Protecting against Swine Flu

during a pandemic, the most successful infection control measures will be those which are the most easily understood and followed. outside the healthcare setting, the primary focus of businesses should be on environmental, organisational and general hygiene measures (see page 11 for more information) to reduce the risk of transmission of flu.

self-isolation by individuals with symptoms consistent with an influenza-like illness (iLi) is central to containing the spread of the flu virus. in addition, respiratory etiquette (using disposable tissues,2 covering the mouth when coughing or both nose and mouth when sneezing) and disciplined hand hygiene will help to reduce the spread of flu among the healthy population. These measures should not be neglected on the assumption that more specific measures, such as the use of face masks, will work.

broadly speaking, the circumstances where face mask use may possibly play a part in reducing the risk of infection would be where they are used by symptomatic individuals to retain infectious droplets (thereby preventing them spreading the virus to others) or where someone is in close contact (less than one metre away) with someone known to have symptoms consistent with an iLi.

if face masks are worn, staff must follow the procedures for their safe use, paying particular attention to how they are both removed and disposed of. staff may expose themselves to additional risk of infection if they fail to use or dispose of face masks correctly. The use of a face mask must not decrease the strict application of other, more relevant, infection control measures.

businesses may want to use this guidance to determine the most appropriate ways to reduce the spread of the flu virus within the work environment and build this into their business continuity planning.

What is Pandemic flu?

flu is a familiar infection in most countries, especially during the winter months. The illness, caused by the flu virus, can be mild or severe and, occasionally, can lead to death. Generally, some groups of people are more susceptible to the complications of flu than others, especially older people and people of any age with certain medical conditions. This is why the seasonal flu vaccination is recommended to these groups of people each year.

a pandemic is a worldwide epidemic. Pandemic flu is different from seasonal flu because it occurs when a new flu virus emerges into the human population to which most people will be susceptible and which can be spread easily from person to person worldwide – all countries will be affected. This will result in many more people becoming severely ill and potentially many more deaths than occur due to seasonal flu. although a pandemic has not yet started, experts warn that the next one could occur soon.

signs and smptoms of flu

it is likely that the signs and symptoms of pandemic flu will be similar to those of seasonal flu, but they may be more severe and cause more serious complications.

The most significant symptoms are the sudden onset of:

●● fever

●● cough or shortness of breath.

Other symptoms may include:

●● headache

●● tiredness

●● chills

●● aching muscles

●● sore throat

●● runny nose

●● sneezing

●● loss of appetite.

The incubation period (time between contact with the virus and the onset of symptoms)

The range is from one to four days, though for most people it will be two to three days.

The infectious period (how long you are infectious to others)

People are most infectious soon after they develop symptoms. They can continue to spread the virus, for example in coughs and sneezes, for up to five days (seven days in children). People become less infectious as their symptoms subside, and once symptoms are gone, they are considered no longer infectious to others.

How is Pandemic flu caught and
spread to others?

it is likely that pandemic flu, just like seasonal flu, will spread from person to person by close contact. some examples of how it can be spread include:

●●    large droplets from coughing and/or sneezing by an infected person within a short distance (usually 1 metre or less) of someone

●●    touching or shaking the hand of an infected person and then touching your mouth, eyes or nose without first washing your hands

●●    touching surfaces or objects (eg door handles) that have become contaminated with the flu virus and then touching your mouth, eyes or nose without first washing your hands.

What should individuals do if
They Have symptoms or are ill?

if an individual feels ill with symptoms consistent with an iLi while at work, it is important that he or she does not simply carry on working.

Their symptoms should be reported immediately to their manager or the occupational health department and, if they are consistent with flu, the individual should be sent home.

They should be advised to contact the national Pandemic flu Line service (which will be in operation at the outset of the pandemic) and told not to return to work until the symptoms have cleared and they feel well enough to return.

if individuals develop symptoms while not at work, they should adhere to the following advice:

●●    stay at home (self-isolate).

●●    do not go to work until you are fully recovered.

●●    contact the national Pandemic flu Line service for advice and an initial assessment of symptoms in the first instance.

●●    inform your employer or occupational health department to let them know you are ill.

What should individuals do to Protect Themselves and others from Pandemic flu?

it is important that the following practices are adhered to:

●●    individuals should use a tissue to cover their nose and mouth when coughing and/or sneezing, dispose of the tissue promptly and then wash their hands.

●●    Tissues should be disposed of in domestic waste – they do not require any special treatment.

●●    individuals should not use cloth handkerchiefs or reuse tissues. This practice carries a risk of contaminating pockets or handbags which may then recontaminate hands every time they go into those pockets or handbags.

●●    individuals should clean their hands frequently, especially after coughing, sneezing and using tissues. soap and water is a perfectly effective means of cleaning hands; however, handrubs (microbicidal handrubs, particularly alcohol-based) can be used as an alternative.

●●    individuals should minimise touching of the mouth, eyes and/or nose, unless they have recently cleaned their hands.

●●    normal household detergent and water should be used to clean surfaces frequently touched by hands.

●●    individuals should clean their hands as soon as they get to work and when they arrive home.

Model for risk assessment

The following section provides details on the route of transmission/spread of the flu virus and the routes for reducing the potential for spread.

spread of the disease

for disease to spread within a community there must be a source of infection, a route by which the infection is transmitted, and individuals who are susceptible to the disease. This is illustrated below, along with additional information.

Source

Transmission

Recipient

The source – the symptomatic individual

it is generally accepted that individuals should be considered potentially infectious from the time symptoms appear to the time their symptoms have completely disappeared. in general terms, the more severe the symptoms, the more infectious a person is likely to be.

Transmission – via droplets over a distance of under 1 metre or direct/indirect contact

flu is generally transmitted from person to person through close contact and over short distances – in the region of 1 metre. This pattern of transmission is known to be associated with spread by respiratory droplets from coughs and sneezes, by direct contact with an infected person, or indirectly from objects or surfaces which have become covered with virus-infected secretions.

flu viruses are easily removed or destroyed by soap and water, normal household detergents or handrubs (microbicidal handrubs, particularly alcohol-based).

The recipient – the susceptible individual

in order to pass on the virus, individuals who are susceptible to the disease must be present. until an individual has acquired immunity, either through natural infection or through vaccination, they remain at risk of infection.

for a person to become infected with pandemic flu, each one of three elements must be present: (1) an individual with symptoms consistent with an iLi (2) who transmits the virus by direct or indirect contact with (3) a susceptible individual.

Mitigating actions

interventions that block all or part of the transmission route of a virus from a person with symptoms consistent with an iLi to a susceptible person have the potential to stop the chain of infection. These interventions generally have one of the following objectives:

reduce transmission of infection from an individual(s) with symptoms consistent with an iLi to a susceptible person, and/or

reduce the risk of susceptible people becoming infected.

The measures that businesses may want to consider in an effort to reduce the spread of a flu virus within the work environment fall into three broad categories:

Environmental

actions taken within the environment to reduce the spread of the flu virus

Organisational

actions taken to modify behaviour and practice in the workplace to help reduce the spread of the flu virus

Individual behaviour

actions taken at the level of the individual to restrict the spread of the flu virus

These actions are ranked in this way to reflect their potential effectiveness. in general, the most effective measures will be those that are easy to accommodate, implement and interpret within a given workplace.

The use of personal protective equipment, such as face masks, by individuals is deemed to be the least effective because it relies on compliance and interpretation of guidance, and is easy for individuals to misuse, misapply or fail to use. it tends to give a false sense of protection and can lead to the abandonment of other, more effective, control measures. The specific evidence base regarding the use of face masks by the general public is currently too uncertain and too limited to firmly support face masks for use by the public during a flu pandemic.3