Does Traditional Flu Prevention Protect Contemporary Clinicians?

“How Do You Not Get Sick?”

I know I’m not the only provider who hears this question on a regular basis, especially during cold and flu season. Although it’s tempting to tout my superhuman powers or to claim I’ve spent the last decade of my life in health care acquiring the immune system of a mythological goddess, the truth is, I’m a normal person just like everyone else. Each year, the same vile viruses that threaten the well-being of the general population eagerly seek to invade my body, as well.

So what is the secret? What are the best ways for frontline providers to prevent the flu, colds, coughs, and sniffles despite our spending hundreds of hours each winter treating those very conditions? More importantly, are we properly putting these techniques into practice as our clinical environments continue to evolve?

The Only Constant Is Change

I transitioned from practicing in a traditional, primary care office setting to the world of walk-in health care just over 3 years ago. As a growing number of providers begin to leverage the full potential of technology to support ambulatory care, we often find ourselves on more autonomous turf than ever before. Where previously there were any number of people interacting with each patient—from the front desk staff to the clinical support staff to the exam provider to checkout—retail-based clinics facilitate increasingly efficient ways of supporting providers who now perform many, if not all, of these roles over the course of a patient’s visit.

Following this same trend is a reduction in the number of clinical staff coming into contact with the patients, which means there is usually no one to point a finger at but ourselves if we suspect we’ve been direct recipients of a patient’s ailment. These past 3 years of convenient care practice have opened my eyes to how, more than ever before, individual clinicians must be equipped with the knowledge and know-how to take complete responsibility for our work environments if we are to successfully halt the spread of communicable illnesses from our patients to ourselves and from one patient to another.

From Recommendations to Reality

Whereas the universal concepts of infection control and prevention remain the same across all settings in health care, contemporary clinicians often face uncharted obstacles to their application. Infection control in the modern clinic does not require any changes to the basics, but, instead, a change in how we execute standard precautions when disinfection duty falls solely to the clinician.

In the spirit of collaboration, here are the most essential provider protection measures, with some real-life examples of what application often looks like, from a fellow clinician who has survived recent winters without having to raise the white flag of influenza-like illness so far:

1. Wash and disinfect your hands. A lot.Before my debut in self-manned clinic maintenance, I could mostly skate by with my pre- and postexamination lathers. Today? I find myself fighting the urge to turn my clinic into a sterile shrine that puts operating rooms to shame. The double-edged sword of multitasking necessitates that our hands move between caregiving and administrative tasks, often multiple times over the course of a single visit. Here are just a few tips for keeping your hands germ-free without sacrificing the efficiency of your care:

Wash your hands with soap and water:

• At the beginning and end of a shift
• When visibly soiled
• When patient symptoms suggest gastrointestinal infection, tuberculosis, or any other tough-to-kill infectious agent
• Before and after eating (and I suggest skipping the finger foods on clinic days, opting for forkable fare instead)
• Before and after applying or reapplying makeup or lip balm

Disinfect your hands with alcohol-based sanitizer:

• In between handling patient insurance cards and IDs
• Before and after your hands touch your keyboard, mouse, or computer screen
• Before and after your hands touch vital sign and exam tools, such as blood pressure cuffs, thermometers, otoscopes, etc
• Any time your hands contact a surface outside your clinic environment
• And just for fun, whenever it comes to mind. (Most of us are a little obsessive. But we’re still alive, aren’t we?)

2. Get your flu shot. Every year.Remember, prior years’ products do not count. While there may only be 2 primary flu viruses known to cause widespread outbreaks in humans on a yearly basis, influenza A and B, genetic drift and shifts in the antigenic proteins happen so rapidly that no one is ever considered fully immune to the flu. Standard trivalent flu vaccines include the “latest versions” of the 2 primary influenza A strains—H1N1 and H3N2—as well as a single B strain. Quadrivalent influenza vaccines that include a second B strain are becoming increasingly available and gaining better insurance coverage each year in the United States. Regardless of which one you choose, get the vaccination every flu season as soon as it becomes available to you. Even in the occasional incident of an unexpected strain mutation, you will still be grateful you had protection from the additional 2 or 3 strains once they are being uncontrollably deposited on your clinic surfaces by symptomatic patients.

3. Study your enemies.All successful infection control practices are underpinned by one thing: an understanding of what our microscopic enemies are ultimately after. In the case of flu and cold viruses, they desperately need access to your face if they are going to thrive. How they get there makes no difference to them: a direct entry from rubbing your eye, a flight to your mouth after a brief layover on your sandwich bread, or a skydive straight from your patient’s sneeze to your skin is all the same. Keep your hands and your patients’ secretions away from your eyes, nose, and mouth and respiratory viruses will meet their bitter ends within the bastion of health and wellness that is your clinic space.

When it comes to cleaning a clinic’s surfaces, there is some great news for those of us who spend the bulk of our time treating winter colds and coughs: unlike the measures needed to destroy those dreaded stomach viruses that can live on hard surfaces for weeks on end, killing the viruses that cause the flu does not require an arsenal of specialized chemicals wielded by a professional hazmat team. As a matter of fact, flu viruses are downright wimpy little things once they are outside of the moist, accommodating environment of the respiratory tract. Influenza can’t survive more than a single day on a cold, hard surface, much less threaten you and your patients for weeks on end. Simple, alcohol-based products are all that are needed to rid surfaces of flu germs.

As long as we prioritize ongoing communication among colleagues, we will continue to find innovative solutions to the practical implementation of our rapidly changing industry’s best practices for keeping providers and patients infection-free.

MaryWells Smith, MSN, FNP-C, is a board-certified family nurse practitioner at MinuteClinic. In addition to seeing patients in the retail setting, she performs house calls for those in her community who are non-ambulatory or lack transportation, and she serves as a consultant on electronic health records and other emerging health information technology for small practices in the greater Nashville area.