Well, it’s that time of year again. As per the CDC, flu activity usually peaks between December and February, although activity can last as late as May. As we know, the flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. It can cause mild to severe illness, and at times can lead to death. Anyone can get the flu and serious problems related to the flu can happen at any age, but some people are at a higher risk of developing serious flu-related complications if they get sick. The at-risk group includes people 65 years and older, and people of any age with certain chronic medical conditions (such as asthma, diabetes, or heart disease).

So, what can be done at long-term care facilities on the front end to limit a potential outbreak with such a vulnerable population?

The first step would be for the facility to request that all residents and health care workers be vaccinated, which is the most effective way to guard against getting the flu.

Facilities should also advise all visitors to wash their hands frequently with soap and water or use hand sanitizer. They should also recommend that visitors receive the flu vaccine and educate them as to why it’s so important when they are visiting an environment such as a long-term care facility.

Testing: Even if it’s not influenza season, testing should occur when any resident has signs and symptoms of influenza-like illness. Once a single laboratory-confirmed case of influenza has been identified, it is likely there are other cases among the resident population.

Standard precautions should be implemented during an outbreak:

• Wear gloves if hand contact with respiratory secretions or potentially contaminated surfaces is anticipated.
• Wear a gown if soiling of clothes with a resident’s respiratory secretions is anticipated.
• Change gloves and gowns after each resident encounter and performing hand hygiene.
• Perform hand hygiene before and after touching the resident, after touching the resident’s environment, or after touching the resident’s respiratory secretions, whether or not gloves are worn. Gloves do not replace the need for performing hand hygiene.
• All long-term care facility residents who have confirmed or suspected influenza should receive antiviral treatment immediately.
• All eligible residents in the entire long-term care facility (not just currently impacted wards) should receive antiviral chemoprophylaxis as soon as an influenza outbreak is determined.

When at least two residents are ill within 72 hours of each other and at least one resident has laboratory-confirmed influenza, the facility should promptly initiate antiviral chemoprophylaxis to all non-ill residents, regardless of whether they received influenza vaccination during the previous flu season. Priority should be given to residents living in the same unit or floor as an ill resident. However, since staff and residents may spread influenza to residents on other units, floors, or buildings of the same facility, all non-ill residents are recommended to receive antiviral chemoprophylaxis to control influenza outbreaks.

Consider the following additional measures to reduce transmission among residents and health care personnel:

• Have symptomatic residents stay in their own rooms as much as possible, including restricting them from common activities, and have their meals served in their rooms when possible.
• Limit the number of large group activities in the facility and consider serving all meals in resident rooms if possible when the outbreak is widespread (involving multiple units of the facility).
• Avoid new admissions or transfers to wards with symptomatic residents.
• Limit visitation and exclude ill persons or anyone with known exposure to the flu, from visiting the facility via posted notices. Consider restricting visitation by children during community outbreaks of influenza.
• Monitor personnel absenteeism due to respiratory symptoms and exclude those with influenza-like symptoms from work until at least 24 hours after they no longer have a fever.
• Restrict personnel movement from areas of the facility having illness to areas not affected by the outbreak.

Although this year’s flu season is imminent, there is still time for long-term care facilities to implement procedures to limit the spread of the flu to their residents.

References: Centers for Disease Control and Prevention