Basic ways to prevent nosocomial influenza
Hospitals may take different approaches to surveillance and control of influenza. But here are some basic points that experts agree on:
- Vaccination is the primary way to prevent nosocomial spread of influenza.
Despite this well-established fact, immunization rates of health care workers remain low. The 1997 National Health Interview Surveys found that 34% of health care workers received the influenza vaccine. While that represents a rise from a rate of just 10% in 1989, it is still well below levels that could prevent nosocomial spread.
"Every year, we need to focus on getting maximal vaccination rates of staff members," says Larry Strausbaugh, MD, project director of the Infectious Diseases Society of America (IDSA) Emerging Infections Network in Alexandria, VA.
- Hospitals should have a policy for responding to nosocomial outbreaks.
The IDSA survey found that only 35% of hospitals had a written policy for controlling outbreaks. What was contained in those policies varied greatly, but they addressed droplet precautions, the cohorting of patients, and the use of chemoprophylaxis.
For example, in some institutions, unvaccinated health care workers exposed to influenza cannot work outside the "outbreak" unit.
Cohorting of patients — or grouping together patients with respiratory illness or confirmed influenza — is an established way of reducing spread, as is the use of masks and other basic hygiene techniques, says Carolyn Buxton Bridges, MD, a medical epidemiologist in the influenza branch of the Centers for Disease Control and Prevention.
- Rapid diagnostic tests should be available to diagnose influenza.
These tests, which provide results within hours, greatly enhance the ability to detect and respond to nosocomial influenza. They can be used to screen health care workers who come to work with flu-like respiratory symptoms. "If you have a screening policy, you would like to get the result within a day or so to ensure that the patient is adequately segregated or that health care workers are using protective equipment," says Strausbaugh, hospital epidemiologist and staff physician at Portland (OR) Veterans Affairs Medical Center. "If you have to wait a week or so for a viral culture to come back, clearly you are greatly delayed."
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