CDC Urges Health Care Professionals to Use Proper H1N1 Infection Control Measures

Infected Workers Pose Risk to Patients, Colleagues
By David Mitchell

At least 81 health care workers across the country have confirmed or probable cases of novel influenza A (H1N1), evidence that some workers are not following CDC guidance for personal protection from infectious disease.

Michael Bell, M.D., associate director for infection control in CDC's Division of Healthcare and Quality Promotion, said in a June 18 news conference that health care workers should use fit-tested respirators, gloves and eye protection when caring for a patient with probable H1N1 infection.

He also said that such patients should be placed in single-patient rooms to reduce the risk of transmission, and they should be instructed about proper respiratory hygiene and cough etiquette. Good hand-washing hygiene also is a standard precaution.

Aerosol-generating procedures should be performed in rooms with negative-pressure air handling to prevent spread to other parts of the facility, said Bell. And it is critical that infectious patients be identified "at the front door" in order to protect health care workers and other patients.

The CDC said in its June 19 Morbidity and Mortality Weekly Report or MMWR, that as of May 13, the agency had received reports of 48 confirmed or probable cases of health care workers infected with H1N1 in 18 states. Since that date, however, additional cases have since been reported and are under review, according to Bell.

Of the original 48 cases, CDC has detailed information for 26 patients, half of whom were deemed to have contracted the infection in a health care setting. Of those, 12 were possibly or probably infected through contact with an ill patient, and one case involved worker-to-worker transmission. Of the 26 cases, two workers were hospitalized; neither died.

Bell said that in the more recently reported cases, proportionately more instances of worker-to-worker transmission occurred.

"I think it's very important that health care personnel understand that if they're ill, especially during an epidemic of influenza like this, they need to stay home," said Bell, adding that health care facilities should have appropriate leave policies in place and ensure employees know they won't be penalized for using sick leave.

None of the 12 workers infected by ill patients reported adhering to all recommended infection control practices. Only five reported always using gloves, three used either a mask or respirator, and none used eye protection. The one physician who did use a respirator had not been fit-tested for the equipment.


CDC officials said June 19 that there were 21,449 confirmed and probable H1N1 infections in the United States, with 87 confirmed deaths. The World Health Organization said June 19 there were 44,287 laboratory-confirmed cases worldwide, with 180 deaths.

Although CDC reports show that overall influenza activity in the United States decreased the week of June 7, with nine out of 10 surveillance regions reporting flu activity below baseline, Daniel Jernigan, M.D., Ph.D., deputy director of the CDC's Influenza Division, said during the June 18 CDC news conference there likely have been "hundreds of thousands" of cases in the United States, and the virus is expected to continue to spread here through the summer.

He added that the CDC is monitoring how the virus behaves during the flu season now going on in the Southern Hemisphere in preparation for the fall flu season in North America.


Children have been among those most seriously affected by the H1N1 virus, and Jernigan said it was no surprise that outbreaks have been reported at summer camps in multiple states. Accordingly, the CDC has issued guidance for camps and parents of campers.

Briefly, the agency recommends that people who have had influenza-like symptoms within the past seven days should not attend, work or volunteer in a camp until at least seven days after their symptoms began or until they have been symptom-free for 24 hours.

Camp staff, volunteers and campers should be able to recognize flu symptoms -- in themselves or others -- and report them to staff. Ill campers and staff should be isolated and treated.

Among other highlights in the CDC recommendations:

Parents should plan ahead for the possibility that their child could become ill while at camp. Camps should communicate with local public health authorities to develop plans for addressing potential outbreaks. Hand-washing facilities should be readily available to campers and staff, and they should be reminded to use good hand and respiratory hygiene.

People 18 or younger with a confirmed or suspected case of influenza should not be given aspirin or aspirin-containing products because of the risk of Reye’s syndrome.


Finally, the CDC also has issued guidance for use of the 23-valent pneumococcal polysaccharide vaccine, or PPSV23, during the outbreak. CDC officials are drawing attention to the agency's existing recommendations that all people ages 65 and older and those ages 2-64 years who have certain high-risk conditions receive a single dose of PPSV23 because people in these groups are at increased risk for both pneumococcal disease and serious complications from influenza.

Those high-risk conditions are:
chronic cardiovascular disease,
chronic pulmonary disease,
diabetes mellitus,
chronic liver disease,
cerebrospinal fluid leaks,
functional or anatomic asplenia, and
immunocompromising conditions.

Other high-risk patients indicated for PPSV23 vaccination are those ages 19-64 who smoke cigarettes or have asthma.