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Recommendations for Health Care Facilities/EMS

Influenza is an acute, highly contagious respiratory disease, characterized by abrupt onset of fever, myalgia, sore throat, headache, and cough. In children, it can also cause diarrhea and vomiting. The guidelines below are being provided to assist in reducing the spread and impact of outbreaks.

  • Employees of health care facilities, including EMS and others who have regular patient contact, should be vaccinated against influenza.
  • Influenza vaccine may not be fully protective in frail, elderly, and immunocompromised patients. If an outbreak of influenza should occur, the facility may wish to consider giving some patients and staff prophylactic antivirals. Long-term care facilities can reference the Influenza outbreaks in long-term care facilities: Toolkit for facilities in the event of an influenza or respiratory outbreak.
  • For those who have the flu (both staff and patients), antiviral treatment may reduce viral shedding. For this treatment to be effective, it must be started as soon as possible after symptoms begin and no later than 48 hours after onset.
  • Even if it's not influenza season, influenza testing should occur when any resident has signs and symptoms of acute respiratory illness or influenza-like illness. Information about influenza testing is available at:

How to Prevent Spread

  • Transmission commonly occurs from unprotected coughs or sneezes. Make sure tissues are available at all times, in all common areas, vehicles, and patient rooms. Patients and staff should cover their mouths when coughing and use a tissue when sneezing or blowing their noses. Tissues should be disposed of immediately, followed by proper hand washing (alcohol hand gels may also be used).
  • Provide an easily accessible container for proper disposal of tissues.
  • Any staff member suspected of having the flu should stay home.
  • Staff should use universal and droplet precautions when caring for patients.
  • Staff must practice good hand hygiene at all times. This means washing hands with warm water and soap for at least 15-20 seconds each time. Alcohol hand gels may be used if hands are not soiled.
  • Patients should wash hands or have hands washed before leaving rooms, after sneezing or coughing, and at other appropriate times. Alcohol hand gels can be used for this purpose if hands are not soiled.
  • Common use surfaces, such as door handles, handrails, table surfaces, etc., should be cleaned twice daily with disinfectant. (Bleach solutions or commercial disinfectants are appropriate.)
  • Ill patients should stay in their rooms. If many patients are ill, cohorting to a specific area or ward may be considered.
  • If cohorting is practiced, staff should be cohorted also; i.e., those caring for patients with influenza should not also care for other patients.
  • Family members and other visitors with respiratory illness should not be allowed into the facility.
  • For specific instructions regarding circulation of COVID and flu at LTCFs, review Health Alert Network (HAN)-537
  • 2023-694-5-11-UPD-IPC for Healthcare

Universal Respiratory Etiquette Strategy for Health Care Facilities (including clinics and EMS)

  • Do not forget that hand hygiene is the most important means of spreading germs. This means washing hands for 15-20 seconds with warm water, friction and soap, and drying with paper towels or air dryers. If hand washing is not available or convenient, antimicrobial hand gels can be used.
  • Provide surgical masks to all patients with symptoms of a respiratory illness prior to entry to facility or ambulance, if possible. Provide instructions on the proper use and disposal of masks. For patients who cannot wear a surgical mask, provide tissues and instructions on when to use them (i.e., when coughing, sneezing, or controlling nasal secretions), how and where to dispose of them, and the importance of hand hygiene after handling this material.
  • Provide hand hygiene materials in waiting room areas, and encourage patients with respiratory symptoms to perform hand hygiene.
  • Designate an area in waiting rooms where patients with respiratory symptoms can be segregated (ideally by at least 3 feet) from other patients who do not have respiratory symptoms.
  • Place patients with respiratory symptoms in a private room or cubicle as soon as possible for further evaluation.
  • Have health care providers (and others such as intake personal) use surgical masks during the processing and evaluation of patients with respiratory symptoms.
  • Instruct intake personnel to remain at least 3 feet from unmasked patients.
  • Use droplet precautions to manage patients with respiratory symptoms until it is determined that the cause of symptoms is not an infectious agent that requires more than standard precautions.
  • Encourage all health care providers to receive the influenza vaccine annually.