Health Alert
INFLUENZA OUTBREAK MANAGEMENT IN LONG-TERM CARE FACILITIES

Delaware Division of Public Health (DPH) has been notified of increasing reports of influenza outbreaks in long-term care facilities. Influenza can be introduced into long-term care facilities by newly admitted residents, healthcare workers, ancillary staff, and visitors. Residents of long-term care facilities can experience severe and even fatal illness during influenza outbreaks.

DPH is providing the following information to assist personnel in long-term care facilities with the prevention and control of influenza outbreaks.

Prevention

Preventing transmission of influenza within long-term care facilities requires a multi-faceted approach that includes vaccination, testing, infection control, antiviral treatment, and antiviral chemoprophylaxis.

Vaccination - It is not too late to get vaccinated. Aim to achieve 100% vaccination rates among residents and staff.  Vaccinations can be obtained from private physicians, many pharmacies and grocery stores, and public health clinics.  For further information on immunizations or where to get vaccinated visit www.flu.delaware.gov or call 800-282-8672.

Testing –During a suspected influenza outbreak, it is important to confirm the diagnosis to define the outbreak. Nasopharyngeal swabs should be collected from 5-6 of the most recently ill persons. The Division of Public Health Laboratory (DPHL) will perform Real-Time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) for long-term care facility outbreaks.  Consult with the DPHL prior to sending a sample and also on if additional testing is necessary after a flu outbreak is confirmed in a facility, at 302-223-1520. Additionally, DPHL provides the following information regarding specimen collection and shipment: http://dhss.delaware.gov/dhss/dph/lab/files/fluvirusspeccoll.pdf.

Infection Control –

• Aggressive standard precautions facility-wide with careful attention to respiratory etiquette and hand hygiene.
• Aggressive droplet precautions for all residents with suspected or confirmed influenza.
• Consider enforcing the use of facemasks among all unvaccinated healthcare workers for the duration of the influenza season.
• Place ill residents in private rooms or in the same room or wing as other ill patients.
• In the event of an outbreak, restrict residents to units and encourage them to remain in their rooms as much as possible.
• In the event of an outbreak, cancel all group activities, outside appointments and communal dining.
• Ill staff should be excluded from work until they have recovered (and for at least 24 hours after their fevers resolve). To the extent possible, limit staff from ‘floating’ between units.
• In the event of an outbreak, consider limiting or stopping visitation to the facility.
• Terminal cleaning throughout the facility followed by routine daily cleaning and frequent common touch surface disinfection.

Antiviral Treatment and Antiviral Chemoprophylaxis

Administer antiviral treatment and chemoprophylaxis to residents and healthcare personnel according to current recommendations which are located at:

• http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#dosage
• http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Infuenza.pdf

Reporting

Outbreaks are immediately reportable to DPH. Please contact the DPH Immunization Program at 302-744-1060 to report outbreaks of influenza.

An epidemiologist will work with you throughout the duration of the outbreak.

When to Send Residents to the Emergency Room

Reserve emergency room transfer for those residents whose signs and symptoms suggest a need for acute level of care. 

The following signs/symptoms may suggest a need for hospital transfer:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Altered mental status or new confusion
• Severe or persistent vomiting
• Abnormal vital signs including persistent tachypnea or tachycardia

Additional Information

• CDC Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities: http://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm
• CDC Infection Control in Healthcare Facilities: http://www.cdc.gov/flu/professionals/infectioncontrol/index.htm
• CDC Communications to Healthcare Providers: http://www.cdc.gov/flu/professionals/communications_hcp.htm

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