The First Facility Management Blog

For the protection of frontline healthcare and emergency medical workers at high risk of infection, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued a compliance directive earlier this week to ensure uniform procedures when conducting inspections to identify and minimize or eliminate high to very high risk occupational exposures to the 2009 H1N1 influenza A virus.The directive, which closely follows the Centers for Disease Control’s (CDC) guidance, is available as a PDF.

“OSHA has a responsibility to ensure that the more than nine million frontline healthcare workers in the United States are protected to the extent possible against exposure to the virus,” said acting Assistant Secretary of Labor for OSHA Jordan Barab. “OSHA will ensure healthcare employers use proper controls to protect all workers, particularly those who are at high or very high risk of exposure.”

In response to complaints, OSHA inspectors will ensure that healthcare employers implement a hierarchy of controls, and encourage vaccination and other work practices recommended by the CDC. Where respirators are required to be used, the OSHA Respiratory Protection standard must be followed, including worker training and fit testing. The directive also applies to institutional settings where some workers may have similar exposures, such as schools and correctional facilities.

The CDC recommends the use of respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for healthcare personnel who are in close contact (within six feet) with patients who have suspected or confirmed 2009 H1N1 influenza.

Where respirators are not commercially available, an employer will be considered to be in compliance if the employer can show a good faith effort has been made to acquire respirators.

Where OSHA inspectors determine that a facility has not violated any OSHA requirements but that additional measures could enhance the protection of employees, OSHA may provide the employer with a hazard alert letter outlining suggested measures to protect workers further.

The 2009 H1N1 influenza is transmitted via direct or indirect person-to-person spreading of infectious droplets passed when an influenza patient coughs, sneezes, talks, or breathes. Transmission occurs when expelled infectious droplets or particles make direct or indirect contact with the mucus membranes of the mouth, nose, or eyes of an uninfected person. The OSHA directive and other guidelines show steps to eliminate the hazard.

Under the Occupational Safety and Health Act of 1970, OSHA’s role is to promote safe and healthful working conditions for America’s men and women by setting and enforcing standards, and providing training, outreach and education.

This Web Exclusive comes from Peter M. Leahy, segment manager, Office Building & Lodging, Kimberly-Clark Professional.

It happens around this time every year. The sore throats, runny noses, and coughs herald the start of flu season.

Up to 20% of the U.S. population gets the seasonal flu annually. More than 200,000 are hospitalized with flu-related complications, and 36,000 people in this country die from flu-related causes.

This year, the emergence of the H1N1 influenza virus—which has caused the first influenza pandemic (global outbreak of disease) in more than 40 years—may cause this flu season to be worse than a regular flu season. It is thought that a lot more people will get sick, be hospitalized, and die than during a typical flu season. As of October 25, there have been more than 440,000 confirmed cases of H1N1 and 5,700+ deaths worldwide, according to the World Health Organization, which cautions that the actual number of cases (ie, milder, unreported cases) is likely significantly higher.

While flu outbreaks can happen before the winter months set in, most of the time influenza activity peaks in January or later. This year, the 2009 H1N1 virus caused illnesses, hospitalizations, and deaths in the U.S. even during the summer months, when influenza is very uncommon.

The uncertain severity and timing of this year’s seasonal-plus-H1N1 flu activity means that schools, businesses, and workplaces need to prepare for higher absenteeism rates, along with cases of presenteeism—when someone goes to work or school while sick—leading to productivity declines and the possibility of spreading illness to others.

Fortunately, there are several things facility managers can do to help prepare their employers and occupants of their buildings for the upcoming flu season and to respond if an outbreak occurs in their facilities. Even seemingly simple strategies like facility sanitation and giving occupants the tools they need for proper personal hygiene can help reduce the spread of germs during flu season and other times of the year.

Influenza 101
Some people may confuse the symptoms of the common cold with those of the flu. Both viruses enter the body through the mucous membranes of the nose, eyes or mouth. Cold symptoms are less severe than flu symptoms and typically begin with a sore throat, which usually goes away after a day or two. Nasal symptoms, runny nose, and congestion follow, along with a cough by the fourth and fifth days. Fever is uncommon in adults. Cold symptoms usually last for about a week with the contagious period being the first three days.

The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times it can lead to death. Some people—including older people, young children, pregnant women, and people with certain health problems such as asthma, diabetes, or heart disease—are at increased risk for serious complications from the flu. These may include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions.

Someone infected with the flu may be able to infect others beginning one day before symptoms develop and up to seven or more days after becoming sick. Symptoms of seasonal flu include:

• Fever (often high)
• Headache
• Extreme tiredness
• Dry cough
• Sore throat
• Runny or stuffy nose
• Muscle aches
• Stomach symptoms such as nausea, vomiting, diarrhea (particularly associated with H1N1 flu)

Flu viruses spread mainly from person to person through coughing or sneezing. Sometimes, people may become infected by touching something with flu viruses on it and then touching their mouth or nose. In fact, some germs can live for two hours or more on surfaces like doorknobs, desks, and tables.

Preventing the Spread of Flu: Education
There are several steps facility managers can take to help prevent the spread of influenza and other germs in their buildings. Education is critical; people not only need to know how to spot the signs of flu (as outlined above) so they can care for themselves appropriately, they also need to know how to avoid getting sick in the first place and how to avoid spreading germs to others.

Consider instituting a Healthy Tips campaign with letters to building occupants and posters in prominent locations detailing recommendations from health experts like the Centers for Disease Control and Prevention, which advocates the following tips to help stop the spread of germs:

• Cover your mouth and nose when you sneeze or cough. It’s best to cough or sneeze into a tissue, which should be thrown away after it is used, or into one’s sleeve. If you sneeze or cough into your hands, be sure to clean your hands afterward—every time you cough or sneeze.
• Clean your hands often. When possible, use soap and warm water and rub hands vigorously together for 15 to 20 seconds, scrubbing all surfaces of the hands to help dislodge and remove germs. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. If using a gel, rub the gel in your hands until they are dry.
• Avoid touching your eyes, nose, or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
• Stay home when you are sick (and for at least 24 hours after fever is gone) and check with a health care provider when needed. Keeping your distance from others may protect them from getting sick.

The CDC offers free, downloadable posters and other materials to help you get started at these links: www.cdc.gov/germstopper/work.htm and www.cdc.gov/flu. In addition, the World Health Organization posts a visual, step-by-step guide for proper handwashing here. Consider posting this guide in every restroom in the building as well as by hand sinks in break areas.

Preventing the Spread of Flu: Facility Issues
Educating yourself and building occupants about how to prevent the spread of flu is only one step. You’ll also need to make sure you have the right infection control tools for the job. That means stocking workstations and public areas with plenty of facial tissue. Anti-viral facial tissue is now available for this purpose. In addition, you should install wall-mounted dispensers for alcohol gel hand sanitizers throughout your facility. It’s also important to make sure restrooms don’t run out of hand soap and paper towels, and that sufficient numbers of no-touch disposal receptacles are provided for used hand towels and used facial tissue. Keeping surfaces spot-sanitized throughout the day is another good idea.

When stockpiling items like hand soaps and cleaning supplies, the Occupational Safety & Health Administration recommends being aware of each product’s shelf life and storage conditions (e.g., avoid areas that are damp or have temperature extremes) and incorporating product rotation (e.g., consume oldest supplies first) into your stockpile management program.

One area of particular concern when stepping up facility sanitation efforts is the restroom—an area where microorganisms can flourish. Lavatory surfaces that are touched frequently may serve as reservoirs of microbial contamination. In fact, research from Dr. Charles Gerba of the University of Arizona discovered high amounts of bacteria on restroom surfaces:

• The average toilet paper dispenser has more than 150 times the amount of bacteria than the average toilet seat.
• Paper towel dispensers were found to have more than 50 times more bacteria on average than a typical public restroom toilet seat.

Facility managers looking to minimize the potential spread of germs can install touchless restroom dispensing systems. The electronic revolution that has taken place in the washroom in recent years has greatly enhanced restroom hygiene by eliminating the need to touch dispensers, faucets and toilet handles during use. These systems can help make the task of using as well as maintaining the restroom easier, more efficient and more cost-effective.

Not all touchless systems are electronic, however. There are also mechanical no-touch towel dispensers, for example, with no levers to pull, that provide the same hygienic benefits as sensor-activated dispensers. Continue the no-touch theme by providing no-touch disposal receptacles for used towels and installing doorless entryways so that freshly washed hands don’t have to grab a dirty door handle on the way out of the restroom.

Remember that nothing says unhygienic more than a restroom without an adequate supply of toilet paper, hand soap, and paper towels. Highcapacity systems help ensure adequate supply as well as ease maintenance headaches and reduce costs and waste.

Not All Disinfection Methods Are Equal
While germs are common on certain surfaces in the restroom, they can also flourish throughout a building. To prevent the spread of flu, the CDC recommends that routine cleaning of commonly touched surfaces be performed regularly. Use the cleaning agents that are usually used in these areas, and follow directions on the label.

In the case of a flu outbreak, facility managers may choose to increase their surface sanitation efforts. If that happens, it is important for janitorial staff to minimize contamination of the cleaning solution and cleaning tools used for these efforts. Keep in mind that bucket solutions become contaminated almost immediately during cleaning, and continued use of the solution transfers increasing numbers of microorganisms to each subsequent surface to be cleaned. Another source of contamination in the cleaning process is the cleaning cloth, especially if left soaking in dirty cleaning solution. This is why the choice of wiping materials is important.

Indeed, it may be surprising to learn that common systems, such as using a cotton rag or cellulose-based wiper to apply common disinfectants such as bleach to surfaces, deliver less-than-ideal concentrations of disinfectants to the surface. However, a non-woven wiper designed specifically to be compatible with bleach (and used in a closed-bucket system) can keep the active bleach ingredients stable for 72 hours, allowing a much higher concentration of active ingredients to reach the surface being cleaned, according to recent studies.

An enclosed system, with pre-saturated wipes dispensed from a port in the top of the closed bucket, helps avoid contamination of the wipes and cleaning solution while reducing exposure to chemical vapors and splashes, an advantage for janitorial staff.

According to the CDC, businesses and employers, in general, can play a key role in protecting employees’ health and safety, as well as in limiting the negative impact of influenza outbreaks on the individual, the community, and the nation’s economy. Facility managers should be on the front lines in the war against the flu and other germs in their facility. A combination of education and effective flu-prevention tools and practices will put facilities and their occupants in a good position to avoid the brunt of the flu this season.

Additional Resources
The CDC has published a number of Guidance documents to help different groups and facilities decrease the spread of flu:

• CDC Guidance for Businesses and Employers to Plan and Respond to the 2009-2010 Influenza Season
• CDC Guidance for Responses to Influenza for Institutions of Higher Education during the 2009-2010 Academic Year
• CDC Guidance for State and Local Public Health Officials and School Administrators for School (K-12) Responses to Influenza during the 2009-2010 School Year

With cold and flu season upon us, spending time reviewing your HVAC system, its major components, and air and water distribution is time well spent to help mitigate the spread of type A (H1N1) and other types of Influenza. Some of the precautions may be based on adopting simple common sense measures, while others are related to proper maintenance protocols. In addition, there are system upgrades that can be performed to help mitigate risks. Below is a list of tips to consider during cold and flu season:

• Monitor facilities to ensure that no warm, stagnant water is present (which can provide an environment conducive to the growth of problematic microbes such as Legionella, the cause of Legionnaire’s Disease).
• Monitor areas including cooling towers, pooled water on roofs, or clogged drains that can harbor unhealthy contaminants that can be introduced into the building and circulated by the air distribution systems into occupied spaces.
• One simple change facilities can implement is to upgrade the efficiency of the air filters. As filter efficiency increases, typically their resistance to air flow also increases. Always check to be sure the fan system can handle the resistance being imposed by the filters and other components in the system. Also, select replacement filters based on the specific particles you intend to collect. Viral droplets or droplet nuclei of influenza, for instance, are very small but are typically surrounded by a mucus shell making them larger and easier to remove.
• It is necessary to re-evaluate how and when filters should be changed. Rather than set a simple schedule, it may be more prudent to measure the pressure drop through filter banks and set up basic performance metrics to determine the best model for filter changes.
• Simple measures are the first line of defense. Technicians should wear cut-resistant gloves when performing filter changes or basic maintenance to air dampers and commonly exposed system components. Also, properly fit respirators may help to ensure that the risk of exposure while working above the ceiling or in poorly ventilated areas is minimized.
• A common service and maintenance procedure is to verify correct outside air intake dampers settings and operation. Most commercial spaces should operate at a slightly positive pressure relative to the outdoors to reduce the likelihood of contaminants infiltrating into the occupied areas.
• Check and validate restroom and other critical area exhaust fans to assure they are removing contaminants from the building before they become mixed with the indoor air. Perform preventive maintenance on small exhaust fans to ensure they have not accumulated dirt, reducing their effectiveness.
• Provide staff with basic training and increase overall awareness about the risks of influenza exposure and the likely ways to contract the virus. Also, conduct formal training of staff technicians and subcontract workers in how to work with your building systems to reduce risk and increase health and safety as well as reducing exposure to other harmful airborne particles.
• Direct contact is the most common pathway for the spread of disease. Communicate influenza safety tips and precautions to all building departments – especially those whose primary function includes occupancy of guests, visitors, and the general public.
• Encourage hand washing among all staff. If possible, add hand cleaner and hand sanitizer supplies at air handler locations, equipment controls, railings and access doors.

There are many resources to provide details and more complete planning recommendations including:

• · IFMA Foundation’s Pandemic Preparedness Manual
• · The Center for Disease Control and Prevention
• · The Federal Emergency Management Agency

These tips have been provided by Trane (although the image at the beginning of the article was supplied by Cathy Aste).

RNs from the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) have filed an urgent plea with the state of California to step in and force Sutter Solano Hospital to provide nurses with proper safety equipment when they care for patients infected with the H1N1 “swine flu” virus. The nurses fear that the unsafe procedures at the hospital create a danger of infection for every patient at the facility as well as for the surrounding community.

The plea comes as nurses are actively caring for hospital patients infected with the virus. And with up to 10 RNs from the facility experiencing severe respiratory illness in recent weeks that their physicians have called “probably” the swine flu, many have been left physically unable to work.

The nurses requested assistance from the California Division of Occupational Health and Safety just days after the World Health Organization re-classified H1N1 as an “unstoppable” Level 6 pandemic, with the number of confirmed cases worldwide approaching 100,000, and 170 confirmed deaths in the United States alone.

Sutter Solano has purchased so few of the proper N95 masks that most nurses working with patients are unable to procure an adequate supply of disposable masks. The union has raised its concerns with management.

The hospital has supplied new masks that did not properly fit, making them useless for stopping the virus. Management responded by ordering the nurses to wear a contact mask on top of the ill-fitting N95 masks, but the nurses raised concerns because doing so can increase carbon dioxide retention in the mask wearer. Previously, management had given nurses a single mask in a plastic bag with instructions to re-use it repeatedly, rendering the mask useless for infection control purposes.

Compounding these problems, some rooms with infected patients lack appropriate HEPA filters, and proper isolation protocol is not being followed, with visitors moving in and out of contact with infected patients.

“Nurses will be on the front line of the fight against the H1N1 virus. However, if hospitals refuse to take basic safety steps to protect them from exposure, then infected RNs will be physically unable to continue working and may well become a vector for further infection. We nurses are shocked that hospital management is exposing us to this risk. It endangers every other person we come into contact with—our patients, our family, even management. This is not a time for finger pointing, this is the time for Sutter Solano management to do their job and provide nurses with basic safety protections,” said Sherry Ramsey, a RN at Sutter Solano.

Hospital management has claimed that there is a national shortage of the appropriate masks, a charge not verifiable in any way: neither the Centers for Disease Control nor the mask’s manufacturers have reported any shortage, and other hospitals are able to provide their nurses with this safety protection.

“Sutter Health is an outlier with their refusal to protect nurses against the H1N1 virus. They must immediately move to safeguard these nurses, because we have a very busy and deadly flu season coming up, and hospitals must meet safety standards,” said Deborah Burger, RN, a diabetes case management nurse and co-President of CNA/NNOC.

Now available as an online course, the International Facility Management Association’s (IFMA) Pandemic i-Session is now available anytime, anywhere, so it can be ordered and viewed at the convenience of the facility manager (fm)

This i-session helps fms prepare for current and future pandemics by focusing on challenges and priorities. Case studies from the current swine flu pandemic will be used to assist participants with establishing response plans.

Facility professionals charged with crisis management, emergency preparedness, and business continuity are encouraged to participate in this workshop. The information obtained will assist them in protecting their organizations, minimizing panic, and highlighting proactive measures to senior management.

Fms who participate in this session should learn how to:

• Understand the risk factors and control options for pandemic planning and response.
• Define response priorities customized for your organization.
• Identify triggers and actions for your organization.

This session is delivered by Stephen Craig, CBCP, CPM, managing principal for EORM’s Business Continuity Planning Practice. Craig is a molecular biologist by training, and prior to joining EORM in 2003, he managed the facilities and EHS functions in the biotechnology industry.

Professionals who complete the class will early .15 CEUs and 1 CFM maintenance point. The course costs $99 (IFMA/SAME/Alliance members) or $125 (all others).

Wahl Instruments offers a line of Fever Alert™ products designed specifically for rapid screening of individuals in public places for elevated body temperatures, aimed at potentially minimizing the spread of Swine and Bird flu.

Fever Alert from Wahl Instruments detects elevated body temperatures.

The new line from Wahl offers the flexibility to choose the product that bests suits the user application. These include a handheld infrared thermometer, a thermal imaging camera, and a high resolution thermal imaging system. Wahl Fever Alert™ products detect the hottest temperature on a subject, facilitating further evaluation. They detect critical temperature differences in real time and give off both audible and visible alarms for increased body temperature, or fever above the “normal” (98.6°F or 37°C) which is often a relevant clinical indication of possible infection.

Companies, health departments, government agencies, and all public facilities could benefit from using Wahl Fever Alert™ products to screen individuals, potentially minimizing the spread of Swine and Bird flu. There is no delay processing people with Wahl’s Fever Alert™ products. Non-contact and non-invasive, they are safe for both the subject and the operator. Also available is a blackbody temperature reference source which allows for calibration verification of the unit prior to, and during, use.

Let’s all take a moment to applaud ”big media” for cultivating a culture of ignorance, fear, and “crisis saturation.” How many examples can we count where big media was fanning the flames of global hysteria for relatively minor incidents? From religion to politics to the environment (is there really a difference between these three subjects any more?), how can anyone really know when they should start paying attention to the 24/7 news cycle?!

Pick your favorite crisis and decide which of these REALLY justified sounding the global panic alarm:  Pending Ice Age?  Killer Bees?  Y2K Meltdown?  SARS?  EBOLA?  AIDS?  Ozone Layer?  Global Warming?  Avian Flu?  CO2?  Polar Bears? 

Are things different this time?  Is the so-called “Swine Flu Virus” a potential global pandemic that could kill millions similar to past epic plagues?  Or will it prove to be another Y2K media-fueled exaggeration?

Only time will tell, but have you ever considered how many college kids and business travelers returning from Mexico have brought back a sexually transmitted disease compared to the numbers that may have contracted a unique strain of flu?
 
A few more questions to ponder: 

• How many pedestrians will be hit by vehicles in New York City today? 
• How many murders took place in Detroit last year? 
• How many women are chronic victims of domestic abuse or rape? 
• How many fatal vehicle accidents are caused by drunk drivers each day? 
• How many children will be molested or abused by family members this year? 
• How many people of faith are assaulted, maimed, executed, and denied basic human rights in various parts of the world each day? 
• How many homeowners and convenient store clerks have prevented a crime by owning a gun?
• How many terror plots have been disrupted by the U.S. and international allies since 2001?
• How many terror plots might be resurrected as the new administration “stands down” and refuses to even utter the word “terrorist”?
• How many people vote but pay ZERO income taxes?
• Are obese kids the victims of child abuse?

 
Are any of these stories worthy of “epic” media coverage today, tomorrow, next month?  Which of them should earn the most “buzz” and attention?
 
So thanks for nothing, big media.  How does it feel to help the ignorant masses go on living from one soundbite to the next without any real sense of priority, scale, or context?
 
Poor Richard

[For FacilityBlog's coverage of swine flu, click here.]

The following post is based on information provided by Stephen Ashkin, president of The Ashkin Group and leader in the green cleaning and maintenance industry. It has been supplemented with information from IFMA and updated with data from CNN.

On Sunday (4/26/09), the U.S. Department of Homeland Security declared a public health emergency in a bid to stop the spread of a swine flu virus. As of today (4/28/09), the World Health Organization has raised its pandemic alert level based on newly gathered data.

Richard Besser, acting director of the U.S. Centers for Disease Control and Prevention (CDC), said his agency has confirmed 50 non-fatal cases of swine flu within the United States, including several cases found among New York City high school students. The other cases were detected in Ohio, Kansas, Texas, and California. Besser indicated that the U.S. cases were identical to the swine flu that has been hitting Mexico, where 152 deaths were deemed “likely linked” to the new strain of the virus with more than 1,600 reported ill.

The following are some “tips” for limiting the risk of catching the swine flu. These suggestions come from the CDC. WebMD has also compiled a list of “Frequently Asked Questions” that may help facilities professionals deal with this issue on a personal and professional basis. (This list appears below.)

Additionally, the International Facility Management Association has a free Pandemic Preparedness Manual, a valuable resource for those facility managers (fms) charged with the task of developing an action plan. Workplaces have a vested interest in mitigating the effects of a pandemic. The Spanish flu of 1918, for example, affected hundreds of millions of people and resulted in more than 50 million fatalities. Today, a flu outbreak could lead to the absenteeism of 25% to 50% of employees for up to four months, potentially causing supply chain disruptions and the closure of retail facilities, further impacting the global economic downturn. The IFMA Foundation’s PDF is available for download here: pandemic.

There are several easy and affordable ways for fms to assist with employee health, including:

• Displaying hand care posters for the restroom;
• Providing articles for their internal newsletters (such as the CDC tips presented below);
• Posting small signs and other materials to encourage hand washing:
• Considering the installation of waterless hand sanitizer stations in their buildings (to be used in addition to washing with soap and water, not in lieu of it); and
• Placing hand sanitizing stations strategically around the facility where employees congregate—such as elevator lobbies, break rooms, etc. (people tend to use resources that are provided in plain view).

CDC’s tips for limiting your risk of catching the swine flu virus:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
• Try to avoid close contact with sick people.
• If you get sick, stay home from work or school and limit contact with others to keep from infecting them.
• Avoid touching your eyes, nose, or mouth. Germs spread that way.

Frequently Asked Questions from WebMD:

What is swine flu?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people.

Are there human infections with swine flu in the U.S.?
In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses were first reported in Southern California and near San Antonio, Texas. Other U.S. states have reported cases of swine flu infection in humans and cases have been reported internationally as well. An updated case count of confirmed swine flu infections in the United States is kept here. CDC and local and state health agencies are working together to investigate this situation.

Is this swine flu virus contagious?
CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it not known how easily the virus spreads between people.

What are the signs and symptoms of swine flu in people?
The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

How does swine flu spread?
Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

How can someone with the flu infect someone else?
Infected people may be able to infect others beginning 1 day before symptoms develop and up to seven or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

What should I do to keep from getting the flu?
First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

Are there medicines to treat swine flu?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within two days of symptoms).

How long can an infected person spread swine flu to others?
People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to seven days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches their own eyes, mouth or nose before washing their hands.

How long can viruses live outside the body?
We know that some viruses and bacteria can live two hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent handwashing will help you reduce the chance of getting contamination from these common surfaces.

What can I do to protect myself from getting sick?
There is no vaccine available right now to protect against swine flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. (See aforementioned list of tips from the CDC.)

What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. Wash with soap and water. or clean with alcohol-based hand cleaner. we recommend that when you wash your hands—with soap and warm water—that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?
If you live in areas where swine influenza cases have been identified and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed. If you become ill and experience any of the following warning signs, seek emergency medical care.

In children emergency warning signs that need urgent medical attention include:

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

How serious is swine flu infection?
Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died eight days later. A swine flu outbreak in Fort Dix, NJ occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

Can I get swine influenza from eating or preparing pork?
No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products.

Additional CDC Resources:
General Information About Swine Flu
CDC Health Advisory (pdf) download here: CDC Health Advisory