Controlling H1N1 exposure in physicians’ offices

Physicians’ offices are one of the few places that people with H1N1 symptoms are like­ly to visit. With the rapidly escalating incidence of H1N1 in early October (when this article was written), exposure control in doctors’ offices is essential to protect the health of not only the doctors and their staff, but also patients and their families.

To the best of our knowledge at this time, H1N1 is transmitted through contact with contaminated surfaces or droplets/aerosols from infected individuals. While viruses are typically contagious for 3 to 5 days from onset of symptoms, H1N1 remains infectious for up to 7 days.

And just how virulent is it? Al­though the majority of individuals infected with H1N1 experience mild symptoms, a small minority (including those who are pregnant, immune-compromised, morbidly obese, etc.) may experience more severe symptoms, as it appears this novel virus may be more virulent than seasonal influenza. 

Additionally, according to the latest from the World Health Organization, the H1N1 virus may pose an increased risk to young adults (age 20 to 40) who have no known premorbid medical conditions.

Patients with flu-like symptoms such as fever, sore throat, cough, nausea, or diarrhea, serious enough to visit their doctor should be assumed to have H1N1.

To protect staff
Education is the key to preventing and reducing staff exposure to H1N1. Remind staff to wash their hands frequently or use alcohol-based hand cleaners and attempt to maintain a distance of at least 2 metres from infected patients. Here are other ways to help protect staff:

• Apply brightly colored tape on the floor to indicate the distance patients should stand from the reception desk—2 metres from the receptionist is optimum; 1 metre away, in addition to the width of the desk, is adequate.

• Place an angled (i.e., 3-sided) piece of Plexiglas on the desk to provide a physical barrier between patients and the receptionist—an opening in the bottom would allow objects to be passed back and forth when necessary.

• Provide alcohol-based hand cleaner for use after handling anything from a patient with H1N1 symptoms.

• Provide surgical masks for staff to wear in the presence of a symptomatic patient.

To protect patients
Patients who visit their doctor deserve to be protected from other patients who may have H1N1. Here are some suggestions:

• Create as much space as possible between chairs in the waiting room—for example, remove every second chair

• Sanitize chair arms and doorknobs at least every night.

• Clean with disinfectant—ensure cleaning staff understand what is required.

• Designate a period of time during the day specifically for patients with suspected respiratory problems and try not to schedule other patients during this time.

• Isolate patients who come in with H1N1 symptoms—after they leave, sanitize the room where they were quarantined.

• Provide surgical masks for symptoma­tic patients to wear while in the waiting area (if they can tolerate them).

To protect yourself
It’s critical that physicians remain healthy so we can continue to provide care to patients. Some steps are common sense:

• Wash hands between patient visits.

• Wear gloves and change them for each patient.

• Wear at least a surgical mask and preferably a fit-tested N95 respirator.

If a physician or any staff member has H1N1 symptoms, he or she should not be at work and should stay away from the office for at least 7 days from the onset of symptoms.

WorkSafeBC Occupational Health and Safety Regulation
While the above suggestions are intended to protect you, your staff, your patients, and their families from H1N1, physician employers are res­ponsible, under the WorkSafeBC Occupational Health and Safety Regulation, for protecting their workers from not only H1N1, but from all other occupational diseases. 

As an employer, you are required to have a written exposure control plan and implement it. Information on the Occupational Health and Safety Regulation and H1N1 is also available on our web site at

If you have any questions or require further information regarding occupational disease protection, please contact your nearest WorkSafeBC office for the name of the occupational hygiene officer for your area.

—Peter Rothfels, BEd, MD, ASAM
WorkSafeBC Director of 
Clinical Services and 
Chief Medical Officer

—Geoffrey Clark, MSc, CIH, ROH
WorkSafeBC Senior Occupational Hygienist

Peter Rothfels, MD, Geoffrey Clark, MSc,. Controlling H1N1 exposure in physicians’ offices. BCMJ, Vol. 51, No. 10, December, 2009, Page(s) 434 - WorkSafeBC.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

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An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

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