Influenza 2018

Guide for considering influenza testing when influenza viruses are circulating in the community (regardless of influenza vaccination history). 1Confirmation of influenza virus infection by diagnostic testing is not required for decisions to prescribe antiviral medication. Decision making should be based upon signs and symptoms consistent with influenza illness and epidemiologic factors. Initiation of empiric antiviral treatment should not be delayed while influenza testing results are pending. Antiviral treatment is clinically most beneficial when started as close to illness onset as possible. 2Signs and symptoms of uncomplicated influenza. 3Clinical manifestations and complications associated with influenza and persons who are at high risk of complications from influenza. 4All hospitalized patients with suspected influenza should be tested, as detection of influenza virus infection and prompt initiation of antiviral therapy are most clinically beneficial, and implementation of infection prevention and control measures is essential for prevention of nosocomial influenza outbreaks. 5Influenza testing may be used to inform decisions on use of antibiotics or continuation of antiviral medication, on need for further diagnostic tests, on consideration for home care, or on recommendations for ill persons living with others who are at high risk for influenza complications. 6Influenza testing may be required to inform decisions on infection control practices. 7Antiviral treatment is recommended for outpatients with suspected influenza who are at high risk for complications from influenza, or those with progressive disease not requiring hospital admission. Antiviral treatment of outpatients who are not at high risk for influenza complications can be considered based upon clinical judgment if presenting within 2 days of illness onset. Abbreviations: HF, heart failure; COPD, chronic obstructive pulmonary disease.

Here is an evidence based list of what you should be wearing to the ED

  1. “Bare below the elbows” (BBE): BBE is defined as wearing of short sleeves and no wristwatch, jewelry, or ties during clinical practice.
  2. White Coats: A doctor should have two or more white coats available and have access to a convenient and economical means to launder it OR should remove it prior to contact with patients or a patient’s immediate environment.
  3. Laundering: any apparel worn at the bedside that comes in contact with the patient or patient environment should be laundered after daily use; if laundering at home, a hot water wash cycle (ideally with bleach) followed by a cycle in the dryer or ironing has been shown to eliminate bacteria.
  4. HCP footwear: All footwear should have closed toes, low heels, and non-skid soles.
  5. Shared equipment including stethoscopes should be cleaned between patients.
  6. No general guidance can be made for prohibiting items like lanyards, identification tags and sleeves, cell phones, pagers, and jewelry, but those items that come into direct contact with the patient or environment should be disinfected, replaced, or eliminated.