Flu safety measures

The extent and seriousness of the current flu epidemic is well-established. According to the CDC, those at high risk for serious complications are children younger than 5, pregnant women, people 65 years and older, those who have compromised immune systems, and those with chronic pulmonary, cardiac, metabolic, hematologic, renal, hepatic, neurological, and developmental conditions. Co-morbidities, such as morbid obesity, enhance risk. Although a greater number of children have died from Type A Influenza subtype H3N2 virus than usual, the elderly have greater natural risk than younger adults. Monocytes from older people produce less interferon. Their antiviral genes don’t work as well. H3N2 thrives in the lungs and causes a large immune response. It’s not surprising that flu kills from co-infection with another germ, by aggravating pre-existing conditions and by creating a cytokine storm.

A recent study in the American Journal of Infection Control revealed that more than 40% of healthcare professionals continued to work while sick. The reasons they gave for continuing to work while ill included: “I can still do my job”, “I don’t feel badly enough to miss work”, “I don’t think I’m contagious”, “I don’t want to make it harder on co-workers”, and “It will be too hard to find somebody to cover my shifts.” Forget the facts that we’re febrile and spreading the infection by droplet contamination. The duration of the illness is usually 3-5 days.

The CDC has specific recommendations for healthcare workers:

  • Receive the influenza vaccine
  • Use good respiratory hygiene and cough etiquette
  • Get proper medical management
  • Follow infection control precautions for all patient care activities and aerosol generating procedures
    • Remember, evaluate the patient from at least six feet away before making direct contact to determine the need for and type of personal protective equipment.
  • Implement environmental and engineering infection control measures
  • Handwashing

The World Health Organization has a motto: “Clean care is safe care.” A major component of clean care is good handwashing technique. There are five moments of hand hygiene: before touching a patient, before clean aseptic procedures, after other potentially infectious materials (OPIM) exposure risk, after touching a patient, and after touching patient surroundings. Soap and water washes should require 40-60 seconds and hand rubs 20-30 seconds. Other non-WHO sources recommend 15 seconds.

The WHO recommends that for soap and water you wet hands with water and apply enough soap to cover all hand surfaces. For rubs, apply a palm-full of product in a cupped hand and cover all surfaces.

The next procedures are the same for both soap and rubs:

  • Rub hands palm to palm
  • Rub right palm over left dorsum with interlaced fingers and vice versa
  • Rub palm to palm with fingers inter-laced
  • Rub backs of fingers to opposing palms with fingers interlocked
  • Rotational rubbing of left thumb clasped in right palm and vice-versa
  • Rotational rubbing, backwards, and forwards with clasped fingers of right hand in left palm and vice-versa

At this point with alcohol based hand rubs, once dry, your hands are safe. For soap and water, rinse hands with water, dry hands thoroughly with a single use towel, use the towel to turn off the faucet and open the door.

You are performing a service for your patients if you stay home when ill. You are performing a service to your patients and yourself if you use good hygiene.


  • “Alarming rate of health care professionals work while having flu symptoms: study” Safety + Health, page 24, January, 2018
  • ‘Influenza A (H3N2) variant virus related hospitalizations-Ohio-2012: MMWR 2012: 61 (38) 764-767
  • “Why aging attenuates viral responses” Science Vol 358, Issue 6369, 1397, 15 December 2017
  • “WHO Guidelines on Hand Hygiene in Healthcare” www.who.int Accessed January 22, 2018
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