The current 2009 H1N1 influenza pandemic and the start of seasonal influenza season is a good time to for all of us to review infection prevention and control etiquette, especially when going to hospitals and health care facilities. Basic infection control measures can go a long way in preventing the spread of influenza.

This is especially important since vaccine is currently in short supply for seasonal influenza. H1N1 vaccine is just starting to reach some of the groups at the highest risk for complications, pregnant women and children 6 months to 4 years old. The 2009 H1N1 is causing influenza in younger age groups then we normally see with seasonal flu. The Centers for Disease Control and Prevention reports over 24,000 people have required hospitalization with 2,400 deaths in the United States since April. As seasonal influenza season begins we can expect older people (born before 1950) to be impacted.

Hospitals and clinics across the country are experiencing a surge of patients with influenza like illness in their offices, emergency rooms, ICUs and inpatient units. To prevent the spread of influenza where those infected are congregated and treated, increased infection prevention measures have been implemented per CDC recommendations. These increased measures to control the spread of H1N1 involve the patients, visitors and health care workers. Some of these infection control measures require a change in behavior, are inconvenient and cause restriction to access and mobility within facilities. Actions such as social distancing, cough and respiratory hygiene and enhanced respiratory precautions have been instituted.

Cough and respiratory etiquette are part of standard precautions to prevent the spread of respiratory infections. Please report symptoms of influenza - especially fever and cough - to the first employee you encounter when entering a health care facility. Signs are placed all around facilities to remind everyone. A mask, tissue and hand sanitizer will be made available to you. Wearing a mask, covering your cough and sneezes, and cleaning your hands afterwards will help prevent the spread of flu. You will be asked to sit apart from others who do not have flu symptoms to prevent the spread of infection.

With the increase in patients coming to clinics and emergency rooms, you must minimize who you bring with you. Family or friends that come with you may be in the incubation period and can be infectious themselves. Or they be exposed in the health care facility and acquire influenza as a result. At most, bring only one other person with you to minimize exposure potential and reduce congestion in waiting areas.

Most hospitals in the country have implemented restricted visitation policies, including St. Patrick Hospital, St. Joseph Medical Center and Community Medical Center. Please observe posted signs addressing visitation. Each facility has their own restrictions based on the patient populations they serve. Pediatric visitation restriction serves both to protect the children and patients. This age group has the highest incidence of H1N1 influenza and is the most vulnerable to H1N1. Allowing this age group to visit hospital patient care areas presents a potential risk to patients. Since children are more susceptible to this strain of H1N1, visiting in the hospital also significantly increases the child's own risk for contracting H1N1. Exceptions for special situations (for example, visitation of a gravely ill relative) can usually be arranged with special precautions.

Most people with H1N1 influenza do not need to be seen by a health care provider. It is unlikely they will be ill enough to need emergency room care or hospitalization. But if they are ill enough to seek hospital care and admission they are too ill to be visited by extended family and friends. If you have a loved one in the hospital with the flu, only people needed for emotional support and care should visit. (A limit of two people in the inpatient setting and one person in the emergency room.)

All infection control precautions posted on the patients door must be followed. Ask the nurse for help before you enter the patient's room. You must follow guidelines for hand hygiene, and use masks and other personal protective equipment such as gowns and gloves. Do not visit the hospital if you have any symptoms of influenza. You can express your concerns and get well wishes with cards, flowers and by phone. Visit them once they are home.

If you are visiting in the hospital in flu season or any other time the year, it is important to minimize touching of all surfaces, especially medical equipment like IV pumps, monitors and other frequently touched items. Do not sit on the patient's bed or eat their food. Most infections are transferred by direct contact with the patient or items within their area and transferred by contaminated hands. Keep the room free of clutter by taking unnecessary personal items home. An organized room with minimal clutter is easier for environmental service workers to clean and that is very important to reduce all health care acquired infections.

By following some basic infection prevention and control measures, you can prevent the spread of influenza to yourself, your family, other hospital patients and health care workers. For more information on H1N1 and seasonal influenza visit: www.co.missoula.mt.us/Health/ or www.cdc.gov/flu/ or call 258-INFO.

Tammy Powers is a registered nurse and the Infection Control Coordinator at St. Patrick Hospital and Health Sciences Center.