Flu Season

Even with flu season underway, it’s not too late to help your accounts protect their patients

Regardless of how large or small the facility, during flu season, it takes a concerted effort to prevent the spread of influenza among elderly, frail and immuno-compromised residents. Informed sales reps can reinforce the efforts of facility directors, clinicians, caregivers and staff to help prevent a flu outbreak.

Influenza can be introduced into a long-term care facility by newly admitted residents, healthcare workers and visitors, according to the Centers for Disease Control and Prevention (CDC). One outbreak of flu can lead to any number of residents experiencing severe and fatal illness.

Preventing transmission of influenza viruses and other infectious agents within healthcare settings – including long-term care facilities – requires a multi-faceted approach, notes the CDC. It includes:

1. Vaccination
2. Testing
3. Infection control
4. Antiviral treatment
5. Antiviral chemoprophylaxis.

Vaccination
The time to target flu is before any patients succumb to it. For this reason, influenza vaccination should be provided routinely to all residents and healthcare workers of long-term care facilities. Since October 2005, the Centers for Medicare and Medicaid Services (CMS) has required nursing homes participating in Medicare and Medicaid programs to offer all residents influenza and pneumococcal vaccines and to document the results. According to requirements, each resident is to be vaccinated unless contraindicated medically; the resident or legal representative refuses vaccination; or the vaccine is not available due to lack of storage. This information must be reported as part of the CMS Minimum Data Set, which tracks nursing home healthcare parameters.

Whenever possible, all residents should receive trivalent inactivated influenza vaccine (TIV) annually before the start of season, says the CDC. Generally, TIV is available to long-term care facilities beginning in September. Informed consent is required to implement a standing order for vaccination, but this does not necessarily mean a signed consent must be present. When a new patient or resident is admitted after the influenza vaccination program has concluded in the facility, the benefits of vaccination should be discussed, educational materials should be provided, and an opportunity for vaccination should be offered to the new resident as soon as possible.

No one’s exempt
Residents aren’t the only ones who should receive a flu vaccination. The CDC and the Advisory Committee on Immunization Practices (ACIP), recommend that all U.S. healthcare personnel get vaccinated annually against influenza. Studies show that:

• Higher vaccination levels among personnel have been associated with a lower risk of healthcare facility-associated influenza cases.
• Influenza outbreaks in hospitals and long-term care facilities have been attributed to low influenza vaccination coverage among healthcare personnel.
• Higher influenza vaccination levels among healthcare personnel have been associated with a reduction in influenza-related illness, including death, in settings such as nursing homes.

Finally, when influenza activity has spread in the local community, active daily surveillance for influenza illness should be conducted among all new and current residents, staff and visitors of long-term care facilities, and continued until the end of influenza season, notes the CDC. Ill residents, personnel and visitors should be excluded from the facility until illness has resolved.

Testing
Although it’s unusual, an influenza outbreak can occur outside of the normal influenza season. Therefore, influenza testing should occur when any resident has signs and symptoms of influenza-like illness. The CDC recommends testing when there is a confirmed or suspected influenza outbreak (two or more ill residents). One laboratory-confirmed influenza-positive case, together with other cases of respiratory infection in a unit of a long-term care facility, can indicate a possible outbreak. Once an outbreak has been identified, outbreak prevention and control measures should be implemented immediately.

Managing an outbreak
Once a single laboratory-confirmed case of influenza has been identified, it is likely there are other cases among exposed persons, the CDC warns. In such cases, the facility should conduct daily active surveillance until at least one week after the last confirmed influenza case occurs. The following residents should be tested for influenza during an outbreak:

• Ill individuals who are in the affected unit, as well as previously unaffected units in the facility.
• Residents who develop acute respiratory illness symptoms more than 72 hours after beginning antiviral chemoprophylaxis.

Sometimes long-term care residents, including those who are elderly, medically fragile and those with neurological or neurocognitive conditions, may manifest atypical signs and symptoms with influenza virus infection, and may not have a fever. So, it’s especially important that the lab performing the tests notifies the facility of tests results promptly. In addition, the local health and state health departments should be notified of every suspected or confirmed influenza outbreak in a long-term care facility, especially if a resident develops influenza while on or after receiving antiviral chemoprophylaxis.

Four times the protection
The quadrivalent flu vaccine is designed to protect against four different flu viruses: two influenza A viruses and two influenza B viruses. Of the 151 to 156 million doses of influenza vaccine projected to be available for the 2014-2015 season, manufacturers estimate that 76 million doses will be quadrivalent flu vaccine, according to the Centers for Disease Control and Prevention.

Link to chart of available flu vaccines for the 2014-2015 season (Source: The Centers for Disease Control and Prevention)

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a3.htm#table-6