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Influenza In Long Term Care


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  • Influenza in Long-Term Care Bill Cayley Jr MD MDiv UW Health Augusta Family Medicine [email_address]
  • Transcript

    • 1. Influenza in Long-Term Care Bill Cayley Jr MD MDiv UW Health Augusta Family Medicine
    • 2. Acknowledgement
      • This presentation is an adaptation of material available to the public on the website of the Centers for Disease Control (
    • 3. Learning Objectives
      • Participants will be able to:
      • Describe influenza
      • Describe the importance of influenza in long-term care
      • Describe how to reduce the risk of influenza in long-term care
    • 4. 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
    • 5. 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
    • 6. 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
    • 7. Increased Risk of Complications
      • Children 6-23 months
      • Children and adolescents (aged 6 months--18 years) on receiving long-term aspirin therapy
      • Women who will be pregnant during the influenza season
      • Adults and children with chronic pulmonary or cardiovascular disease
      • 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.
      • Adults and children who have any condition that can compromise respiratory function or the handling of respiratory secretions
      • Residents of nursing homes and other chronic-care facilities
      • Persons aged > 65 years.
    • 8. Long-term Care Environment
      • Susceptible patients
        • Mainly over 65
        • High-risk cardiac, pulmonary, and medical conditions
      • High risk of transmission
        • Close quarters
        • Airborne or contact transmission
      • Staff transmission to patients
    • 9. 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
    • 10. Respiratory Hygiene
      • Visual alerts instructing residents and persons who accompany them to inform health-care personnel if they have symptoms of respiratory infection
      • Discourage those who are ill from visiting the facility.
      • Tissues or masks for residents and visitors who are coughing
      • Tissues and alcohol-based hand rubs
      • Ensure that supplies for handwashing are available
      • Encourage coughing persons to sit 3 feet away from others
      • Residents with symptoms of respiratory infection should be discouraged from using common areas where feasible.
    • 11. Standard Precautions
      • Wear gloves if hand contact with respiratory secretions or potentially contaminated surfaces is anticipated.
      • Wear a gown if soiling of clothes with a resident’s respiratory secretions is anticipated.
      • Change gloves and gowns after each resident encounter
      • Decontaminate hands before and after touching the resident
      • When hands are visibly soiled or contaminated with respiratory secretions, wash hands with soap and water.
      • If hands are not visibly soiled , use an alcohol-based hand rub for routinely decontaminating hands.
    • 12. 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 .
    • 13. Influenza Vaccine
      • Two types of vaccines protect against influenza
        • “ Flu shot&quot; - 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
    • 14. 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
    • 15. 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 r espiratory hygiene help reduce transmission
      • Vaccination is vital!
    • 16. CDC Resources
      • Questions & Answers: Flu Vaccine
      • Infection Control Measures for Preventing and Controlling Influenza Transmission in Long-Term Care Facilities
    • 17. THANKS!