Stocking up on orifice supplies

What supplies should you acquire to prepare your office for an epidemic of mutated avian influenza?

The same supplies you would acquire for an outbreak of any other kind of influenza.

You don't normally stock special supplies for your office when flu season arrives? That's one reason epidemiologists are worried. Maybe you should reconsider.

I focus on supplies because, unlike other BCP preparations for infectious disease, supplies provide tangible evidence of planning. Simply by having them in the office, you reassure employees, you demonstrate prudent due diligence, and you don't spend much money. Appropriate medical supplies for an office are inexpensive.

Here's my list for most business offices: 1. anhydrous, antiseptic hand sanitizer in small bottles 2. N95 masks for your employees, visitors and contractors 3. one digital ear thermometer for each office or facility entrance

Hand sanitizer Celebrity physician and author Dr. Michael Greger provides a pithy, memorable quotation: "Everything you need to know about preventing a pandemic, you learned in kindergarten: wash your hands."

"Anhydrous" means the liquid base is alcohol instead of water. The disinfectant evaporates from your hands in less than a minute. No paper towels to throw away, no water wasted, no bathroom sinks to clean.

To save extra trips to the bathroom, offer all employees personal bottles of alcohol-based disinfectant to keep in their purses and brief cases. I like the two-ounce size, but they come as small as half-an-ounce. Give the bottles away to everyone like...well, water.

I saw bottles of hand disinfectant at an American Express office in Singapore last month--in the coffee pantry, an excellent distribution point. Put bottles where people congregate. Would you like coffee, tea, or anhydrous hand sanitizer?

Most important: actively encourage employees to use the stuff often. It's not something most people--men, at least--are going to do regularly in an office environment without considerable prodding, or someone's example to follow. If you could get your CEO to use hand sanitizer--visibly, regularly--you'd be doing more to protect your colleagues from a pandemic than anything else I can think of that costs so little.

Masks N95 masks are used to keep sick people from spraying saliva and mucous all over you. Masks will not prevent healthy people from inhaling an influenza virus.

"N95" is the U.S. National Institute of Occupational Safety & Health (NIOSH) standard that specifies a mask that will trap 95 percent of particles 0.3 microns or larger. A sneeze or cough generates a droplet about 4 microns or larger. An influenza virus is .1 microns in size, way too small to be trapped by a mask.

Give masks to people in your office who "present" (doctor-talk for "display") flu symptoms (fever, chills, headache, sneezing)--just before you order those people out of the office until they recover.

How many masks should you buy? One insurance company in Asia purchased 40,000 masks for its 400 employees, assuming every employee would use three masks each day for up to six weeks.

My diagnosis: overkill.

Of course, you have to wear a mask properly (sealed against the face over the mouth and nose) for it to work. Most people won't, or won't for long. Wearing an N95 mass makes it difficult to breathe, difficult to talk on the phone, difficult for others to hear you, and impossible to eat or drink.

But wearing it properly does seal in sneezes, saliva and snot.

I figure the appropriate number of masks is about 20 percent (1 in 5) of the number of your employees. That's my best guess at the percentage of people in your office who will actually catch the flu this year or any other year (maybe 10 percent, maybe more, maybe less)--plus some for other employees, visitors and contractors who may ask for a mask as a precaution when an epidemic gets underway. The masks don't have a shelf-life after all; you can keep them around forever if you don't use them this year.

Remember the masks used during SARS? They may keep someone from spraying saliva directly onto you, but they don't prevent "shedding" (read: spraying out the sides). Don't buy masks that don't seal over the nose and mouth.

Digital thermometer There's no reason to be taking temperatures in your office. If someone in your office is found to have a fever or other symptoms of influenza, it's already too late to prevent the spread of infection. He or she has been contagious for up to four days before the symptoms appeared.

The only plausible place at which to take someone's temperature is at the front door before he or she gets into the building.

For that purpose, a digital ear thermometer with disposable earpiece covers is my preferred weapon. You can't catch influenza from earwax. Of course, the poor security guards and receptionists assigned to wield the thermometer to check people's temperatures should have masks and gloves--and the authority to turn people away.

I believe the publicity value of a digital thermometer at the front door is greater than its medical value, but there aren't many ways to be seen exercising due diligence that cost less money.

Don't buy this stuff Here's a list of the supplies I would NOT buy for any office: • anti-viral, neuraminidase inhibitors oseltamivir phosphate (Tamiflu) or zanamivir (Relenza). It's not a company's responsibility to stockpile or dispense prescription medication to employees; that's what doctors and hospitals are supposed to do.

I understand that in an epidemic, when there may be a shortage of medicine, employees may expect a company to use its buying power to acquire potentially life-saving drugs. I'm not prepared to predict that either an epidemic or shortage will occur, but I am prepared to say that current price of Tamiflu is a ludicrous result of "irrational exuberance".

I have dosages of both Tamiflu and Relenza for my spouse and myself; that was a personal decision and purchase.

• nitrile gloves. They're uncomfortable and make your hands sweat. There is no less risk of spreading infection by sneezing on your gloved hand than there is from sneezing on your un-gloved hand. No one will wear them all day to work in an office; try wearing one for an hour and see your fingertips turn into little prunes. When you take them off, used gloves become potential biohazards; that's why doctors have separate biological hazardous waste bins in their offices. Nitrile gloves are not biodegradable, and they increase your office waste stream--unnecessarily.

If you are the company doctor or nurse, or have expect to have an assignment to handle potentially infectious individuals or surfaces, gloves are indispensable, of course.

• disposable oral thermometers These were used in Malaysia, for example, during the 2003 SARS epidemic in Asia. I can't think of a bigger health hazard during an infectious disease epidemic than hundreds or thousands of saliva-soaked, disposable thermometers, sitting in office trash cans. I would not want the job of disposing of them every day, and I wouldn't want to sit near a trash can full of them in an office.

Prudent purchases I suspect that mask and glove salesmen in Asia are buying fancy golf club memberships these days. Items they used to peddle only to hospitals for fractions of pennies are suddenly in demand in whole dollars by investment bankers and lawyers with tasseled loafers.

My suggestions about supplies have nothing to do with my opinion about the likelihood of a human influenza pandemic. I don't know when a widespread infectious disease outbreak will happen, but I'm quite sure it will eventually, and I think it's prudent for a company to make some, cost-effective preparations.

Just as I think it's prudent to make some preparations for a tsunami if you live near the ocean in Southeast Asia, or for terrorism if you live in a major city in America.

No matter what you decide to do about supplies, please...wash your hands.