NO GUARANTEE A flu shot is the best prevention, but this year's vaccine is only a moderate 62% effective, says the CDC.

Flu season reached epidemic levels early this year, so the worst may be yet to come. We've already had our first patient cancel surgery due to flu-like symptoms. Although I can't know if he's the first of many, here are 3 things we can do to try to keep flu at bay.

Mandatory staff flu shots. Our facility has mandatory flu shots each year, with only 2 exceptions: medical and religious. Staff who otherwise choose not to get a flu shot are subject to disciplinary action, though no one's been fired. Most doctors and nurses do get flu shots, but in the past few months at least 15 nurses and other hospital staffers in 4 states have been fired for refusing, according to reports.

With the CDC's epidemic announcement, our facility announced mandatory surgical masks for any staff who've not gotten flu shots. That goes for anyone, by the way. Employees, physicians, students — even vendors — must wear a mask in our facility if they can't prove receipt of a flu shot.

The vaccine, even if it's not 100% effective, is still your best line of defense against influenza. Vaccination can reduce the severity of the illness and symptoms, which may shorten the duration or keep pneumonia or other more serious effects from settling in. But because this year's vaccine is only a moderate 62% effective, according to the CDC, it's important to reinforce other preventive actions. We're stressing hand hygiene within the facility, but also reminding staff to carry hand sanitizer and even surgical masks for use when they're away from the facility.

Patient screens. We start contacting patients 2 weeks out from their surgeries, initially to get them scheduled, with perhaps a check-in, and then the pre-op phone call a couple days before. So each patient gets 2 or 3 contacts from us before they show up, just as a matter of customer service (which helps make them more comfortable in the facility when they arrive).

But now we're able to ask at each step about flu-like symptoms (fever, cough, chills) and whether they've been sick at all recently. It's also smart to ask if any family or close friends have been sick, and whether the patient may have been exposed. The earlier you reach out to patients, the more advance notice you'll have if they need to cancel, and the less a cancellation will affect the surgical schedule.

If you see in the patient's H&P that they work in a school, or that the patient lives in a nursing home — if they spend a lot of time in any higher-risk setting — educate them about good hand hygiene practices and advise them to call the surgeon if they start to have flu symptoms.

Finally, extend prevention efforts to families and caregivers — we're encouraging all family and patients to wear masks while in our facility. We've posted notices about flu prevention at the front door and registration areas. To make it easy, we provide free masks and extra bottles of hand sanitizer in the lobby.

Sanitizing wipes. In addition to the regular surface disinfection efforts — devices, blood pressure cuffs, chairs and the like in patient areas — we're stepping up our cleaning of counters, nurses stations and keyboards. Phones in particular are getting special attention. In the lobby, tables and doorknobs (especially on the restroom doors) aren't waiting until the end of the day to get wiped down. Finally, the front office is now cleaning binders containing medical records daily. Patient files go through a lot of hands on a daily basis, and it's not time-consuming to sweep a sanitizing wipe over them.