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Questions and Answers about CDC’s Guidance for Businesses and Employers to Plan and Respond to the 2009-2010 Flu Season

December 28, 2009 3:00 PM ET

About the Guidance for Businesses and Employers

How does CDC’s new flu guidance for businesses differ from the previous business guidance documents?

The new guidance applies to any flu virus circulating during the 2009-2010 flu season, not only 2009 H1N1 flu. It will be very hard to tell if someone who is sick has 2009 H1N1 flu or seasonal flu. The new guidance offers specific steps for business owners and managers to take to protect employees and to maintain continuity of operations. It provides guidance for the current flu conditions as well as for more severe flu conditions.

This guidance also recommends that, based on current flu conditions, employees with flu-like illness stay home until at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius) or signs of a fever (have chills, feel very warm, have a flushed appearance, or are sweating). This should be determined without the use of fever-reducing medicines (any medicine that contains ibuprofen or acetaminophen). This is a shorter time period than the previous guidance, which recommended that sick people stay home for 7 days after symptoms began. The 7-day period would still be recommended in business settings under more severe flu conditions.

What types of businesses should follow this guidance?

The guidance is intended for businesses of all sizes and types except those that cover healthcare services. People who care for sick people as part of their jobs will need to take additional steps to protect themselves because of their risk at work. See CDC's specific guidance for steps health care employees should take for 2009 H1N1 flu.

Rationale for Planning

Why should businesses plan for a flu response?

Businesses may have already been impacted by the April through December 2009 H1N1 flu outbreak. Steps can be taken now to slow the spread of flu in the workplace.  It is also possible that flu conditions may become more severe, so it is important to plan now for how to respond under those circumstances. An estimated 25% of businesses do not reopen following a major disaster, according to the Institute for Business and Home Safety. A severe flu pandemic could have a major effect on the global economy, including travel, trade, tourism, food, financial markets and other types of businesses. Business planning for pandemic flu is essential to minimize a pandemic's impact.
Planning from the outset can help protect your business and your employees if flu conditions become more severe. Planning can help

• minimize disruption to business activities,
• protect employees’ health and safety, and
• limit the negative impact to the community, economy, and society.

Why should we be concerned about the spread of flu in the workplace?

The workplace may act as a “point of spread,” where employees can easily spread flu to their fellow employees as well as to others in the community. The flu can have a major impact on business operations, causing employees to stay home because they are sick or because they need to care for sick family members. They may also need to stay home and take care of their children, if schools dismiss students or early childhood programs close. The guidance and this toolkit provide action steps that business owners, managers, and employees can take to minimize the effect of flu in the workplace.

How to Plan and Prepare

What should businesses do to prepare?

• Review your current pandemic flu plan or develop a new plan. Involve your employees in development and review of the plan.
• Conduct an exercise, drill, or discussion to test key components of your plan.
• Share your plan with employees and explain what policies, leave options, pay, and benefits will be available to them.
• Engage your state and local health department to confirm channels of communication and methods for dissemination of local outbreak information.
• Review sick-leave policies and consider making them flexible and consistent with public health recommendations. Make sure employees are well-aware of these policies.
• Try to provide flexible leave policies to allow employees to stay home to care for sick household members or for children, if schools dismiss students or early childhood programs close.
• Share best practices with other businesses in your community. Work with companies in your supply chain as well as chambers of commerce and local associations to improve response efforts.
• Add a “widget” or “button” to your company Web page or employee Web site so employees can access the latest information on the flu:
• www.cdc.gov/widgets
• www.cdc.gov/SocialMedia/Campaigns/H1N1/buttons.html
• www.hhs.gov/web/library/hhsfluwidgets.html
• www.flu.gov/news/socialmedia
• Purchase supplies such as tissues, soap, and alcohol-based hand rubs to encourage healthful habits in the workplace.

What should a business include in a pandemic flu plan?

A flu response plan should do the following:

• Provide a variety of measures to protect employees and ensure that business operations can continue. 
• Identify essential business functions and critical supply chains (e.g., raw materials, suppliers, sub-contractor services/products, and logistics) that are needed to keep your business running. Plan how your business will operate if a high number of employees must stay home or supply chains are interrupted.
• Create policies for flexible sick leave, worksites (e.g., telecommuting), and work hours (e.g., staggered shifts) to promote social distancing if flu conditions become more severe.
• If possible, develop plans for the IT infrastructure needed to support more teleworkers.
• Consider changing business operations (e.g., possibly changing or closing operations in affected areas) and ways to transfer knowledge to key employees.
• Set up triggers and procedures for starting and ending your pandemic flu response plan. Work closely with your local health officials to identify these triggers.
• Establish a process to communicate information to employees and business partners on your pandemic flu response plans and the latest flu information.

Why should businesses have flexible leave policies or alternate work schedules?

An important way to reduce the spread of flu is to keep sick people away from those who are not sick. Therefore, any worker who has flu-like symptoms should stay home and not come to work. It is possible that employees will need to take care of sick household members or care for children if schools are dismissed or early childhood programs are closed. Flexible leave policies and alternate work schedules will help prevent the spread of flu at your workplace, allow employees to continue to work or function while limiting contact with others, help maintain continuity of operations, and help people manage their health and their family’s needs.

Steps for Businesses under Current Flu Conditions

What steps can businesses take to keep employees from getting sick?

Businesses should take the following steps to keep employees from getting sick with flu. These steps should be followed ALL the time, not only during a flu outbreak.

• Encourage all employees who want protection from flu to get vaccinated for seasonal flu and 2009 H1N1 flu. Encourage employees who are at higher risk for 2009 H1N1 flu complications to get the 2009 H1N1 flu vaccine. People at higher risk for 2009 H1N1 flu complications include pregnant women and people with chronic medical conditions (such as asthma, heart disease, or diabetes). Review the health benefits you offer your employees and consider including flu vaccination. If possible, you should offer seasonal flu vaccination opportunities at the worksite.

• Advise all employees to stay home if they are sick until at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius) or signs of a fever (have chills, feel very warm, has a flushed appearance, or is sweating). This should be determined without the use of fever-reducing medicines (any medicine that contains ibuprofen or acetaminophen). They should stay home until at least 24 hours after they no longer have a fever, even if they are using antiviral medicines. Businesses should review their policies and practices to consider ways to allow flexibility for employees to stay home when they are sick.
• Encourage respiratory etiquette by providing 
• education and reminders about covering coughs and sneezes with tissues, and
• easy access to tissues and trash cans.
• Encourage hand hygiene by providing
• education and reminders about washing their hands, and
• easy access to running water and soap or alcohol-based hand rubs.
• Separate employees who become sick at work from other staff and ask them to go home.
• Those who become ill with symptoms of an influenza-like illness during the work day should be:

• Separated from other workers and asked to go home promptly. For recommendations on personal protective equipment for a person assisting the ill employee, see Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission;
• When possible and if they can tolerate it, workers with influenza-like illness should be given a surgical mask to wear before they go home if they cannot be placed in an area away from others.
• Employees exposed to a sick co-worker should monitor themselves for symptoms of influenza-like illness and stay home if they are sick. There is no need to close the worksite or ask exposed workers to stay away from the worksite.

• Routinely clean surfaces and items that are more likely to have frequent hand contact with cleaning agents that are usually used in these areas. Additional disinfection beyond routine cleaning is not recommended.
• Encourage sick employees at higher risk of complications from flu to contact their health care provider as soon as possible. Taking antiviral medicines early might prevent severe complications from the flu. People at higher risk for flu complications include pregnant women and people with chronic medical conditions (such as asthma, heart disease, or diabetes). It’s very important that antiviral drugs be used early to treat flu in people who are very sick (e.g., people who are in the hospital) and people who are sick with flu and have a greater chance of getting serious flu complications. Other people may also be treated with antiviral drugs by their doctor this season.
• Prepare for employees to stay home from work and plan ways for essential business functions to continue. Employees may stay home because they are sick, need to care for sick household members, or because schools have been dismissed and they need to care for their children. Cross-train staff to perform essential functions so that the business can continue operating.

• Provide information to employees overseas about what to do if they become sick.

What should an employer do if they believe employees at work have the flu?

CDC recommends that workers who appear to have an influenza-like illness upon arrival to work or become ill during the day be promptly separated from other workers and be advised to go home until at least 24 hours after they are free of fever (100° F [37.8° C] or greater), or signs of a fever, without the use of fever-reducing medications.

• Those who become ill with symptoms of an influenza-like illness during the work day should be:
• Separated from other workers and asked to go home promptly. (For recommendations on personal protective equipment for a person assisting the ill employee, see Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission.
• When possible and if they can tolerate it, workers with influenza-like illness should be given a surgical mask to wear before they go home if they cannot be placed in an area away from others. 
• If an employee becomes ill at work, inform fellow employees of their possible exposure in the workplace to influenza-like illness but maintain confidentiality as required by the Americans with Disabilities Act (ADA). For more information on privacy issues, please visit the Flu.gov. Employees exposed to a sick co-worker should monitor themselves for symptoms of influenza-like illness and stay home if they are sick. 
• Influenza viruses are thought to spread mainly from person to person in respiratory droplets of coughs and sneezes. Employers should:        
• Provide employees with messages on the importance of covering coughs and sneezes with a tissue or, in the absence of a tissue, one’s sleeve.
• Provide tissues and no-touch disposal receptacles for use by employees.  Influenza may also be spread via contaminated hands.
• Instruct employees to wash their hands often with soap and water especially after coughing or sneezing.  If soap and water are not available, instruct them to use an alcohol-based hand rub.
• During the 2009-2010 flu season, employees should frequently clean all commonly touched surfaces in the workplace, such as workstations, countertops, and doorknobs.  The cleaning agents that are usually used in these areas are sufficient and the directions on the label should be followed.
• If the sick employee shares a work station with other employees, clean the sick worker’s work station after he or she leaves for home.  The cleaning agents that are usually used in these areas should be used following the directions on the label. CDC does not believe any additional disinfection of environmental surfaces beyond the above recommended cleaning is required.

What is the best way to practice good hand hygiene?

Wash your hands with soap and water for at least 20 seconds (the time it takes to sing “Happy Birthday” twice). Be sure to wash both sides of the hands, between fingers and under the nails. That is the best way to keep your hands from spreading the virus.
Alcohol-based hand rubs containing at least 60% alcohol are also useful. After applying the hand rub, rub hands until dry. If you cannot wash your hands with soap and water and do not have an alcohol-based hand rub, other hand rub (that do not have alcohol in them) may kill flu germs on hands. There is not as much information about whether these types of hand rubs are effective.

How long should a sick employee stay home?

Under current flu conditions, employees with flu-like symptoms should stay home for at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius) or signs of a fever (have chills, feel very warm, have a flushed appearance, or are sweating). This should be determined without the use of fever-reducing medicines (any medicine that contains ibuprofen or acetaminophen).
The sick person may decide to stop taking fever-reducing medicines as he or she begins to feel better. This person should continue to monitor his or her temperature until it has been normal for 24 hours.
If flu conditions become more severe, the sick employee should stay home for 7 days. A person who is still sick after 7 days should stay home until 24 hours after their symptoms have gone away. 
Sick people should stay at home, except if they need to get medical care, and they should avoid contact with others. Keeping people with a fever at home may reduce the number of people who get infected with the flu virus.

Should household members of sick people stay home, too?

No, an employee with an sick household member may go to work.  It is especially important that these employees monitor themselves for illness.
Employees with school-aged children may need to stay home to care for their children. Employers should review leave policies for the flexibility to allow employees to stay home if they need to care for their children or other household members.
If flu conditions are more severe, CDC guidance for school-aged children is that they should stay home for 5 days from the time someone in their home became sick.  However, this guidance does not apply to adults.

Should our business require a note from a health care provider to allow employees who have been sick to return to work?

No, a note from a doctor’s office or health care provider should not be required. Health care facilities may be very busy during flu season and it will be hard to provide these notes. Under current flu conditions, if an employee has symptoms of flu they should stay home until they are free of fever (100 degrees Fahrenheit or 37.8 degrees Celsius measured by mouth) for at least 24 hours, without use of fever-reducing medicines. This is usually about 3 to 5 days.

Why didn’t my business send home a letter that there was a case of 2009 H1N1 flu?

CDC does not recommend notifying employees or sending home a letter when one or more employees in a business have 2009 H1N1 flu. Though we recognize this is something many individuals want to know, unless this is something that a business does routinely every flu season, there is no reason to do so now. 
Businesses in communities experiencing a flu outbreak should, in coordination with their state or local health and education agencies, send home information on the importance of staying home when sick and ways to reduce the spread of flu. The "Preparing for the Flu: A Communication Toolkit for Businesses and Employers" includes fact sheets for employees and templates for letters that businesses can send to employees regarding steps businesses are taking during current or more severe flu conditions. These materials can be found at http://www.flu.gov/h1n1flu/professional/business/toolkit/.

What are fever-reducing medicines?

Fever-reducing medicines are medicines that contain acetaminophen (such as Tylenol®) or ibuprofen (such as Motrin®). These medicines can be given to people who are sick with flu to help bring their fever down and relieve their pain. Aspirin (acetylsalicylic acid) should not be given to children or teenagers (anyone 18 years old and younger) who have flu; this can cause a rare but serious illness called Reye’s syndrome.

Can the flu virus live on surfaces, such as computer keyboards?

Yes, the virus can live on hard objects up to 8 hours. Flu viruses may be spread when a person touches a hard surface (such as a desk or doorknob) or an object (such as a keyboard or pen) where the virus has landed and then touches his or her eyes, nose, or mouth. Routine cleaning of surfaces will help stop the virus from spreading in this way.
Routinely clean surfaces and items that are more likely to have frequent hand contact with cleaning agents that are usually used in these areas. Additional disinfection beyond routine cleaning is not recommended.