Survival of the Fittest

Weathering the Cold and Flu Season

During the peak months of cold and flu season, it seems that everything conspires to expose us to illness. Sick people who should be at home in bed are up and about, exposing others. By following some common sense practices both in the work place and at home, you can minimize your chances of coming down with cold or flu, thereby protecting those around you as well.

The Centers for Disease Control and Prevention (CDC) lists three basic “Good Health Habits” for cold and flu prevention:

• Avoid close contact. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
• Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.
• Cover your mouth and nose. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.

In the healthcare setting, these practices are important not only in patient-care areas, but in the lobby or reception areas as well.

“We post signs in our reception area to put some of the responsibility on the patient,” says Beth Young, RN, BSN, CIC, an infection control coordinator at Robinson Memorial Hospital in Ravenna, Ohio. “Our signs say, ‘If you have a cough, please ask the receptionist for a mask or box of tissues.’ What we’re trying to do is educate and put the onus of responsibility on the patient who is sitting in the lobby coughing, so that they know that they can ask. We’ve also empowered our receptionist to say, ‘I hear that you are coughing; I need you to put on a mask.’ You do need to have somebody assume responsibility for doing that — no one likes to sit next to the person who’s hacking and coughing. It’s a big public relations issue in any kind of waiting area. This year, with an under-immunized population, it’s more important than ever before.”

Hand Hygiene

The keys to minimizing cold and flu in the work place are in your hands. In the healthcare setting, one of the strongest tools for preventing the spread of illness is observing proper hand hygiene. Washing hands frequently — between patients and between procedures — seems like a no-brainer, yet non-compliance with proper handwashing is a persistent problem among healthcare workers (HCWs).

Why aren’t HCWs washing their hands? A study by the CDC cited perceived barriers to adherence with hand-hygiene practice recommendations, including skin irritation caused by hand-hygiene agents, inaccessible hand-hygiene supplies, interference with HCW-patient relationships, priority of care (i.e., the patients’ needs are given priority over hand hygiene), wearing of gloves, forgetfulness, lack of knowledge of the guidelines, insufficient time for hand hygiene, high workload and understaffing, and the lack of scientific information indicating a definitive impact of improved hand hygiene on health-care-associated infection rates.¹

CDC has released guidelines to improve adherence to hand hygiene in healthcare settings. In addition to traditional hand washing with soap and water, the CDC is recommending the use of alcohol-based handrubs by healthcare personnel because they address some of the obstacles that healthcare professionals face when taking care of patients.

Hand Hygiene Guidelines

• When healthcare personnel’s hands are visibly soiled, they should wash with soap and water. The use of gloves does not eliminate the need for hand hygiene. Likewise, the use of hand hygiene does not eliminate the need for gloves. Gloves reduce hand contamination by 70 percent to 80 percent, prevent cross-contamination and protect patients and healthcare personnel from infection. Handrubs should be used before and after each patient, just as gloves should be changed before and after each patient.
• When using an alcohol-based handrub, apply product to the palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. Note that the volume needed to reduce the number of bacteria on hands varies by product.
• Alcohol-based handrubs significantly reduce the number of microorganisms on skin, are fast-acting, and cause less skin irritation.
• Healthcare personnel should avoid wearing artificial nails and keep natural nails less than one-quarter of an inch long if they care for patients at high risk of acquiring infections (e.g. Patients in intensive care units or in transplant units.)

When evaluating hand hygiene products for potential use in healthcare facilities, administrators or product selection committees should consider the relative efficacy of antiseptic agents against various pathogens and the acceptability of hand hygiene products by personnel. Characteristics of a product that can affect acceptance and therefore usage include its smell, consistency, color, and the effect of dryness on hands.

As part of these recommendations, the CDC is asking healthcare facilities to develop and implement a system for measuring improvements in adherence to these hand hygiene recommendations. Some of the suggested performance indicators include: periodic monitoring of hand hygiene adherence and providing feedback to personnel regarding their performance, monitoring the volume of alcohol-based handrub used/1,000 patient days, monitoring adherence to policies dealing with wearing artificial nails, and focused assessment of the adequacy of healthcare personnel hand hygiene when outbreaks of infection occur.

Allergic contact dermatitis due to alcohol handrubs is very uncommon. However, with increasing use of such products by healthcare personnel, it is likely that true allergic reactions to such products will occasionally be encountered.

Alcohol-based handrubs take less time to use than traditional hand washing. In an eight-hour shift, an estimated one hour of an ICU nurse’s time will be saved by using an alcohol-based handrub.²

The Diet and Exercise Connection

When cold and flu season hits, one of the first lines of defense for staying well is a healthy immune system. By strengthening your immune system, you lay the foundation for staying well. Establishing a regime to keep your immune system in peak condition is the first step, and the way to begin is through proper nutrition — a balanced diet of foods that will help keep you in top form.

Foods that are high in natural sources of antioxidants, vitamins A, C, E, betacarotene and zinc strengthen the immune system. Antioxidants help the body in fighting the breakdown of cells during the onset of illness. The palate of foods to choose from is varied and vast, so you can combine some of your favorites and avoid what you don’t care for.

• Vitamin A
  You’ll find vitamin A in vegetables like sweet potatoes, red peppers, spinach, carrots, broccoli, endive, mustard greens, and cabbage. The A fruits include fresh or dried apricots, watermelon and cantaloupe. Other sources: fish and dairy foods.
• Vitamin C
  The foods rich in vitamin A will also bring you vitamin C. In addition to citrus fruits, you’ll do well by green vegetables of all kinds, tomatoes, avocados, butternut squash and cauliflower.
• Vitamin E
  In addition to the foods listed above, all green vegetables are rich in vitamin E. You’ll also find it in liver, clams, salmon, chicken and turkey, almonds, hazelnuts and sunflower seeds.
• Zinc
  Whole grains, wheat bran, pumpkin seeds, beans and lentils, yeast, nuts, some seafood, poultry and lean red meats are your best bets for zinc.

The unfortunate truth is that most people don’t eat the well-balanced diet necessary for peak immune system function. Taking supplements as part of your daily diet is an excellent way to balance things out.

Calling All Couch Potatoes

You may have impeccable dietary habits, but a sedentary lifestyle is not part of the healthy equation. Get moving. Walk instead of driving, take the stairs in lieu of the elevator. If you live or work on a high floor, start slow, and work your way up gradually. Join a gym or find a buddy to walk or jog with during your lunch hour. Find something you enjoy and stick with it. Your healthy heart and immune system will thank you.

1. CDC. Guideline for Hand Hygiene in Health-Care Settings.

2. CDC. Hand Hygiene Guidelines Fact Sheet.

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