Influenza in Long-Term Care

Bill Cayley Jr MD MDiv

UW Health Augusta Family Medicine

Acknowledgement

• This presentation is an adaptation of material available to the public on the website of the Centers for Disease Control (http://www.cdc.gov)

Learning Objectives

Participants will be able to:

1. Describe influenza

2. Describe the importance of influenza in long-term care

3. Describe how to reduce the risk of influenza in long-term care

Influenza

• Influenza is…– Viral respiratory illness– Fever, muscle aches, headache, malaise,

nonproductive cough, sore throat, and rhinitis• Seriousness

– Usually resolves in 3-7 days– Severe illness in presence of chronic disease

• Pulmonary or cardiac disease, diabetes– Risks

• Serious illness or death in long-term care residents• Serious illness in long-term care personnel

• Influenza is NOT: upset stomach, a bad cold

The Influenza Virus

• Two types of viruses– Influenza A – subtypes by H & N antigens– Influenza B

• Transmission:– Small droplets from cough or sneeze

• Settle in airways of nearby persons• Direct or indirect contact w/ infected surfaces

– “Incubation” period of 1-4 days– “Contagious”

• Adults – from 1 day before to 5 days aftetr start of symptoms• Children – for 10 or more days

Impact of Influenza

• Hospitalization rates for children <5 years– 500/100,000 children with high-risk medical conditions– 100/100,000 children without high-risk medical conditions

• From 1979-80 through 2000-01– 54,000 to 430,000 influenza hospitalizations per epidemic– 226,000 influenza-related excess hospitalizations per year– 63% of all hospitalizations were among persons >65 years

• Influenza-related deaths– Pneumonia, exacerbations of cardiopulmonary other chronic

diseases– Deaths of adults >65 years account for >90% of deaths from

pneumonia and influenza

Increased Risk of Complications

1. Children 6-23 months2. Children and adolescents (aged 6 months--18 years) on receiving

long-term aspirin therapy3. Women who will be pregnant during the influenza season4. Adults and children with chronic pulmonary or cardiovascular

disease5. Adults and children who have required regular medical follow-up or

hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, etc.

6. Adults and children who have any condition that can compromise respiratory function or the handling of respiratory secretions

7. Residents of nursing homes and other chronic-care facilities8. Persons aged >65 years.

Long-term Care Environment

1) Susceptible patients• Mainly over 65• High-risk cardiac, pulmonary, and medical

conditions

2) High risk of transmission• Close quarters• Airborne or contact transmission

3) Staff transmission to patients

Prevention Strategies

• Surveillance • Education • Influenza Testing • Respiratory Hygiene• Standard Precautions• Droplet Precautions• Restrictions for Ill Visitors and Personnel

– when widespread influenza activity is occurring in the surrounding community

• Antiviral Chemoprophylaxis

Respiratory Hygiene

1. Visual alerts instructing residents and persons who accompany them to inform health-care personnel if they have symptoms of respiratory infection

2. Discourage those who are ill from visiting the facility. 3. Tissues or masks for residents and visitors who are

coughing4. Tissues and alcohol-based hand rubs 5. Ensure that supplies for handwashing are available6. Encourage coughing persons to sit 3 feet away from

others7. Residents with symptoms of respiratory infection should

be discouraged from using common areas where feasible.

Standard Precautions

1. Wear gloves if hand contact with respiratory secretions or potentially contaminated surfaces is anticipated.

2. Wear a gown if soiling of clothes with a resident’s respiratory secretions is anticipated.

3. Change gloves and gowns after each resident encounter

4. Decontaminate hands before and after touching the resident

5. When hands are visibly soiled or contaminated with respiratory secretions, wash hands with soap and water.

6. If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands.

Droplet Precautions

• Place resident into a private room, – OR cohort suspected influenza residents with other residents

suspected of having influenza; cohort confirmed influenza residents with other residents confirmed to have influenza.

• Wear a surgical or procedure mask upon entering the resident’s room or when working within 3 feet of the resident. Remove the mask when leaving the resident’s room and dispose of the mask in a waste container.

• If resident movement or transport is necessary, have the resident wear a surgical or procedure mask.

Influenza Vaccine

• Two types of vaccines protect against influenza– “Flu shot" - killed virus injectable vaccine– Nasal-spray - weakened live viruses (5 - 49 years)

• Viruses– One A (H3N2) virus, one A (H1N1) virus, and one B virus

• Both flu vaccines cause antibodies• Timing

– Best to get vaccinated in October or November, influenza peaks between late December and early March

• Immunity– Takes about two weeks after vaccination

• Can I still get sick?– Vaccination may prevent disease or reduce severity

Vaccination

• Health-care personnel and all residents of long-term care facilities should be encouraged to receive annual influenza vaccination – The National Healthy People 2010 goal for annual influenza

vaccination long-term care residents is 90%.– Vaccination is the primary measure to

• Prevent influenza• Limit transmission• Prevent complications from influenza in long-term care

facilities– Vaccination of elderly persons may not prevent infection, but

can reduce serious complications from influenza

Summary

• Influenza is a serious viral illness• Long-term care residents are at high risk of

death or illness• Long-term care staff are at risk for illness or

transmission• Contact precautions and respiratory hygiene

help reduce transmission• Vaccination is vital!

CDC Resources

• Questions & Answers: Flu Vaccine– http://www.cdc.gov/flu/about/qa/fluvaccine.htm

• Infection Control Measures for Preventing and Controlling Influenza Transmission in Long-Term Care Facilities– http://www.cdc.gov/flu/professionals/infectioncontrol/

longtermcare.htm

THANKS!