Workplace Exposure to Flu Guidelines for DMC Employees

What is the difference between Flu and the “Common Cold”?

The flu and the common cold are both respiratory illnesses but they are caused by different viruses. In general, the flu is more severe than the common cold, and symptoms such as fever, body aches, extreme tiredness, and dry cough are more common and intense. Colds are usually milder, and are more commonly associated with a runny or stuffy nose. Colds generally do not result in serious health problems such as pneumonia, hospitalization or bacterial infections.

How do I know if a patient has Flu?

If a patient has characteristic symptoms (sudden onset of high fever, headache, body aches and upper respiratory symptoms), regardless of test results, they are presumed to have Flu.

Caring for patients with Flu – General Guidance

Employees and staff caring for patients with Flu should use both droplet and standard precautions. This includes appropriate hand washing, use of gloves where indicated and use of a surgical type facemask (an N95 mask is not required for droplet protection). Certain situations (e.g. bronchoscopy, suctioning, sputum induction, collection of nasopharyngeal swabs, intubation/extubation) require special precautions including the use of an N95 mask and eye protection. In order to perform any tasks using an N95 mask, fit testing and OHS N95 certification is required.

• N95 Respirators
• Infection Control Precautions

 Individuals with certain health conditions or risk factors may be at higher risk of complications if they become infected. A full list can be seen here.

Such individuals are advised not to enter isolation rooms containing patients with Flu, or be present during procedures which may generate aerosols (see above). Such individuals should discuss options for avoiding patients with Flu during this season with their supervisor. Health concerns should be discussed with DMC OHS and the individual’s personal physician.

When is antiviral treatment appropriate?

H1N1 influenza virus is no more severe than seasonal influenza for most healthy individuals. Most healthy persons with H1N1 or seasonal flu recover without any antiviral treatment. Treatment is indicated primarily for those who are at high risk for complications of influenza and individuals who are hospitalized.

When should exposed individuals be referred to DMC Occupational Health Services (OHS)?

Current indications for referring occupationally exposed individuals to OHS include:

• Significant aerosol or droplet exposure (e.g. patient sprayed HCW with droplets while coughing or sneezing in close proximity), or
• HCW is at high risk for complications of influenza because of pregnancy or an underlying chronic health condition and is concerned about an exposure, or
• HCW is anxious about their exposure to patients with influenza, or
• HCW develops symptoms of Flu (an incident report must be completed)

All individuals with documented droplet or aerosol exposure to a patient with Flu should:

• Monitor themselves for symptoms (especially fever and acute upper respiratory symptoms). Most healthy individuals who are not pregnant will not require antiviral medication or prophylaxis.
• All pregnant women and others at high risk of complications of influenza who have documented exposure should report to OHS ASAP (or the emergency department after hours) for evaluation.
• If exposed at work and symptoms develop:
• Inform supervisor
• Remain off work
• Report to OHS during OHS business hours
• If pregnant or otherwise at higher risk for complications of influenza, report to OHS ASAP (or the emergency department after hours).

What if my employee thinks they have the flu?

If your employee has fever and respiratory symptoms, have them remain off work. Refer to their personal physician for treatment recommendations. Most healthy individuals will not require antiviral treatment.

When can employees return to work after they have developed Flu?

The employee with ILI may return to work once he or she has been without a fever for 24 hours (and the fever is not masked by fever reducing medications such as Tylenol). You may determine this by communicating directly with the employee. If the HCW is working with severely immunocompromised patients (e.g. bone marrow transplant or solid organ transplant) or if the HCW is still quite symptomatic, please check with DMC Occupational Health Services (OHS) prior to considering returning the employee to work. If there is any question about an employee’s ability to return to work, check with OHS.