Flu Pandemic Home Care

Home care will be the predominant mode of care for most people infected with influenza. During the Novel Virus Alert Phase, individuals should discuss with their health care provider specific recommendations for both vaccination and chemoprophylaxis. This page is not medical advice, but rather an inventory of issues to discussion with your health care provider.

Most patients with pandemic influenza will be able to remain at home during the course of their illness and can be cared for by other family members or others who live in the household. Anyone residing in a household with an influenza patient during the incubation period and illness is at risk for developing influenza. A key objective in this setting is to limit transmission of pandemic influenza within and outside the home. When care is provided by a household member, basic infection control precautions should be emphasized (e.g., segregating the ill patient, hand hygiene). Infection within the household may be minimized if a primary caregiver is designated, ideally someone who does not have an underlying condition that places them at increased risk of severe influenza disease. Although no studies have assessed the use of masks at home to decrease the spread of infection, use of surgical or procedure masks by the patient and/or caregiver during interactions may be of benefit.

The term “flu” is much used and abused. Some people use the term “stomach flu” as an informal way of saying “gastroenteritis of unknown etiology.” Sometimes people confuse cold and flu, which share some of the same symptoms and occur at the same time of the year (cold and flu season). However, the two diseases are very different. Most people get a cold several times each year, and the flu only once every several years. Others think that “flu” is any kind of illness with aches and fever with or without respiratory symptoms. In reality, influenza is none of these things. Influenza is a specific, often severe, respiratory viral infection caused by influenza viruses. The whole body suffers from it.

Typical symptoms include:

·  The flu usually begins abruptly, with a fever between 102 to 106°F (with adults on the lower end of the spectrum). Other common symptoms include a flushed face. Some people have dizziness or vomiting. The fever usually lasts for two or three days, but can last 5 days.

·  Somewhere between day 2 and day 4 of the illness, the "whole body" symptoms -- chills, weakness, lack of energy, loss of appetite, and aching of the head, back, arms, legs -- begin to subside, and respiratory symptoms begin to increase.

·  The virus can settle anywhere in the respiratory tract, producing symptoms of a cold, croup, sore throat, bronchiolitis, ear infection, or pneumonia. The most prominent of the respiratory symptoms is usually a dry, hacking cough. Most people also develop a sore (red) throat and a headache. Nasal discharge and sneezing are common. These symptoms (except the cough) usually disappear within 4-7 days.

·  Sometimes there's a second wave of fever at this time.

·  Often the person continues to feel sick for several days. Cough and tiredness usually last for weeks after the rest of the illness is over.

·  Sometimes the person can have complications, such as dehydration or pneumonia.

The disease is characterized by abrupt onset of constitutional and respiratory symptoms, including fever, chills, muscle aches, headache, malaise, nonproductive cough, sore throat, and runny nose. Upper respiratory and constitutional symptoms tend to predominate in the first several days of illness, but lower respiratory symptoms, particularly cough, are common after the first week. In children, nausea and vomiting and, occasionally, ear infection are also symptoms.

Since several other respiratory pathogens (including adenovirus, respiratory syncytial virus, parainfluenza virus, rhinovirus, coronavirus, human metapneumovirus, Mycoplasma pneumoniae and Legionella) can also cause a similar clinical picture, definitive diagnosis of influenza requires laboratory confirmation. However, laboratory testing is not necessary for all patients. In the presence of a community outbreak of respiratory illness, a presumptive diagnosis can be made based on knowledge of the predominant agent causing the outbreak.

Uncomplicated influenza gets better with or without treatment, but may cause substantial discomfort and limitation of activity before getting better. Complications of influenza can include bacterial infections, viral pneumonia, and cardiac and other organ system abnormalities. People with chronic medical conditions may have increased risk of complications when they get influenza. Many other diseases, including serious infections such as rapidly progressive bacteremias, may start with symptoms that resemble influenza and may need to be considered in treatment decisions. Many people with uncomplicated influenza use over-the-counter medicines to help lessen their symptoms.

Here are some tips to keep from spreading your germs to others, and to keep from catching someone else’s germs.

Keep your germs to yourself:

§                Cover your nose and mouth with a tissue when sneezing, coughing or blowing your nose.

§                Throw out used tissues in the trash as soon as you can.

§                Always wash your hands after sneezing, blowing your nose, or coughing, or after touching used tissues or handkerchiefs. Wash hands often if you are sick.

§                Use warm water and soap or alcohol-based hand sanitizers to wash your hands.

§                Try to stay home if you have a cough and fever.

§                See your doctor as soon as you can if you have a cough and fever, and follow their instructions, including taking medicine as prescribed and getting lots of rest.

§               If asked to, use face masks provided in your doctor’s office or clinic’s waiting room; follow their instructions to help stop the spread of germs.

Keep the germs away:

§               Wash your hands before eating, or touching your eyes, nose or mouth.

§               Wash your hands after touching anyone else who is sneezing, coughing, blowing their nose, or whose nose is running.

§               Don’t share things like cigarettes, towels, lipstick, toys, or anything else that might be contaminated with respiratory germs.

§               Don’t share food, utensils or beverage containers with others.

Plan Ahead

People should plan ahead and think about what they need to have in their house in case someone in their household were to become infected with influenza and need to receive care at home. If you live alone, are a single parent of young children, or are sole caregiver for a frail or disabled adult, it would be a good idea to have some items stored in your home in case of illness:

·  Have enough fluids (e.g. water, juice, soup) available to last for 2 weeks.

·  Have enough basic household items (e.g. tissues) to last for 2 weeks.

·  Have acetaminophen and a thermometer in the medicine cabinet. Do you know how to use/read a thermometer correctly? If not, ask someone to show you how.

·  Think of someone you could call upon for help if you became very ill with the flu and discuss this possibility with him or her.

·  Think of someone you could call upon to care for your children if you were required to work and their school or day care was closed because of the influenza pandemic; discuss the possibility with them.

Infection Control Measures in the Home

·  All persons in the household should carefully follow recommendations for hand hygiene (i.e., handwashing with soap and water or use of an alcohol-based hand rub) after contact with an influenza patient or the environment in which care is provided.

·  Although no studies have assessed the use of masks at home to decrease the spread of infection, use of surgical or procedure masks by the patient and/or caregiver during interactions may be of benefit. The wearing of gloves and gowns is not recommended for household members providing care in the home.

·  Soiled dishes and eating utensils should be washed either in a dishwasher or by hand with warm water and soap. Separation of eating utensils for use by a patient with influenza is not necessary.

·  Laundry can be washed in a standard washing machine with warm or cold water and detergent. It is not necessary to separate soiled linen and laundry used by a patient with influenza from other household laundry. Care should be used when handling soiled laundry (i.e., avoid “hugging” the laundry) to avoid contamination. Hand hygiene should be performed after handling soiled laundry.

·  Tissues used by the ill patient should be placed in a bag and disposed with other household waste. Consider placing a bag for this purpose at the bedside.

·  Normal cleaning of environmental surfaces in the home should be followed.

Management of Well Persons in the Home

·  Persons who have not been exposed to pandemic influenza and who are not essential for patient care or support should not enter the home while persons are actively ill with pandemic influenza.

·  If unexposed persons must enter the home, they should avoid close contact with the patient.

·  Persons living in the home with the pandemic influenza patient should limit contact with the patient to the extent possible; consider designating one person as the primary care provider.

·  Household members should monitor closely for the development of influenza symptoms and contact a telephone hotline or medical care provider if symptoms occur.

Management of Influenza Patients

Persons who have a sudden onset of influenza-like symptoms (e.g. headache, fever, chills, cough, chest pain, sore throat, muscle aches, weakness, exhaustion) should do the following:

·  Remain at home at least until all symptoms have resolved (approximately 4-5 days)

·  Take medication as needed to relieve the symptoms of the flu.

§               Decongestants, such as phenylephrine, and pseudoephedrine, produce a narrowing of blood vessels. This leads to clearing of nasal congestion, but it may also cause an increase in blood pressure in patients who have high blood pressure. OTC drugs to relieve stuffy noses often contain more than one ingredient. Some of these products are marketed for allergy relief and others for colds. They usually contain both an antihistamine and a nasal decongestant. The decongestant ingredient unstuffs nasal passages; antihistamines dry up a runny nose. But some of these products may also contain aspirin or acetaminophen, and some contain a decongestant alone. Closely related products with similar names may have different ingredients. There are other medications in the form of nasal drops and sprays sold OTC for this purpose. As with pills, some of these are long acting (up to 12 hours) and some are shorter acting. And, as with pills, most have some side effects. Many of the products contain a nasal decongestant such as oxymetazoline or phenylephrine. When used for more than three days or more often than directed by the label, these drops or sprays can sometimes cause a "rebound" effect, in which the nose gets more stuffy. Other nose drops and sprays are formulated with a saline (salt) solution and can be used for dry nose or to relieve clogged nasal passages.

§               Dextromethorphan, an antitussive, is used to relieve a nonproductive cough caused by a cold, the flu, or other conditions. Dextromethorphan comes as a liquid or as a lozenge to take by mouth. It is usually taken every 4-8 hours as needed. Do not take more than 120 mg of dextromethorphan in a 24-hour period. Refer to the package or prescription label to determine the amount contained in each dose. The lozenge should dissolve slowly in your mouth. Drink plenty of water after taking a dose. Follow the directions on the package or prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.

§               Antipyretics are fever-reducing medications; the term comes from the Greek word pyresis, which means fire. Ibuprofen (Motrin) and acetaminophen (Tylenol) are generally recognized as safe and effective single analgesic-antipyretic active ingredients. These two antipyretics can be taken together or on an alternating 4 hour schedule. Ibuprofen provides greater temperature decrement and longer duration of antipyresis than acetaminophen when the two drugs are administered in approximately equal doses.

§               Never give aspirin to children or teenagers who have flu-like symptoms (and particularly fever) without first speaking to your doctor. Giving aspirin to children and teenagers who have influenza can cause a rare but serious illness called Reye syndrome. Reading the label becomes especially important when it comes to products containing aspirin (acetylsalicylic acid) or their chemical cousins, other salicylates, which are used to reduce fever or treat headaches and other pain.

§               A person's fluid needs are greater when that person has fever. Drink lots of fluids (water and other non-alcoholic, non-caffeinated beverages) to avoid becoming dehydrated. Start with sips of any fluid other than caffeinated beverages. Drinking too much fluid at once can bring on more vomiting. Electrolyte solutions available in drugstores are usually best. Sport drinks contain a lot of sugar and can cause or worsen diarrhea.

§               If you have diarrhea, it's a good idea to rest, eat only small amounts of food at a time, and drink plenty of fluids to prevent dehydration. Avoid over-the-counter diarrheal medications unless specifically instructed to use one by your doctor. Certain infections can be made worse by these drugs. When you have diarrhea, your body is trying to get rid of whatever food, virus, or other bug is causing it. OTC products marketed to stop diarrhea may contain loperamide (Imodium A-D), or attapulgite (Diasorb, Kaopectate and others), or bismuth subsalicylate (Pepto-Bismol and others).

·  Use either a traditional glass thermometer for each person [don't cross-contaminate patients], or a digital thermometer with lots of disposable sleeves. The thermometers are a few dollars. The sleeves are a dollar or so per hundred.

·  Get plenty of bed rest

·  Do not smoke

·  Restrict visitors to their home

·  Cover mouth and nose with a tissue when coughing or sneezing.

·  Keep at least 3 feet away from others.

·  Patients should not leave the home during the period when they are most likely to be infectious to others (i.e., 5 days after onset of symptoms). When movement outside the home is necessary (e.g., for medical care), the patient should follow cough etiquette (i.e., cover the mouth and nose when coughing and sneezing) and wear procedure or surgical masks if available.

To protect the patients infected with influenza, individuals having contact with the patient, and the community in general, certain infection control measures should be practiced:

·  Wash hands often with warm soap and water, scrubbing for 15-20 seconds

·  Family members should wash hands or use waterless hand sanitizer after contact with the patient

·  Do not share eating utensils or drinks

·  Do not rub eyes, touch nose or mouth

·  Patients should cover their mouths and noses with tissue when coughing or sneezing, dispose of used tissues immediately after use and wash hands after using tissues

·  In general, wearing goggles or a face shield for routine contact with patients with pandemic influenza is not necessary. If sprays or splatter of infectious material is likely, goggles or a face shield should be worn as recommended for standard precautions.

·  In the absence of visible soiling of hands, approved alcohol-based products for hand disinfection are preferred over antimicrobial or plain soap and water because of their superior microbiocidal activity, reduced drying of the skin, and convenience.

·  Physically separate the patient with influenza from non-ill persons living in the home as much as possible.

In a pandemic influenza event, some individuals who are cared for at home may develop complications. Should complications develop, these individuals should seek medical care immediately, either by calling the doctor or going to an emergency room. Upon arrival, the receptionist or nurse should be told about the symptoms so that precautions can be taken (providing a mask and or separate area for triage and evaluation).

Warning Signs to seek urgent medical care:

In children, these include:
1. High or prolonged fever for more than 4-5 days
2. Fast breathing or trouble breathing
3. Bluish skin color
4. Not drinking enough fluids
5. Changes in mental status, somnolence, irritability
6. Seizures, confusion or seizures
7. Influenza-like symptoms improve but then return with fever and worse cough
8. Worsening of underlying chronic medical conditions (for example, heart or lung disease, diabetes)
9. Cough becomes productive of yellow sputum

In adults, these include:

1. High or prolonged fever for more than 4-5 days
2. Difficulty breathing or shortness of breath
3. Cough becomes productive of yellow sputum
4. Pain or pressure in the chest
5. Near-fainting or fainting
6. Confusion or seizures
7. Severe or persistent vomiting [2 to 3 times in 24 hours] (vomiting is usually present in young children and elderly persons with influenza infection)
8. Skin color changes (lip and hands)

Persons should seek medical attention at their physician’s office, urgent care facility or hospital emergency department if they are at high risk for the development of complications

·  People age 65 and older, people of any age with chronic medical conditions and very young children are more likely to get complications from influenza.

·  Pregnant women also have an increased risk for pneumonia, lung insufficiency,