Dawn Mangine

    Each year, five to 20 percent of U.S. residents catch the flu, and many will seek care in healthcare settings such as pediatrician offices, urgent-care centers, doctor's offices, and even emergency rooms. More than 200,000 people will be hospitalized because of influenza-related complications.

    With numbers like this, it is important that healthcare professionals take precautions to protect themselves and other patients from infection by the influenza virus. A healthcare education curriculum should include prevention measures so students becoming healthcare providers (HCP) know best practices.

    Understanding Fundamentals

    Influenza is primarily spread through large-particle respiratory transmission – that is, when a sick person coughs or sneezes. Another vector of transmission is when an infected person touches an object, and the virus is spread to another person who touches that object, then inadvertently puts his hands near the mucosal membranes of the mouth or nose.

    The basics of preventing the transmission of influenza include:

    • Getting a flu vaccine
    • Implementing respiratory hygiene and cough etiquette
    • Managing ill HCP appropriately
    • Adhering to infection control precautions for patient-care activities and aerosol-generating procedures
    • Implementing environmental and engineering infection control measures

    Education on Standard Precautions

    Standard precautions in this context means that every person – patient and provider – is assumed to be infected with a virus or other pathogen that can be transmitted. Students should be taught the following elements of standard precaution regarding patients with a respiratory infection like influenza.

    • Hand hygiene – Proper hand hygiene should be taught in the classroom. Students will learn that HCP perform hand hygiene often, before and after all patient contact, after contact with potentially infection material, and before donning and doffing personal protective equipment (PPE). Healthcare facilities and classrooms should ensure supplies to perform proper hand hygiene are available.
    • Gloves – Gloves should be worn for any contact with potentially infectious material. Wear a different pair of gloves for each patient, and perform hand hygiene each time gloves are removed. Never wash gloves, especially for the purpose of reusing them.
    • Gowns – Although gowns are not often used in healthcare settings for patients with flu, teaching how to properly put on gowns as part of PPE education can still be valid. Gowns protect against many types of bodily secretions, including blood, body fluids, and respiratory secretions. When using gowns, remove them and perform hand hygiene before leaving the patient’s environment. Use a different gown for each patient.

    Management of Ill HCP

    When a healthcare provider becomes ill, he or she should be appropriately managed. Teach students that they should learn how to monitor themselves for the flu, and what to do if they feel they are getting sick.

    The first signs of a flu infection are respiratory illness with a fever (not all flu presents with a fever, however). If HCP develop symptoms, the following precautions should be implemented:

    • If at work, HCP should stop patient-care activity, put on a face mask, report to their supervisor, and leave work.
    • If they are not yet at work, they should not report to work, and should alert their supervisor according to the workplace policy.
    • An HCP who had the flu should not return to work until fever-free for 24 hours without medication.
    • If no fever is present, but HCP are still sneezing or coughing, they should practice good cough etiquette (coughing into the crook of their elbow) and wear a face mask for patient-care activities.
    • If a HCP works with immunocompromised patients, they should be reassigned for up to seven days from symptom onset or until symptoms resolve.

    Teach students to be educated on sick leave policies at their future or current places of employment. Facilities and organizations providing healthcare services ideally will have non-punitive sick leave policies for the health of providers and patients alike.

    For instruction on administering flu vaccine, proper hand hygiene, and donning gloves, see the Pocket Nurse website.



    The complete list of recommendations for preventing transmission of the flu in healthcare settings can be found at the CDC site.