a disposable particulate respirator (e.g. N95, N99 or N100) used in accordance with 29 CFR 1910.134 for respiratory protection programs. Workers must be fit tested for the model and size respirator they wear and must be trained to fit check for facepiece-to-face seal, when entering the room.

If transport or movement is necessary, ensure the patient wears a surgical mask. If a mask cannot be tolerated, apply the most practical measures to contain respiratory secretions.

For additional information regarding these and other health care isolation precautions, see the CDC’s Guidelines for Isolation Precautions in Hospitals. These precautions should be continued for 14 days after onset of symptoms until an alternative diagnosis is established or until diagnostic test results indicate that the patient is not infected with influenza A virus.

Patients managed as outpatients or hospitalized patients discharged before 14 days should be isolated in the home setting on the basis of principles outlined for the home isolation of SARS patients. (Go to: