Preventing flu - anti-flu vaccination

Annual anti-flu vaccination is the main prevention measure for flu.

The vaccinations available in Spain are all inactive (they do not contain the flu virus, just part of the virus) and they are administered by intramuscular injection in a single dose. The side effects of the vaccination are not very common and generally mild (pain, hardening and redness at the injection site that do not restrict activity).

The purpose of the anti-flu vaccination is to generate protection against the flu virus strains that circulate in the flu season. There are normally changes in these strains each year. Vaccinations must therefore be prepared each year to include the strains that are most likely to be responsible for flu cases in the coming season. Vaccinations are manufactured based on strains recommended by the World Health Organization (WHO).

The effectiveness of the anti-flu vaccination in preventing hospitalisation due to flu and pneumonia ranges from 30% to 70%. In older people living in institutions, vaccinations have proven to be between 50% and 60% effective to prevent hospitalisation or pneumonia, and 80% to prevent death by flu.

The vaccination is particularly recommended for people at high risk of suffering complications in the event of a flu infection:

• People aged 60 or above, as well as those who live in closed institutions.
• People under 60 at high risk of presenting flu complications: pregnant women, morbidly obese people and people of any age who suffer from one of the following types of illness: cardiovascular, pulmonary (including bronchopulmonary dysplasia, cystic fibrosis and asthma), neurological, neuromuscular, metabolic (including diabetes mellitus), kidney failure, immunosuppression, cancer, chronic liver diseases, asplenia and iron deficiencies.
• Healthcare staff and other people who may transmit flu to those at high risk of complications.

As well as vaccination, there are a series of hygiene measures that help to prevent flu:

• Cover your mouth and nose with a disposable tissue when coughing or sneezing, and then throw it away.
• It is essential to wash your hands regularly with soap and water for 15-30 seconds and dry them properly (especially after touching shared surfaces such as handrails, door handles, computer keyboards and mice, telephones, supports on public transport and after sneezing and blowing your nose), or with alcohol solutions by rubbing your hands for 15-30 seconds.
• Enclosed spaces should be kept ventilated.
• Avoid close contact with people who have flu and do not share food or utensils with them (such as cutlery, glasses, serviettes and napkins) or other objects without cleaning them properly.

If you get symptoms of flu or the doctor has diagnosed you with the illness, you should make sure not to share enclosed spaces with people for the first 3-5 days, especially people who are ill in hospital and community care workers.

Preventing falls

• Never leave the baby unattended on top of a changing table, bed, sofa or chair. If you are unable to hold or carry them, leave them in a safe place, such as their cot.
• Make sure that the changing table is stable, especially when the baby can crawl or walk. If you need to step away, always hold onto them with one hand.
• Before they start crawling, install gates on stairs, windows and doors.
• Always place the baby’s rocker on the floor. When the baby is bigger, hold the rocker’s legs so that it cannot fall forward.

Bath time

• At bath time, hold onto the baby tight. Do it gently, but firmly and do not get distracted.
• Never leave a baby unattended near to a bathtub, pool, the sea or a vessel containing water. An infant can drown in less than 5 cm of water.
• Make sure that the water in the tub is not more than 37ºC. When you fill it up, if there is no mixer tap, first fill it with cold water and then add warm water.

To avoid burns

• Do not carry hot drinks when you are holding the baby.
• Make sure that the baby stays in the shade and protect their skin.
• Cover plug sockets, especially when they start crawling.
• Be very careful with stoves, both with regard to burns and the emission of polluting gases.

Car journeys

• Always use car seats and boosters appropriate to the age of the child and vehicle characteristics. Follow the manufacturer’s assembly instructions.
• Always make sure that the child and their seat are well secured.
• Put the baby in the appropriate basket or chair with the approved safety fittings, in accordance with current regulations.
• Never leave them in the car unattended!
• It is a good idea for young babies to travel facing backwards and in the back of the car, as this reduces the risk of injury. If the chair is in the front seat for some reason, turn the air bag off.
• Check that there are no loose objects in the car, as they may be thrown around and distract the drive.

Ear protection

• Avoiding having the music volume too high or loud and repetitive noises.
• Check that the volume on toys is not too loud or acute. Better yet, check toys before buying them.

Other accidents

• Check that the car’s brakes function correctly.
• Check that the teats on dummies and bottles are not cracked.
• Make sure that hanging towels or cables, if pulled, do not cause objects to fall.
• Do not leave small objects within reach nor give them hard foods such as apple, carrot, popcorn or crisps,
• Be careful with bags or plastic wrap, balloons or other objects that may lead to suffocation.
• Do not leave the baby alone with pets, as their reactions are unpredictable.
• Medicines and cleaning products and toxins should be kept well out of reach.
• Do not put anything around your neck, wear large earrings or rings and do not use needles.

Passive smoking

Passive smoking harms the baby’s health. Tobacco smoke in the air, also known as second-hand smoke, is a mixture of the smoke that smokers exhale and smoke from the passive combustion of the cigarette. Both are toxic and contain respiratory irritants and carcinogens. Tobacco smoke behaves like vapour: it hangs in the atmosphere and impregnates clothes, hair, furniture, curtains, etc. Despite having snubbed out the cigarette, the toxic elements remain in the air, which you should bear in mind when protecting your baby’s health. Therefore:

• Do not smoke at home, by the window or in any rooms, as there is no device that eliminates tobacco smoke from the environment.
• Ask visitors not to smoke in the house.
• If you smoke on the balcony or terrace, close the door into the house.
• Do not smoke in the car, even if the baby is not there.
• When you go out with the baby, avoid enclosed spaces where people are allowed to smoke.
• Do not smoke in front of the baby, even in open spaces.

On a physical level, postpartum is characterised by an involuntary and regression process of the body areas and organs that have undergone changes, with the exception of the mammary gland, which at this time is of greater importance for feeding the baby. In addition to physiological changes, there are also changes in mothers on a psychological level, in the family structure and in their social role.

A period in which so many changes appear can translate into a complex or difficult adaptation, so it is important that the care provided by health professionals is carried out from a biopsychosocial and holistic approach, and it is recommended that they be coordinated by a midwife.

Three stages of postpartum

From a clinical point of view, three stages can be distinguished.

First stage: immediate postpartum

The immediate postpartum period includes the first 24 hours, of which the first two represent a period of close surveillance, due to the increased risk of postpartum haemorrhage.

Regular monitoring of vital signs, such as temperature, blood pressure, and heart rate, will be carried out in the delivery room. Vaginal bleeding and the size of the uterus will be assessed, which after delivery must gradually recover to its size before pregnancy.

It must be verified that there is no wound or laceration in the vagina that is actively bleeding and, in the event that the woman has requested anaesthesia, the recovery of mobility of her legs must be checked.

Immediate skin-to-skin contact of the baby with the mother will be initiated, under the appropriate supervision of health professionals, as well as the early start of breastfeeding if the mother wishes. The pertinent care of the newborn will also be carried out without altering the mother-child relationship, whenever circumstances allow.

During the hospital stay, checks and care must be aimed at promoting the bond between mother and baby, together with the establishment of breastfeeding. During this process, it is important to instruct the mother and her family with regards identifying the warning signs to detect possible complications early.

It is necessary to offer the mother truthful and simple information so that at the time of discharge she has maximum autonomy regarding the care of her baby. During the hospital stay, active participation of the couple in parenting will also be encouraged.

Second stage: early postpartum

The "early", "mediate" or "clinical" postpartum covers from 24 hours to the tenth day of postpartum and is considered the most important involuntary period. During this period, attention should be paid to the following possible complications: Infection of the endometrium, the surgical wound, the episiotomy, urine or the breasts; circulatory problems such as varicose veins, haemorrhoids and difficulties related to breastfeeding: pain, cracks, inflammation and problems with the baby's latch.

The hospital stay can be extended by 2 to 3 days depending on the type of delivery and as long as the evolution of the mother and baby is within normal limits. Once hospital discharge occurs, the midwife of the primary care centre will be in charge of the continuity of care for both the woman and her baby.

Third stage: late postpartum

Finally, the third phase, which corresponds to the late postpartum period, is between the 11th and the 42nd day after delivery (6 weeks).In this period, the physical changes that occurred during pregnancy in the mother have disappeared, breastfeeding is usually in place and the first menstruation appears in mothers who are not breastfeeding.

In this period, the physical changes that occurred during pregnancy in the mother have disappeared, breastfeeding is usually in place and the first menstruation appears in mothers who are not breastfeeding. We should also provide information on postpartum support groups and breastfeeding groups.

Changes to the patient's diet

• A varied diet rich in proteins and fibre and low in salt is recommended, restricting fats and fried foods. Following a Mediterranean diet, which features fresh and seasonal products, is advisable.
• Patients who experience changes in their sense of smell or taste, or decreased hunger, should be monitored to avoid excess weight loss that can be caused by malnutrition.
• If they have a decreased sensitivity to heat and can not tell if the food is too hot, the temperature of the foods given should be controlled to avoid burns.

Patients with dysphagia

• The food should not have lumps and should not be too hot. To encourage swallowing, cold and hot (but not hot enough to burn) foods can be alternated.
• The patient should have their back straight and head upright. Sometimes, however, their chin can be lowered to facilitate swallowing.
• To make drinking easier, you can use small glasses, avoiding straws and small bottles.
• Food should be given frequently but in small quantities, on the patient's good side. To ensure there is no food left in their mouth, you can wait until they swallow once or twice.
• Avoid distractions while eating.
• If the patient tends to cough or choke, chemical thickeners (bought at the pharmacy) or natural thickeners (potato, flour, or bread, among others) can be used.

Using a feeding tube

• The food should be finely mashed and mixed with water.
• The patient should be in a seated or semi-seated position while being fed.
• Even when feeding is done through a tube, correct oral hygiene should be practised.
• When the feeding is interrupted, it is important to put a little water into the tube to avoid blockages and to later keep the cover of the feeding tube closed. If an obstruction occurs, you can try to unblock the tube with oil or a cola soft drink. If this does not work, you should go to the health centre.
• If it is a nasogastric tube, the nasal cavities should be cleaned daily and the place in the nose where the tube is inserted should be rotated to avoid the formation of ulcers.
• If the patient has a gastrostomy tube, the skin around the tube, the tube itself, and the connectors should be cleaned daily with soap and water. The tape securing the tube must also be changed daily, covering the area with gauze affixed with surgical tape.

If the patient has mobility problems

• Use cups with two handles.
• Serve the food in bowls or soup plates.
• The handles of the cutlery should be thick.
• Non-slip tablecloths should be used.

If the patient has problems defecating

In the case of constipation:

• Maintain a diet rich in fibre and encourage mobility whenever possible.
• Establish a set time to defecate, preferably on the toilet, avoiding faecal collection systems or nappies.
• Laxatives or enemas should only be used if a doctor prescribes them.

In the case of diarrhoea:

• Provide an astringent diet and keep the patient hydrated.
• If it continues for more than two days, consult a physician.

If urinary incontinence is an issue

• Take note of the quantity and frequency of urine (incontinence, urine infection and retention).
• The patient must drink one and a half litres of liquid a day and reduce liquid intake from late afternoon onwards.
• If the patient has light bladder leakage, offer them the chance to go to the bathroom frequently until they have better control of their sphincter.
• In the case of incontinence, nappies or a urine collector can be used, keeping the skin clean and dry.