Staying Ahead of Respiratory Illness Season: Best Practices for Healthcare Workers

Respiratory illness season is fast approaching once again and typically peaks in fall and winter. The CDC expects that the upcoming fall and winter virus season will likely have a similar or lower peak number of combined hospitalizations from COVID-19, influenza (flu), and Respiratory Syncytial Virus (RSV) compared to last year. At the time of this article, flu and RSV are being reported low nationally; COVID is elevated nationally, but there are signs of decline in many areas.

These viruses take root in the nose, mouth, airway, and/or lungs. Illnesses that have been reported are the flu, RSV, and COVID-19. Common signs and symptoms among all these illnesses range from fever, cough, runny/stuffy nose, chills, sore throat, and muscle/body aches. Some additional illness-specific symptoms include:

• COVID-19: new loss of taste or smell
• RSV: wheezing
• COVID-19 and influenza can present similar symptoms. Testing is the only way to distinguish between the two.

Illness Transmission

All these illnesses are transmitted differently. COVID-19 is reportedly transmitted through contact with respiratory fluids. A person can be exposed when an infected person coughs or speaks near them. They can also be exposed by inhaling aerosol particles. These particles can travel up to 6 feet and may be carried through the air in droplets so small that they stay in air currents, hence being at risk of being inhaled.

The flu virus is reportedly spread by large droplets when a person coughs, talks or sneezes. RSV can be spread through contact with droplets from the nose and throat of infected people when they cough and sneeze, direct contact (such as kissing the face of a child) or touching a surface with the virus on it (such as a doorknob), and then touching your face without washing your hands.

There are similar ways to prevent the spread of these illnesses. Hand hygiene is the single most critical measure in reducing transmitting organisms to your patients and your coworkers. Frequent hand washing, washing visibly soiled or dirty hands, and hand sanitizer use are three best practices when it comes to hand hygiene. The CDC also reports that vaccinations are one of the best things you can do to help protect yourself from serious diseases.

Preventing Transmission

However, there are other everyday ways to prevent transmission that can be done in healthcare to reduce the spread of these illnesses. To prevent the spread of respiratory illnesses, the CDC states that source control (masking) should be utilized when hospital admission rates are high and when levels of illness are high in your community. To alert patients of masking requirements, signs can be posted at the entrance of your facility and/or messaging on your business website, or a message can be included in their appointment reminders. Non-urgent treatment should be postponed for patients with suspected or confirmed respiratory illnesses.

Personal Protective Equipment (PPE) should be utilized and available during the delivery of healthcare. Use is determined based on the risk of exposure to blood, body fluids, saliva, and possible respiratory illness. PPE is to be provided and maintained by the employer. The different types of PPE are gowns, gloves, masks, eye protection, and N-95 respirators. N-95 respirators should be available and considered to be used during any aerosol generating procedures. Commonly known procedures that create aerosols in medical facilities are intubation, tracheotomy, CPR, bronchoscopy, and sputum induction. Dental equipment known to create aerosols are ultrasonic scalers, high-speed handpieces, air/water syringe, air polishing and air abrasion. It should be noted that fit testing is required for all N-95s prior to their first use and annually thereafter when they are used.

Employee Guidance

If a healthcare employee is sick with a respiratory illness, they should follow the CDC’s guidance on when to return to work:

1. COVID-19:

a) HCP with mild to moderate illness who are not moderately to severely immunocompromised could return to work after the following criteria have been met:

• At least 7 days have passed since symptoms first appeared if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7), and
• At least 24 hours have passed since last fever without the use of fever-reducing medications, and
• Symptoms (e.g., cough, shortness of breath) have improved.

*Either a NAAT (molecular) or antigen test may be used. If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later

b) HCP who were asymptomatic throughout their infection and are not moderately to severely immunocompromised could return to work after the following criteria have been met:

• At least 7 days have passed since the date of their first positive viral test if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7).

*Either a NAAT (molecular) or antigen test may be used. If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later

c) HCP with severe to critical illnesswho are not moderately to severely immunocompromised could return to work after the following criteria have been met:

• At least 10 days and up to 20 days have passed since symptoms first appeared, and
• At least 24 hours have passed since last fever without the use of fever-reducing medications, and
• Symptoms (e.g., cough, shortness of breath) have improved.

2. Flu: Employees with confirmed flu who have a fever should be fever free for 24 hours without the use of fever-reducing medicine. Employees with suspected or confirmed flu, who do not have a fever, should stay home from work at least 4-5 days after the onset of symptoms.

3. RSV: Employees with RSV are contagious for 3 to 8 days. Employees can return to work when fever free for at least 24 hours and symptoms have improved.

With these measures in place and following the guidance from the CDC and other resources, we can provide a safe, healthy environment for our patients as well as our employees.