H1N1 Flu

Some Basic Precautions for All Workers

* H1N1 Flu - Self-EvaluationStay at home if you are sick. The HHS/CDC recommends that workers who have a fever or chills and a cough or sore throat stay at home until 24 hours after their fever ends (defined as 100 degrees Fahrenheit [37.8 degrees Celsius]), without the use of medication. Not everyone who has 2009 H1N1 flu will have a fever. Other symptoms could include a runny nose, body aches, headache, tiredness, diarrhea, or vomiting. Note that HHS/CDC has special instructions for workers returning to work in areas with severely immunocompromised patients.

Woman sneezing into a tissue

Washing hands
* Keep frequently touched common surfaces (for example, telephones, computer equipment, etc.) clean.

* Try not to use a coworker's phone, desk, office, computer, or other work tools and equipment. If you must use a coworker’s equipment, consider cleaning it first with a disinfectant.

* Stay in shape. Eat a healthy diet. Get plenty of rest, exercise and relaxation.

Vaccine

* If you are in a high risk category for 2009 H1N1 flu (e.g., pregnant women, persons with asthma, etc.) talk with your employer about alternative work assignments.

* Get vaccinated for both the seasonal and the 2009 H1N1 flu. For additional information about seasonal flu vaccine priorities, see Key Facts About Seasonal Flu Vaccine. For information about 2009 H1N1 flu vaccine priorities, see 2009 H1N1 Vaccination Recommendations.

Additional Precautions for Healthcare Activities
Your employer should use a combination of the workplace controls, work practices, and personal protective equipment listed below to reduce your exposure to the 2009 H1N1 virus. HHS/CDC has recommended these practices for use during the 2009-2010 flu season. Follow your employer's procedures for implementing these controls and use the protective equipment provided to reduce your exposure risk.

Workplace Controls

* Modify patient intake, triage and other service areas to increase space between workers, coworkers and patients (e.g., install partitions).

* If available, use airborne infection isolation rooms for aerosol-generating procedures and limit the number of people present during the procedure.

* Isolate and group 2009 H1N1 flu patients according to your facility’s procedures.

* Handle 2009 H1N1 flu specimens in Biosafety Level 2 equipment.

* Transport 2009 H1N1 flu patients in ambulances with separate ventilation systems for the driver and patient compartments or increase ventilation by operating the system in non-recirculation mode and letting in as much outdoor air as possible.

* Use closed suctioning systems to suction a patient’s airways and use high quality filters on the expiratory port of ventilators.

Safe Work Practices

* Screen incoming patients and separate those with respiratory illness.

* Only the staff necessary for patient care should enter patient and airborne infection isolation rooms.

* Restrict visits for patients in isolation.

* Use proper respiratory and cough etiquette, and encourage hand washing by patients and visitors.

o Cover your coughs and sneezes with a tissue, or cough and sneeze into your upper sleeve. Throw tissues into a "no touch" wastebasket.

o Clean your hands after coughing, sneezing, or blowing your nose.

o Avoid touching your nose, mouth and eyes.

* Wash your hands with soap and water for 20 seconds before and after contact with patients, after using PPE, and after touching contaminated surfaces; use an alcohol-based hand rub if soap and water are not available.

o When using soap and water, rub soapy hands together for at least 20 seconds, rinse hands with water, and dry completely.

o If soap and water are not available, use of an alcohol-based hand rub may be helpful as an interim measure until hand washing is possible. When using an alcohol-based hand rub, apply liquid to palm of hand, cover all surfaces of the hands with the liquid, and rub hands together until dry.

* Limit the transportation of 2009 H1N1 flu patients within the facility; use mobile diagnostic equipment and collect specimens in the room.

* Check yourself for symptoms of respiratory illness.

* Follow routine cleaning and disinfection strategies during flu season.

* Keep frequently touched common surfaces (for example, telephones, computer equipment, etc.) clean.

Personal Protective Equipment (PPE)

* Use a respirator when you come in contact with or enter the room of a patient who has or may have 2009 H1N1 flu; a fit-tested N95 disposable respirator or better is needed. This contact may include patient support tasks like dietary and housekeeping services when the patient is in the room.

* Use a respirator during aerosol-generating procedures; a fit-tested N95 disposable respirator or better is needed.

* Use gloves, gowns, and eye protection for any tasks that might cause contamination or create splashes.

Note: Demand for disposable respirators may outpace available supplies. Your employer should work with you so that you understand how the other controls identified above will be used to maximize the availability of respiratory protection and how disposable respirator use will be prioritized in your workplace if a severe shortage exists. See the NIOSH Trusted-Source page to verify which respirators are approved by NIOSH, and for more information about how to get and use NIOSH-approved respirators.

Other Work Practices

* Participate in any training offered by your employer. Make sure that you understand your exposure risk; your facility's policies and procedures for isolation precautions, use of workplace controls, work practices, and PPE protection during aerosol-generating procedures; and potential complications of 2009 H1N1 flu.

* Be ready for school and daycare closures; make backup child care plans

Planning for Social Distancing and Other Controls if Severity Increases

If the severity of 2009 H1N1 increases, your employer should be planning to use other control measures to reduce close contact among coworkers and with others in the workplace. Not all of the following options can be used in every workplace or for every job task. The controls that your employer uses will depend on how the workplace is set up and what the job task involves. Workplace controls that you employer should be considering include the following:

* Installing additional sneeze guards, and plexiglas or other barriers between you, coworkers, and the general public.

* Setting up work and service areas to increase the distance between you, coworkers and clients.
* Using the Internet, phone and drive-thru windows more for customer service.

* Avoiding close contact (within 6 feet) with coworkers and clients.

Man talking on the telephone
o Minimizing face–to–face meetings; using virtual/remote meetings, emails, phones and text messaging. If meetings are unavoidable, minimize close contact (within 6 feet) with others.

o Limiting visitors to minimize contact between workers and the general public.

o Physician with stethoscope and young boy Discouraging hand shaking.

For more information, see OSHA’s Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers. OSHA Publication No. 3328, which can be accessed at www.osha.gov. Also see HHS/CDC’s Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel.


This guidance is not a standard or regulation, and it creates no new legal obligations. It contains recommendations as well as descriptions of mandatory safety and health standards. The recommendations are advisory in nature, informational in content, and are intended to assist employers in providing a safe and healthful workplace. The Occupational Safety and Health Act requires employers to comply with safety and health standards and regulations promulgated by OSHA or by a state with an OSHA-approved state plan. In addition, the Act's General Duty Clause, Section 5(a)(1), requires employers to provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm.