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— No matter what Grandma might have warned, simple exposure to frosty winter air won’t lead to getting the flu.

But going to the office might.

Doctors suspect the workplace ranks among the biggest culprits in spreading the virus. Nausea and other symptoms force Americans to take nearly 111 million sick days a year, contributing to about $7 billion in productivity lost to the annual flu season, federal data show.

Businesses and workers can tackle the spread of the flu before anyone so much as coughs, said John Challenger, CEO at the Chicago outplacement firm Challenger, Gray & Christmas. He suggested implementing telecommuting policies that let mildly ill employees work from home, along with more traditional provisions allowing sick time.

“Many people aren’t so sick that they can’t or don’t want to do any work. They often can do some of the most important work while they’re home and ill — and they don’t really mind,” Challenger said.

For the workplace itself, he recommended routine disinfection of keyboards, doorknobs and other surfaces. Fewer meetings, more shifts and more use of videoconferencing also can cut down in-person contacts, reducing flu infection risks, Challenger said.

“Any time you have people working in close proximity of each other, it increases your chances” of picking up the disease, said Heather Rosen, medical director at a Pittsburgh-area University of Pittsburgh Medical Center urgent care clinic. She said those with flu symptoms might want to avoid shaking hands.

“The respiratory droplets can be passed. If you cough and you have them on your hands, you can pass them on to the other person,” Rosen said.

At Greentree Medical Associates, lead physician Jennifer Preiss said those infected are especially contagious in the first three days of flu symptoms, which include fever, coughs and muscle aches. She encourages people to cough into their elbows.

“I think if someone said they didn’t want to shake hands, I wouldn’t push it,” Preiss said.

Still, she said it might be extreme for a healthy person to halt all handshaking for the sake of flu season. It also could strain social ties.

“I find that to be a bit offensive and overstepping, if you will,” said Jacquelyn Flesner, a certified business etiquette trainer who started The Etiquette Network. “It falls into that category that, ‘I’m so concerned about my health and well-being that I won’t even extend you the classic courtesy of shaking your hand.’

Clinicians agreed that annual flu shots are the best method to prevent an office epidemic. Nearly 44 percent of adults nationwide were inoculated for the last season.

Employers can buoy that rate by offering in-house vaccination clinics or giving workers time to be inoculated elsewhere, said Joseph Bresee, an epidemiology chief at the Centers for Disease Control and Prevention in Atlanta. Early projections indicate the shot should be about 60 percent effective this season in preventing the flu nationwide.

“What we’ve found is that people are more likely to be vaccinated if it’s easy for them to be vaccinated,” Bresee said.

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