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Influenza Outbreak Prevention, Identification and Control inLong Term Care Facilities
Claire Brostrom-Smith, RN, MSN, CIC
Healthcare Associated Infections Lead
Communicable Disease Epidemiology & Immunization Section
Public Health- Seattle & King County
Objectives
Create facility protocol to successfully prepare for, and control an influenza outbreak
01Provide staff with tools to effectively conduct influenza-like illness surveillance activities
02Promote and provide support to staff to implement influenza outbreak management recommendations
03
Before an
Outbreak
Before an Outbreak-Vaccinate
Vaccinate, vaccinate, vaccinate
Current residents
High dose vaccine
Staff
New admits
Document, document, document
Pneumococcal vaccine for residents > 65
years old and certain medical conditions.
Before an Outbreak- Training
Flu training
Signs and symptoms
Elderly
NP swab collection
Distribute ILI policy to staff
Staff with influenza-like illness may not work until 24 hours after fever resolution without the use of fever reducing medication; exclusion for a minimum of 5 days is ideal
Staff developing influenza-like illness while working must immediately wear a face mask, notify management, and leave work
Signs and
Symptoms of
Influenza in the
Elderly
Before an Outbreak- Prepare
NP Collection Kits
Treatment and
chemoprophylaxis orders in
place
Education for residents and
families
Fact sheets
Facility flu protocol
Surveillance
During an
Outbreak
CDC Influenza Outbreak
Definition
1 CONFIRMED OR > 2 SUSPECTED CASES OF
INFLUENZA AMONG RESIDENTS AND/OR STAFF
During an Outbreak-Communication
Medical Director or facility administration
Key staff members & residents
Licensor
WA DOH DSHS 1-800-562-6078
Public Health
Call 206-296-4774
Fax 206-296-4803
Influenza death- notifiable condition
Public Health may call you
During an Outbreak- Control Measures
Daily ILI surveillance
Testing
Rapid vs. RT-PCR
PH kits
Line lists
Post outbreak notices
Consider cancelling group
activities
Dinning room
During an Outbreak-
Treatment vs. Chemoprophylaxis
During an Outbreak-
Treatment vs Chemoprophylaxis
Treatment
All ill residents with ILI or confirmed
flu
Start with in 48 hours of onset
Can have benefits if >48hrs
Don’t wait for laboratory
confirmation
Typically for 5 days
CDC dosing guidance
Chemoprophylaxis
All non-ill residents
Priority to residents on same floors
as ill resident
Minimum of 2 weeks, and at least
7 days after last known case
CDC dosing guidance
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
During an
Outbreak-
Control
Measures
Chemoprophylaxis for unvaccinated staff
Caring for high risk residents
Vaccinate
Residents
Staff
During an
Outbreak-
Infection
Control
Measures
Standard and droplet precautions for all ill
residents
7 days after onset or 24 hours after resolution of
fever, whichever is longer
Confine to room, including at mealtime
Use facemasks
During an Outbreak-Infection Control Measures
Staff PPE
Gloves, gowns, face mask
Training
Signs
https://washington-state-hospital-
association.myshopify.com/collections/isolation-
precautions
During an Outbreak-Infection Control Measures
Increase
environmental
cleaning
Shared equipment &
high touch areas
EPA registered
disinfectant
Manufacturers
instructions
During an
Outbreak-Infection
Control
Measures
Limit admissions
Minimize staff movement
Exclude staff with ILI for at least 24 hours after
resolution of fever
Exclude visitors with ILI from facility
After an
Outbreak
After an Outbreak- When is an
outbreak over?
• 7 days with no new
onset of symptoms
After an Outbreak-Communication
Notify Medical Director
facility administration
Report Outbreak
summary to Public Health
After an Outbreak
Resume group activities
Resume unrestricted
admissions
Remove outbreak notices
After an Outbreak- Other Considerations
Post- outbreak debrief/review
Check stock of influenza test kits
Continue active daily surveillance for ILI
Continue environmental cleaning of high touch areas
Encourage continued hand hygiene & respiratory etiquette
Resources
CDC Interim Guidance for Influenza Outbreak Management in LTCF
https://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-
guidance.htm
WA DOH Long-Term Care Guidance
https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/P
ublicHealthSystemResourcesandServices/Immunization/InfluenzaFluI
nformation
PHSKC Flu resources for LTCF
https://www.kingcounty.gov/depts/health/communicable-
diseases/immunization/flu-season/for-long-term-care-facilities.aspx
Resources
CDC Weekly National Influenza Surveillance Report https://www.cdc.gov/flu/weekly/
WA DOH Influenza Surveillance Data
https://www.doh.wa.gov/DataandStatisticalReports/DiseasesandCh
ronicConditions/CommunicableDiseaseSurveillanceData/InfluenzaS
urveillanceData
PHSKC Weekly Flu Surveillance Reports
https://www.kingcounty.gov/depts/health/communicable-
diseases/disease-control/influenza.aspx
Questions?
Claire Brostrom-Smith, RN, MSN, CIC
Healthcare Associated Infections Lead
Communicable Disease/ Epidemiology and
immunization section
Public Health-Seattle & King County
Claire.brostrom-smith@kingcounty.gov
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