New guidelines on protecting hospital workers against the H1N1 swine flu stress keeping influenza patients away from others and put protective equipment such as face masks last.

The new guidelines posted by the U.S. Centers for Disease Control and Prevention urge hospitals to vaccinate as many staff as possible against H1N1 and to bar entry to visitors with flu-like symptoms.

The best way to protect staff and patients from the virus is to keep it out of the facility, the CDC advises.

"Examples ... include: taking steps to minimize outpatient visits for patients with mild influenza-like illness who do not have risk factors for complications, postponing elective visits by patients with suspected or confirmed influenza until they are no longer infectious, and denying entry to visitors who are sick," the CDC said.

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Partitions in waiting rooms can help reduce spread, as can special equipment for airway suction in patients with breathing tubes.

Administrative controls such as required vaccination of staff, keeping sick staff at home, hand hygiene strategies and setting up separate waiting area for patients with flu-like illness can also help, the CDC said.

It said personal protective equipment or PPE ranked last in controlling flu, in part because it only works well when used consistently and properly.

"Careful attention to elimination of potential exposures, engineering controls, and administrative controls will reduce the need to rely on PPE, including respirators," the CDC said.

"This is an especially important consideration during the current year, when shortages of respirators have already been reported by many healthcare facilities."


Face masks called the N95 respirators are considered the best protection against viruses but they are in short supply, must be fitted properly and are uncomfortable to wear.

The Society for Healthcare Epidemiology of America praised the decision.

"We could actually put healthcare workers at greater risk by further reducing an already short supply of a device that is needed for high-risk procedures such as bronchoscopy by using it for routine care," said Dr. Mark Rupp of the University of Nebraska Medical Center, who is president of SHEA.

"The best science available leaves no doubt that the best way to protect people is by vaccinating them."

The CDC has advice on encouraging healthcare workers to get vaccinated against H1N1. Usually only about 40 percent of nurses, doctors and technicians are immunized against seasonal influenza.

"To improve adherence, vaccination should be offered to healthcare personnel free of charge and during working hours. Vaccination campaigns with incentives such as lotteries with prizes should be considered. Healthcare facilities should require personnel who refuse vaccination to complete a declination form," the CDC advised.

Liberal sick leave policies will encourage sick workers to stay at home with their germs and signs can remind workers and visitors alike how to avoid spreading germs, it added.