Interim Guidance for Swine Influenza A (H1N1): Taking Care of a Sick Person in Your Home

April 25, 2009 18:30 EDTThis document provides interim guidance and will be updated as needed.

Swine influenza A virus infection (swine flu) can cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. People with swine flu also can have vomiting and diarrhea. Like seasonal flu, swine flu in humans can vary in severity from mild to severe.Severe disease with pneumonia, respiratory failure and even death is possible with swine flu infection. Certain groups might be more likely to develop a severe illness from swine flu infection, such as persons with chronic medical conditions. Sometimes bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections.

The following information can help you provide safer care at home for sick persons during a flu pandemic.

How Flu Spreads
The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.

People with swine flu who are cared for at home should:
-check with their health care provider about any special care they might need if they are
pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema
-check with their health care provider about whether they should take antiviral medications
-stay home for 7 days after the start of illness and fever is gone
-get plenty of rest
-drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to
keep from being dehydrated
-cover coughs and sneezes. Clean hands with soap and water or an alcohol-based hand rub
often and especially after using tissues and after coughing or sneezing into hands.
-avoid close contact with others – do not go to work or school while ill
-be watchful for emergency warning signs (see below) that might indicate you need to seek
medical attention

Medications to Help Lessen Symptoms of the Flu
Check with your healthcare provider or pharmacist for correct, safe use of medications.

Antiviral medications can sometimes help lessen influenza symptoms, but require a prescription. Most people do not need these antiviral drugs to fully recover from the flu. However, persons at higher risk for severe flu complications, or those with severe flu illness who require hospitalization, might benefit from antiviral medications. Antiviral medications are available for persons 1 year of age and older. Ask your healthcare provider whether you need antiviral medication.

Influenza infections can lead to or occur with bacterial infections. Therefore, some people will also need to take antibiotics. More severe or prolonged illness or illness that seems to get better, but then gets worse again may be an indication that a person has a bacterial infection. Check with your healthcare provider if you have concerns.

Warning! Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause a rare but serious illness called Reye’s syndrome.
For more information about Reye’s syndrome, visit the National Institute of Health website at http://www.ninds.nih.gov/disorders/reyes_syndrome/reyes_syndrome.htm
Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin.

Teenagers with the flu can take medicines without aspirin, such as acetaminophen (Tylenol®) and ibuprofen (Advil®, Motrin®, Nuprin®), to relieve symptoms.

Children younger than 2 years of age should not be given over-the-counter cold medications without first speaking with a healthcare provider.

The safest care for flu symptoms in children younger than 2 years of age is using a cool-mist humidifier and a suction bulb to help clear away mucus.

Fevers and aches can be treated with acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®, Nuprin®) or nonsteroidal anti-inflammatory drugs (NSAIDS). Examples of these kinds of medications include:
Generic Name Brand Name(s)
Acetaminophen Tylenol®
Ibuprofen Advil®, Motrin®, Nuprin®
Naproxen Aleve

Over-the-counter cold and flu medications used according to the package instructions may help lessen some symptoms such as cough and congestion. Importantly, these medications will not lessen how infectious a person is.

Check the ingredients on the package label to see if the medication already contains acetaminophen or ibuprofen before taking additional doses of these medications—don’t double dose! Patients with kidney disease or stomach problems should check with their health care provider before taking any NSAIDS.

Check with your health care provider or pharmacist if you are taking other over-the-counter or prescription medications not related to the flu.For more information on products for treating flu symptoms, see the FDA website: http://www.fda.gov/fdac/features/2005/105_buy.html.

When to Seek Emergency Medical Care
Get medical care right away if the sick person at home:
-has difficulty breathing or chest pain
-has purple or blue discoloration of the lips
-is vomiting and unable to keep liquids down
-has signs of dehydration such as dizziness when standing, absence of urination, or in
infants, a lack of tears when they cry
-has seizures (for example, uncontrolled convulsions)
-is less responsive than normal or becomes confused

Steps to Lessen the Spread of Flu in the Home
When providing care to a household member who is sick with influenza, the most important ways to protect yourself and others who are not sick are to:

-keep the sick person away from other people as much as possible (see “placement of the sick
person at home”)
-remind the sick person to cover their coughs, and clean their hands with soap and water or
an alcohol-based hand rub often, especially after coughing and/or sneezing.
-have everyone in the household clean their hands often, using soap and water or an alcohol-
based hand rub
-ask your healthcare provide if household contacts of the sick person, particularly those
contacts that may have chronic health conditions, should take antiviral medications such as
oseltemivir (Tamiflu®) or zanamivir (Relenza®) to prevent the flu.

Placement of the sick person
-Keep the sick person in a room separate from the common areas of the house. (For example,
a spare bedroom with its own bathroom, if that’s possible.) Keep the sickroom door closed.
-Unless necessary for medical care, persons with the flu should not leave the home when they
have a fever or during the time that they are most likely to spread their infection to others
(7 days after onset of symptoms in adults, and 10 days after onset of symptoms in children).
-If persons with the flu need to leave the home (for example, for medical care), they should
cover their nose and mouth when coughing or sneezing and wear a loose-fitting (surgical)
mask if available.
-Have the sick person wear a surgical mask if they need to be in a common area of the house
near other persons.
-If possible, sick persons should use a separate bathroom. This bathroom should be cleaned
daily with household disinfectant (see below).

Protect other persons in the home
-The sick person should not have visitors other than caregivers. A phone call is safer than a
visit.
-If possible, have only one adult in the home take care of the sick person.
-Avoid having pregnant women care for the sick person. (Pregnant women are at increased
risk of influenza-related complications and immunity can be suppressed during pregnancy).
-All persons in the household should clean their hands with soap and water or an alcohol-
based hand rub frequently, including after every contact with the sick person or the person’s
room or bathroom.
-Use paper towels for drying hands after hand washing or dedicate cloth towels to each
person in the household. For example, have different colored towels for each person.
-If possible, consideration should be given to maintaining good ventilation in shared household
areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.).
-Antivirals can be used to prevent the flu, so check with your healthcare provider to see if
some persons in the home should use antiviral medications.

If you are the caregiver
-Avoid being face-to-face with the sick person.
-When holding small children who are sick, place their chin on your shoulder so that they will
not cough in your face.
-Clean your hands with soap and water or use an alcohol-based hand rub after you touch the
sick person or handle used tissues, or laundry.
-Caregivers might catch flu from the person they are caring for and then the caregiver might
be able to spread the flu to others before the caregiver shows symptoms. Therefore, the
caregiver should wear a mask when they leave their home to keep from
spreading flu to others in case they are in the early stages of infection.
-Talk to your health care provider about taking antiviral medication to prevent the caregiver
from getting the flu.
-Monitor yourself and household members for flu symptoms and contact a
telephone hotline or health care provider if symptoms occur.

Using Facemasks or Respirators
-Avoid close contact (less than about 6 feet away) with the sick person as much as possible.
-If you must have close contact with the sick person (for example, hold a sick infant), spend
the least amount of time possible in close contact and try to wear a facemask (for example,
surgical mask) or N95 disposable respirator.
- An N95 respirator that fits snugly on your face can filter out small particles that can be
inhaled around the edges of a facemask, but compared with a facemask it is harder to
breathe through an N95 mask for long periods of time. More information on facemasks and
respirators can be found at www.cdc.gov/swineflu
-Facemasks and respirators may be purchased at a pharmacy, building supply or hardware
store.
-Wear an N95 respirator if you help a sick person with respiratory treatments using a
nebulizer or inhaler, as directed by their doctor. Respiratory treatments should be
performed in a separate room away from common areas of the house when at all possible.
-Used facemasks and N95 respirators should be taken off and placed immediately in the
regular trash so they don’t touch anything else.
-Avoid re-using disposable facemasks and N95 respirators if possible. If a reusable fabric
facemask is used, it should be laundered with normal laundry detergent and tumble-dried in
a hot dryer.
-After you take off a facemask or N95 respirator, clean your hands with soap and water or an
alcohol-based hand sanitizer.

Household Cleaning, Laundry, and Waste Disposal
-Throw away tissues and other disposable items used by the sick person in the trash. Wash
your hands after touching used tissues and similar waste.
-Keep surfaces (especially bedside tables, surfaces in the bathroom, and toys for children)
clean by wiping them down with a household disinfectant according to directions on the
product label.
-Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned
separately, but importantly these items should not be shared without washing thoroughly
first.
-Wash linens (such as bed sheets and towels) by using household laundry soap and tumble
dry on a hot setting. Avoid “hugging” laundry prior to washing it to prevent contaminating
yourself. Clean your hands with soap and water or alcohol-based hand rub right after
handling dirty laundry.
-Eating utensils should be washed either in a dishwasher or by hand with water and soap.

For More Information
The Centers for Disease Control and Prevention (CDC) Hotline (1-800-CDC-INFO) is available in English and Spanish, 24 hours a day, 7 days a week.

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