PHE NW Flu Resource Pack for Care HomesCheshire and Merseyside2019-2020

Developed by Public Health England North West Health Protection Team (Greater Manchester, Cheshire and Merseyside and Cumbria and Lancashire) and colleagues.

About Public Health England

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. We do this through world-leading science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. We are an executive agency of the Department of Health and Social Care, and a distinct delivery organisation with operational autonomy. We provide government, local government, the NHS, Parliament, industry and the public with evidence-based professional, scientific and delivery expertise and support.

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Contents

Flu Resource Pack for Care Homes 1About Public Health England 2Purpose of this Resource Pack 4Key Messages 4Key Contact Details 5Section 1: Preparation for the flu season 6Action Card 1 – Checklist of actions to prepare for the flu season 7Action Card 2 – Care home resident information template 8Section 2 : Cases and outbreaks of flu 10Action Card 3 - When to suspect flu/ flu like illness 11Action Card 4 - Actions to take if a single case of flu is suspected 12Action Card 5 - Actions to take if an outbreak of flu is suspected 13Action Card 6 - Actions to respond to a suspected or confirmed outbreak of flu or flu-like illness

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Action Card 7- Transfers in and out of the care home when flu is suspected or confirmed 15Action Card 8 – List of residents with suspected/confirmed flu infection 16Action Card 9 – Summary of Infection Prevention and Control Guidance 17Section 3 : Information on Flu 19What is flu? 20What is flu (influenza) like illness? 20Who is affected by flu? 20Guidance for monitoring, treating and cohorting residents with flu 21Guidance for staff members 22How do we protect against flu? 22Eligible groups for flu vaccination 2019/20 23Myth busting 24The importance of vaccinating residents and staff 24Section 4 : Appendices – Resources and Posters 25Appendix 1 - 5 moments for hand hygiene 26Appendix 2 - How to handrub / how to handwash 27Appendix 3 - Catch it Bin it Kill it 28Appendix 4 – Sequence for putting on and removing PPE 29Appendix 5 - Guidance on outbreaks of influenza in care homes 30Appendix 6 - Advice to visitors when an outbreak of flu is suspected / confirmed 31Appendix 7- Advice to visitors who have symptoms of flu 32Appendix 8 - Flu immunisation for social care and hospice staff 33Sources of Information 37

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Purpose of this Resource Pack

Many care homes will have experienced cases and outbreaks of flu (Influenza) and will be aware of the potentially serious and life-threatening implications for vulnerable residents. In addition, measures such as resident isolation and closing the care home to new admissions may stretch the resources of care homes and will present practical challenges to ensure the necessary infection prevention measures are taken. Outbreaks can be difficult and complicated to manage and it is important that care homes are aware of what to do when a case or outbreak is suspected, and who to ask for advice and support.

This document will provide care homes with all they need to know to protect residents and staff against flu. It contains basic information on the flu virus and provides guidance on how to prepare for the flu season and what to do when there is a suspected case or outbreak of flu in the care home.

The principles outlined in this resource pack also apply to other acute respiratory infections or flu-like illnesses.

Key messages Flu is not just a bad cold, it can be a serious illness in certain groups of people,

including those aged 65 and over

The flu vaccine is the best way to protect people against flu: eligible residents and staff should be vaccinated each year

Good infection control practice is essential to limit the spread of flu, particularly once a case occurs in a care home

Residents who are ill with symptoms of flu should be reviewed by their GP

Staff who are ill with symptoms of flu should stay off work until fully recovered .

Report a suspected outbreak of flu or flu-like illness by telephone to:

Monday to Friday 9am – 5pm Community Infection Prevention and Control Team

After 5pm /weekends/bank holidays Public Health England, Health Protection Team

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Key Contact Details

Community Infection Prevention and Control Team

Cheshire East 01889 571837

Cheshire West 01244 397700

Knowsley 01925 664851

Liverpool & Sefton 0151 295 3036

Warrington, Halton & St Helens 01744 457314

Wirral 0151 604 7750

Public Health England North West, Cheshire and Merseyside Health Protection Team

Monday – Friday (0900 – 1700) 0344 225 0562 – Option 1

Out of Hours Contact:

Public Health England first on call Via the Contact People

0151 434 4819

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Section 1: Preparation for the flu season To be completed before flu season and updated as required

It is important that care homes ensure they are fully prepared for the flu season and all necessary actions have been taken in order to protect residents from flu and minimise the impact of flu on the residents. Homes are advised to complete and work through this section now (Autumn)

This section includes:

Action card 1 - Checklist of actions to prepare for the flu season

Action card 2 - Care home and resident information template

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Action Card 1 - Care home to complete prior to flu season(Adapted from PHE London- North East and North Central London Health Protection Team. Acknowledgement: Vivien Cleary)

Date completed Completed by

Checklist of actions to prepare for the flu season √ x

Nominate a staff member to act as a flu coordinator for your homeCare home flu coordinator is - Flu vaccination1. Identify any residents aged over 65?2. Identify any residents in a clinical risk group (e.g. those with chronic respiratory, cardiac, kidney, neurological disease including learning disabilities, pregnant women, morbidly obese, immunocompromised , diabetes)?3.Request &ensure that the GP/pharmacist has administered the seasonal flu vaccine to residents in both elderly and clinical risk group patient categories in the autumn in advance of flu season.4. Ensure that all staff involved in patient care (including pregnant women at any stage of pregnancy) have received their FREE seasonal flu vaccine in the autumn in advance of flu season. Staff should contact their occupational health or registered GP / local pharmacy for vaccination ensuring that they have either a pay slip or identification badge to prove eligibility (Appendix 8).Respiratory hygiene & infection control precautions5. Ensure infection control policies are up to date, read and followed by all staff

6. Reinforce education of staff about hand and respiratory hygiene. See attached respiratory hand hygiene poster - Catch it, Bin it, Kill it (Appendix 3)

7. Ensure that adequate supplies of tissues. liquid soap and disposable paper towels are available in every resident’s room and in bathrooms, toilets, laundry, kitchens, sluice, cleaners’ rooms and utility areas. Ensure stock levels are adequately maintained.8. Ensure that Personal Protective Equipment (PPE) is available i.e. disposable gloves, aprons, surgical masks (Action card 9, Appendix 4)9. Ensure appropriate linen management systems are in place as well as clinical waste disposal systems including foot operated bins.10.Undertake a risk assessment and, if safe to do so, provide alcohol based handrubs for staff / visitor use e.g. personal gels, point of care dispensers, dispensers in areas where there are no hand washing facilities. Maintain supplies.11. Maintain adequate levels of colour coded cleaning materials in anticipation of increased cleaning (e.g. disposable cloths, detergent)

12. Refer to Action card 9 for further guidance on infection prevention and control

Keeping records13. Resident details should be recorded with information on their flu vaccination status and their latest kidney function test prior to flu season - Action card 2

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Action Card 2 - Care Home and Resident Information template- Complete prior to flu seasonIn the event of a flu outbreak, the table will ensure that important information is recorded in one place and is easily accessible

Name of care home TypeResidential / nursing

Manager of care home

Name of flu coordinator

Name of person completing template

Date completed

Date updated

Room Full Name DOB NHS Number Medical conditions GP Practice

Flu vaccine givenYes/NoDate

Kidney function (eGFR) /creatinine clearance/serum creatinineDate of last blood test

Weight

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Room Full Name DOB NHS Number Medical conditions GP Practice

Flu vaccine givenYes/NoDate

Kidney function (eGFR) /creatinine clearance/serum creatinineDate of last blood test

Weight

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Section 2 - Cases and outbreaks of flu

Action Card 3 - When to suspect flu/ flu like illness/flu outbreak

Action Card 4 - Actions to take if a single case of flu is suspected

Action Card 5 - Actions to take if an outbreak of flu is suspected Action Card 6 - Actions to respond to a suspected or confirmed outbreak of flu or flu-like illness .Action Card 7 – Transfers in and out of the care home when flu is suspected or confirmedAction Card 8 – List of residents with suspected / confirmed flu infectionAction Card 9 – Summary of Infection Prevention and Control GuidanceAction card 7 - List of residents with suspected/confirmed influenza infection (daily log)

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Action Card 3 - When to suspect flu / flu like illness

Oral (mouth) or tympanic (ear) temperature of 37.8° or moreAND one of the following:

Acute onset of at least one of the following respiratory symptoms: Cough (with or without sputum) Nasal discharge or congestion Sore throat Wheezing Sneezing Hoarseness Shortness of breath

OR An acute deterioration in physical or mental ability without

other known causeNOTE:

A laboratory detection of flu virus would fulfil the definition of a case of flu

Fever is necessary to define flu like illness using both the World Health Organisation (WHO) and the US Centres for Disease Control and Prevention (CDC) definitions of flu like illness.

It is acknowledged that older persons may not always develop a fever with flu; if a flu outbreak is suspected due to respiratory symptoms or acute deterioration in physical or mental ability without fever, prompt laboratory testing is recommended to confirm diagnosis.

Flu can sometimes cause a milder illness than expected; the severity can depend on the type of flu strain causing the illness and whether the infected person has been vaccinated.

People with chest infections can have flu at the same time: ‘co- infection’ is not uncommon during the flu season due to secondary bacterial chest infections developing

Action Card 4 - Actions to take if a single case of flu is suspected

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When to suspect a flu outbreak?Two or more cases which meet the clinical case definition above, arising within the same 48-hour period in people who live or work in the care home)

Resident displaying signs and symptoms of flu like illness

Protect Case Protect Other Isolate Case

For more detailed Infection Prevention and Control Guidance see Action Card 9

Suspected case in member of staff:

Symptomatic staff should be excluded from the home until they have fully recovered

All care homes should have a business continuity policy in placeect

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Protect Case Protect Other Isolate Case

Action Card 5 - Actions to take when a flu outbreak1 is suspected

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take if a single cAction Card 6 - Actions to respond to a suspected or confirmed outbreak of flu or flu-like illness (i.e. two or more cases linked by time and place).1. Ensure all symptomatic residents are assessed by a GP

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Contact GP

GP to assess residents and advise on immediate treatment

GP to liaise with Community Infection Prevention and Control Nurse (CIPCN) and Cheshire and Merseyside Health Protection Team (HPT) to complete risk assessment and determine if residents have influenza like illness

Report

During office hours - Report the suspected influenza outbreak to the Community Infection Prevention and Control Nurse by telephone

Outside office hours - Report the suspected influenza outbreak to PHE Cheshire and Merseyside Health Protection Team by telephone

Advice

The Community Infection Prevention and Control Nurse / Health Protection Team will give advice on infection prevention and control measures

An outbreak control team may be set up

The Community Infection Prevention and Control Nurses will assist with sample collection and processing (in hours)

If the outbreak is assesssed to be flu, PHE Health Protection Team will trigger the use of antiviral medication

Document

Care home to complete List of Residents with Suspected / Confirmed Flu Infection Document Action card 8

Staff to review and update document regularly / as needed

If antivirals have been advised, Action card 8 to be shared with the Community Infection Prevention and Control Team and / or the prescriber if required.

Implement

Care home to ensure advice from GP / CIPCN / HPT is implemented / completed

Care home to ensure prescribed medications (including antivirals) are administered in a timely manner

The care home may be advised to close the care home to new admissions

1 Two or more cases which meet the clinical case definition of flu like illness as detailed on action card 3 (or alternatively two

or more cases of laboratory confirmed Influenza) arising within the same 48-hour period with an epidemiological link to the

care home (including people who live or work in the care home)

2. Inform your local Community Infection Prevention Control Team (in hours) and PHE Health Protection Team (out of hours) of the situation immediately.

3. Ensure all infection control measures are in place (infection prevention and control advice will be supplied by the local community infection prevention and control team or the local PHE health protection team). Some key aspects include:

Respiratory hygiene for residents, staff and visitors – refer to Appendix 3, Catch It Bin It Kill It

Isolating symptomatic cases for a minimum of 5 days after the onset of symptoms Cohorting residents if appropriate Excluding symptomatic staff until they have recovered If possible, staff should only work with either symptomatic or asymptomatic patients Avoid transfers to other care homes. For transfers to medical facilities see Action card 7 Adequate Personal Protective Equipment (PPE) for staff Enhanced cleaning Exclude symptomatic visitors (Appendix 7) Visitor access to symptomatic residents should be kept to a minimum Signage informing about outbreak and Infection control measures (Appendix 6) Agency staff who are exposed during the outbreak should be advised not to work in

any other healthcare settings until 2 days after last contact with the home or if exposure is continuous, when the home re-opens

For further Infection Prevention and Control guidance see Action Card 9

4. The influenza outbreak co-ordinator to ensure daily logs are completed and liaise with other partners to ensure effective management of flu outbreak Action Card 8

5. Good record keeping is essential for outbreak investigation. Monitor residents daily to identify new cases (symptomatic residents) and keep a daily log of cases Action Card 86. Provide information as required to the local community infection prevention and control team or the local PHE health protection team. Accurate information is essential for outbreak investigation.7. Discuss the need for partial or whole closure to new admissions with the local community infection prevention and control team or the local PHE health protection team.8. Where advised to do so by the local community infection prevention and control team or the local PHE health protection team, support with the collection of respiratory swabs from symptomatic residents

9.The outbreak is usually declared over once no new cases have occurred in the 5 days since the appearance of symptoms in the most recent case. Discuss with your local community infection prevention and control team or the PHE health protection team.

These actions should be completed throughout the course of the outbreak

Completed by

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Action Card 7 - Actions to take for transfers in and out of care home when flu is suspected of confirmed

Transfers from hospital to care home

A patient with flu being transferred from hospital to a care home

Regardless of whether there is a flu outbreak in the care home or not, the following criteria must be met prior to transfer:

the patient is medically fit for discharge (they may still have flu symptoms) all appropriate flu treatment can be completed after transfer appropriate infection prevention and control measures can be implemented until a

minimum of five days after the onset of symptoms

A patient without flu being transferred from hospital to a care home with a flu outbreak (suspected or confirmed outbreak)

Discuss with your Community Infection Prevention and Control Team. Jointly undertake a risk assessment, consider: contact between residents, cross-

over of staff or visitors, compliance with infection prevention and control measures, layout of the care home, ability to isolate / protect this resident.

Other factors such as: virulence of local strains, severity of this outbreak, vaccine effectiveness, vaccine coverage in the home, use of antivirals in this outbreak should also be considered.

Transfers from care home to hospital

A resident with confirmed or suspected flu being transferred from a care home (with or without a flu outbreak) to hospital

Inform the hospital and ambulance prior to transfer of suspected / confirmed flu. Postpone non-urgent hospital appointments / transfers.

A resident without flu being transferred from a care home with a flu outbreak (suspected or confirmed) to hospital.

Inform the hospital and ambulance prior to transfer of the outbreak. Postpone non-urgent hospital appointments / transfers.

season ction card 4 - Actions to take if a single case of flu is suspectedection 2: Cases and outbreaks of Flu

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Action Card 8 - List of residents with suspected/confirmed influenza infection (daily log) In the event of a flu outbreak, the table will ensure that important information is recorded in one place and is easily accessible

Room number

Name Date of onset of symptoms

Symptoms *

Influenza Vaccine Yes / No

Kidney function

Date GP informed

Date swabbed

Date antivirals commenced

Date CIPCN informed

Symptoms * T =Temp (>=37.8 C), C = Cough, NC = Nasal Congestion, ST = Sore Throat, W = Wheezing, S = Sneezing, H = Hoarseness, SOB = Shortness of Breath, CP = Chest Pain, AD = Acute Deterioration in physical or mental ability (without other known source)

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Action Card 9 - Summary of Infection Prevention and Control Guidance

PC Actions When Comment Further GuidanceHand HygieneSoap and water

• Use liquid soap, warm water and paper towels

• Ensure hand washing facilities are available in each resident’s room

• Ensure hand washing facilities are available in key areas e.g. kitchen, sluice, laundry, utility rooms, toilets, bathrooms and cleaners room

Wash hands:• Between residents and between tasks for same resident

• when caring for residents with diarrhoea and/or vomiting

• when hands are visibly dirty

• when a build-up of alcohol based hand rub can be felt on hands

Section 4World Health Organisation Guidance

How to clean your hands (Appendix 2) When to clean your hands 5 Moments

(Appendix 1)

Alcohol based hand rubAlways undertake a risk assessment to ensure it is safe to use, store or carry these in your care setting

Use on hands that are visibly clean

Do not use when caring for residents with diarrhoea and or/vomiting

Alcohol based hand rubs at 60% or above are effective against flu viruses1

Alcohol based hand rubs are generally not effective against viruses that cause diarrhoea and/or vomiting

Residents need to clean their hands regularly too. Assist residents or provide suitable wipes / rubs for residents (always risk assess).

Personal Protective Equipment (PPE)Disposable plastic apronsLong sleeved gowns are not normally required2

Use:• for close personal care• for activities likely to lead to

contamination e.g. cleaning, bed making, handling laundry, spillages

Hand should be cleaned before and after putting on / removing any PPE

Change PPE between residents /tasks

Section 4Add poster on donning and removing PPE(Appendix 4)

Disposable medical gloves• Vinyl• Nitrile

Latex gloves are not advised due to risk of allergyPolythene gloves are not advised due to inadequate protection

As above during an outbreak

Note: gloves are only indicated for contacted with blood and body fluids when not in an outbreak situation

As above

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Disposable surgical masks Use• when within 2 metres of a

symptomatic resident• when working in a symptomatic

cohort area

• Hand should be cleaned before and after putting on / removing masks

• Surgical face masks should be removed and disposed of inside the resident’s room / cohort area once the healthcare worker is more than two metres from the resident(s)

• Change between residents or on leaving a cohort area

Other3

Additional PPE will be required when carrying out aerosol generating procedures (e.g. manual suction, CPR). Refer to your policies or seek specialist advise from your Infection Prevention and Control Team.Environmental cleaning

• Use your regular products• Use colour coding to avoid cross

contamination between areas• Use disposable cloths• Ensure all other cleaning

equipment is cleaned / laundered between uses

In addition to regular cleaning,clean all communal contact surfaces (e.g. door handles, grab rails, arm rests, remote controls, buzzers, taps, flush handles) 3 -4 times a day

Increased cleaning helps to stop the virus spreading

Waste disposalSegregate waste as per national guidance HTM 07-01

Ask your Infection prevention and Control team or waste contractor for advice https://www.gov.uk/government/publications/guidance-on-the-safe-management-of-healthcare-waste

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Section 3: Information on flu This section includes:

Key facts about flu Impact of Flu on Care Homes Guidance for monitoring, treating and cohorting residents Guidance for staff members Information on Flu Vaccination and Eligible groups Myth Busting FAQ about Flu vaccines The importance of vaccinating residents and staff members

What is flu?

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Flu (short for influenza) is a viral infection of the respiratory system (mouth, nose, airways, and

lungs). It occurs mostly in the winter, which is why it is sometimes called ‘seasonal flu’. It is

passed from person to person directly through coughs and sneezes (droplet spread), through

contact, e.g. kissing or shaking hands, and also when a person gets the virus on their hands

after touching surfaces or objects contaminated with the virus.

For most healthy people flu causes fever, headache, sore throat, runny nose, joint pain, muscle

pain and fatigue, with recovery time ranging from two to seven days. However, for some,

especially older people, pregnant women, and people with underlying health conditions, it can

cause serious even life-threatening complications and death.

There are three types of flu virus that cause flu - A, B and C - Influenza A and influenza B are responsible for most clinical illness. There are different types of strains

within these groups. You may have heard of flu branded with names such as ‘H3N2’, or H1N1.

These names refer to the strain of flu virus. Each winter different strains of flu virus circulate,

with one or two strains usually dominating.

What is flu (influenza) like illness ?

Flu-like illnesses, describes illnesses that look like flu but that have not been confirmed as

being caused by a flu virus. Some of these can be caused by other viruses, for example

respiratory syncytial virus or parainfluenza virus. These are passed from person to person in

the same way as flu, so the infection control recommendations outlined in this resource pack

also apply to all.

Who is affected by flu?

Everybody can be affected by flu. There are some people who, if infected with flu, are at a higher risk of serious complications than individuals in the general population: older people > 65years; individuals with underlying chronic health conditions (e.g. chronic lung disease, ischaemic heart disease, diabetes mellitus, obesity); immunocompromised individuals; and pregnant women.

Flu outbreaks can have severe impacts on care home residents because:

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● Care home residents are likely to be more vulnerable to flu due to their age or underlying medical conditions.

● Elderly residents are more likely to die from flu or suffer with severe symptoms or complications of flu, and therefore are more likely to require hospitalisation.

● Care home residents and staff are likely to spend significant periods of time together; therefore flu can spread rapidly in care homes, particularly if stringent infection control measures are not implemented.

The impact on care homes and related services:

● Larger resources required to implement infection control recommendations

● The potential for having to close to new admissions

● The potential impact on reputation, particularly where there are severe cases or deaths and any concerns over whether or not duty of care was met by the care home management and staff.

Guidance for monitoring, treating and cohorting residents with flu

● Residents should be monitored daily for elevated temperatures and respiratory symptoms. It is important to identify infected patients as early as possible in order to implement infection control procedures such as isolation and reduce the spread of infection.

● If possible symptomatic residents should be cared for in single rooms until fully recovered and at least five days after the onset of symptoms.

● This is particularly important for symptomatic residents who are at higher risk of shedding the virus for long periods of time such as those with other major medical conditions or who have a weakened immune system: such residents should be prioritised for isolation (where there are limited facilities) and should be isolated until they are completely recovered.

● If this is not possible then cohort suspected flu residents with other residents suspected of having flu; cohort residents confirmed to have flu with other residents confirmed to have flu. At the very least, symptomatic residents should be cared for in areas well away from asymptomatic residents.

● If the design of the care home and the numbers of symptomatic residents allows, the separation of symptomatic and asymptomatic residents in separate floors or wings of the home is preferable.

Guidance for staff members

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● Symptomatic staff should be excluded from the home until fully recovered ● If possible, staff should work with either symptomatic or asymptomatic residents

(but not both), and this arrangement should be continued for the duration of the outbreak.

● Agency and temporary staff who are exposed during the outbreak should be advised not to work in any other healthcare settings until 2 days after last contact with the home or if exposure is continuous, when the home re-opens

● Depending on the causative organism, there may be a case for staff at risk of complications if they become infected (for example pregnant or immuno-compromised individuals) to avoid caring for symptomatic patients. A risk assessment will need to be carried out .

● Staff should clean their hands thoroughly with soap and water before and after any contact with residents.

● Uniforms should not be worn between home and the place of work.● Uniforms and other work clothing should be laundered at work if there are facilities

for this. If laundered at home the general advice on washing work clothes separately would apply.

Vaccination

How do we protect against flu?

Flu vaccine is the most safe and effective way to prevent flu and its complications.

Vaccine effectiveness varies year on year as the flu virus changes and is difficult to predict. The World Health Organisation monitors the epidemiology of flu viruses throughout the world and makes recommendations about the strains to be included in the vaccines for the forthcoming flu season.

Vaccines for the national flu immunisation programme 2019/20:

For those aged 65 and over, the adjuvanted trivalent influenza vaccine (aTIV) continues to be recommended. Equally suitable, is the newly licenced cell-based quadrivalent influenza vaccine (QIVc).

For those aged 18 to 64 years, there are two vaccines which are equally suitable for use. The standard egg-grown quadrivalent influenza vaccine (QIVe) and the newly licenced cell-based quadrivalent vaccine (QIVc).

It can take around two weeks following vaccination for a protective immune response to be achieved so the ideal time to vaccinate would be between September and early November.

Eligible groups for flu vaccination 2019/20

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For the 2019/20 flu season, the following people are eligible for flu vaccination:

All those aged sixty-five years and over

All those aged between six months and sixty-five years in clinical risk groups

All pregnant women

All children aged two to ten (but not eleven years or older) on 31 August 2019

All those in long-stay residential homes

Carers (in receipt of a carers’ allowance, or those who are the main carer of an older or disabled person whose welfare may be at risk if the carer falls ill)

Very overweight individuals (morbidly obese - defined as BMI of 40 and above)

Health and social care staff, employed by a registered residential care / nursing home or registered domiciliary care provider / hospice staff

Household contacts of immunocompromised individuals

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Myth busting

Myth 1: The flu vaccine can give you flu

The injected flu vaccine given to adults contains inactivated flu viruses, so it cannot give you flu. This is because the vaccine used for adults does not contain any live virus but only contains killed virus. However, there are lots of other respiratory viruses circulating around the same time as flu which could cause a respiratory infection and as the vaccine takes around two weeks to become effective, a vaccinated individual could be infected by the virus whilst their own protective response is developing. The flu vaccine is a safe and effective way to protect yourself and those you care for from the flu virus.

Myth 2: The flu vaccine has bad side effects

Most people have no side effects at all - some complain of pain and a small swelling at the injection site, a fever which might require paracetamol for a day or two. Any other side effects are rare.

Myth 2: I had it last year; I don’t need it again this year

The flu vaccine does not give lifelong protection against flu. Each year the circulating flu viruses change so the components of the vaccine will be different from last year.Therfore, you need to have a flu vaccine every year to ensure you are protected aginst the flu virus.

The importance of vaccinating residents

● The aim of vaccination is to protect this vulnerable group who are at risk of serious illness or death should they develop flu

● It is less likely that there will be an outbreak in a care home where everyone is vaccinated, and this will also contribute to the protection of vulnerable patients who may not have a good response to their own vaccination

● It is important to note that influenza cases may occur even in vaccinated residents however the duration and severity of illness may be reduced

The importance of vaccinating staff members

● Frontline health and social care workers have a duty of care to protect their patients and service users from infection

● Staff members should be offered the flu vaccine and should have it as soon as possible. This will ensure that they are protected from flu and that they do not transmit the virus to those they care for at work or to their family.

● In 2019/20, NHS England will continue to support vaccination of social care and hospice workers. See Appendix 8

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Section 4: Appendices Resources and Posters

This section includes:

Appendix 1 - 5 moments for hand hygiene

Appendix 2 - How to handrub / how to handwash

Appendix 3 - Catch it Bin it Kill it poster

Appendix 4 – Sequence for putting on and removing PPE

Appendix 5 - Guidance on outbreaks of influenza in care homes

Appendix 6 - Advice to visitors when an outbreak of flu is suspected / confirmed

Appendix 7- Advice to visitors who have symptoms of flu

Appendix 8 - Flu immunisation for social care and hospice staff

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Appendix 1 – 5 Moments for Hand Hygiene

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Appendix 2 – How to handrub / How to handwash

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Appendix 3 – Catch It, Bin It, Kill It

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Appendix 4 – Sequence for putting on and removing PPE

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Appendix 5 - Guidance on outbreaks of influenza in care homes

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Appendix 6 : Advice to visitors when an outbreak of flu is suspected / confirmed

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Appendix 7 : Advice to visitors who have symptoms of flu

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Appendix 8 - Flu immunisation for social care and hospice staff

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Sources of Information

Public Health England (2018) Guidelines on the management of outbreaks of influenza-like illness in care homeshttps://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/747543/Influenza-like_illness_in_care_home_2018_FINAL.pdf

World Health Organisation (2009) WHO Guidelines on Hand Hygiene in Health Care. First Global Patient Safety Challenge. Clean Care is Safer Care. ISBN 978 92 4 159790 6. https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf?sequence=1

Loveday et al (2014) epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection 86S1 https://improvement.nhs.uk/documents/847/epic3_National_Evidence-Based_Guidelines_for_Preventing_HCAI_in_NHSE.pdf

Public Health England (2016) Infection Control Precautions to Minimise Transmission of Respiratory Tract Infections (RTIs) in the Healthcare Setting v.2 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/585584/RTI_infection_control_guidance.pdf

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