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Influenza Season 2013-2014

Information for Long-Term Care Facilities

Long-term care facilities may be defined as institutions, such as nursing homes and skilled nursing facilities that provide health care to people (including children) who are unable to manage independently in the community. This care may represent custodial or chronic care management or short-term rehabilitative services.

Influenza can be introduced into a long-term care facility by newly admitted residents, health care workers and by visitors. Spread of influenza can occur between and among residents, health care providers, and visitors. Residents of long-term care facilities can experience severe and fatal illness during influenza outbreaks.

Vaccination Recommendations

Residents

If possible, all residents should receive trivalent inactivated influenza vaccine (TIV) annually before influenza season. In the majority of seasons, TIV will become available to long-term care facilities beginning in September, and influenza vaccination should commence as soon as vaccine is available. Informed consent is required to implement a standing order for vaccination, but this does not necessarily mean a signed consent must be present.

In the event that 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 after admission to the facility.

Health Care Personnel

It's recommended that all health care personnel get vaccinated annually against influenza.

Outbreaks

Definition of an influenza outbreak in long-term care (LTC) facilities:

An outbreak in a LTC facility is defined as a sudden increase of acute febrile respiratory illness (AFRI) cases over the normal background rate or one laboratory-confirmed* influenza positive case along with other cases of respiratory infection in a unit of a long-term care facility.

A cluster of influenza in a LTC facility is defined as three or more cases of AFRI occurring within 48 to 72 hours, in residents who are in close proximity to each other (e.g., in the same are of the facility)

* Rapid influenza tests that are tested positive are not considered lab-confirmed. We recommend you send rapid positives to the State Hygienic Lab (SHL) for RT-PCR confirmation.

Outbreak control

    1. If you suspect an outbreak of influenza-like illness is occurring, please contact local public health , your field epidemiologist, or the Center for Acute Disease Epidemiology (CADE) at 800-362-2736. The regional epidemiologist or the CADE staff will help facilitate outbreak investigation and control and enter cases into the outbreak database maintained by CADE staff.

    2. Collect specimens for patients with influenza-like illness, without other apparent cause and submit specimens to the State Hygienic Laboratory at the University of Iowa (SHL)

    3. Administer antiviral prophylaxis to residents and health care personnel in accordance with current CDC recommendations during influenza outbreaks.

    4. Vaccinate all unvaccinated residents and staff with the current season influenza vaccine unless medically contraindicated.

    5. Reinforce respiratory hygiene/cough etiquette in long-term care facilities.

    6. Implement droplet precautions during the care of a resident with suspected or confirmed influenza.

    7. Cohort and/or isolate ill residents as appropriate.

    8. Restrict ill personnel from patient care. Restrict personnel movement from areas of the facility having outbreaks to areas without patients with influenza.

    9. Limit visitation, exclude ill visitors. Consider restricting visitation of all visitors via posted notices.

    10. Limit new admissions.