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]
  • Influenza In Long Term Care

    1. 1. Influenza in Long-Term Care Bill Cayley Jr MD MDiv UW Health Augusta Family Medicine
    2. 2. Acknowledgement <ul><li>This presentation is an adaptation of material available to the public on the website of the Centers for Disease Control ( </li></ul>
    3. 3. Learning Objectives <ul><li>Participants will be able to: </li></ul><ul><li>Describe influenza </li></ul><ul><li>Describe the importance of influenza in long-term care </li></ul><ul><li>Describe how to reduce the risk of influenza in long-term care </li></ul>
    4. 4. Influenza <ul><li>Influenza is… </li></ul><ul><ul><li>Viral respiratory illness </li></ul></ul><ul><ul><li>Fever, muscle aches, headache, malaise, nonproductive cough, sore throat, and rhinitis </li></ul></ul><ul><li>Seriousness </li></ul><ul><ul><li>Usually resolves in 3-7 days </li></ul></ul><ul><ul><li>Severe illness in presence of chronic disease </li></ul></ul><ul><ul><ul><li>Pulmonary or cardiac disease, diabetes </li></ul></ul></ul><ul><ul><li>Risks </li></ul></ul><ul><ul><ul><li>Serious illness or death in long-term care residents </li></ul></ul></ul><ul><ul><ul><li>Serious illness in long-term care personnel </li></ul></ul></ul><ul><li>Influenza is NOT: upset stomach, a bad cold </li></ul>
    5. 5. The Influenza Virus <ul><li>Two types of viruses </li></ul><ul><ul><li>Influenza A – subtypes by H & N antigens </li></ul></ul><ul><ul><li>Influenza B </li></ul></ul><ul><li>Transmission: </li></ul><ul><ul><li>Small droplets from cough or sneeze </li></ul></ul><ul><ul><ul><li>Settle in airways of nearby persons </li></ul></ul></ul><ul><ul><ul><li>Direct or indirect contact w/ infected surfaces </li></ul></ul></ul><ul><ul><li>“ Incubation” period of 1-4 days </li></ul></ul><ul><ul><li>“ Contagious” </li></ul></ul><ul><ul><ul><li>Adults – from 1 day before to 5 days aftetr start of symptoms </li></ul></ul></ul><ul><ul><ul><li>Children – for 10 or more days </li></ul></ul></ul>
    6. 6. Impact of Influenza <ul><li>Hospitalization rates for children <5 years </li></ul><ul><ul><li>500/100,000 children with high-risk medical conditions </li></ul></ul><ul><ul><li>100/100,000 children without high-risk medical conditions </li></ul></ul><ul><li>From 1979-80 through 2000-01 </li></ul><ul><ul><li>54,000 to 430,000 influenza hospitalizations per epidemic </li></ul></ul><ul><ul><li>226,000 influenza-related excess hospitalizations per year </li></ul></ul><ul><ul><li>63% of all hospitalizations were among persons > 65 years </li></ul></ul><ul><li>Influenza-related deaths </li></ul><ul><ul><li>Pneumonia, exacerbations of cardiopulmonary other chronic diseases </li></ul></ul><ul><ul><li>Deaths of adults > 65 years account for > 90% of deaths from pneumonia and influenza </li></ul></ul>
    7. 7. Increased Risk of Complications <ul><li>Children 6-23 months </li></ul><ul><li>Children and adolescents (aged 6 months--18 years) on receiving long-term aspirin therapy </li></ul><ul><li>Women who will be pregnant during the influenza season </li></ul><ul><li>Adults and children with chronic pulmonary or cardiovascular disease </li></ul><ul><li>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. </li></ul><ul><li>Adults and children who have any condition that can compromise respiratory function or the handling of respiratory secretions </li></ul><ul><li>Residents of nursing homes and other chronic-care facilities </li></ul><ul><li>Persons aged > 65 years. </li></ul>
    8. 8. Long-term Care Environment <ul><li>Susceptible patients </li></ul><ul><ul><li>Mainly over 65 </li></ul></ul><ul><ul><li>High-risk cardiac, pulmonary, and medical conditions </li></ul></ul><ul><li>High risk of transmission </li></ul><ul><ul><li>Close quarters </li></ul></ul><ul><ul><li>Airborne or contact transmission </li></ul></ul><ul><li>Staff transmission to patients </li></ul>
    9. 9. Prevention Strategies <ul><li>Surveillance </li></ul><ul><li>Education </li></ul><ul><li>Influenza Testing </li></ul><ul><li>Respiratory Hygiene </li></ul><ul><li>Standard Precautions </li></ul><ul><li>Droplet Precautions </li></ul><ul><li>Restrictions for Ill Visitors and Personnel </li></ul><ul><ul><li>when widespread influenza activity is occurring in the surrounding community </li></ul></ul><ul><li>Antiviral Chemoprophylaxis </li></ul>
    10. 10. Respiratory Hygiene <ul><li>Visual alerts instructing residents and persons who accompany them to inform health-care personnel if they have symptoms of respiratory infection </li></ul><ul><li>Discourage those who are ill from visiting the facility. </li></ul><ul><li>Tissues or masks for residents and visitors who are coughing </li></ul><ul><li>Tissues and alcohol-based hand rubs </li></ul><ul><li>Ensure that supplies for handwashing are available </li></ul><ul><li>Encourage coughing persons to sit 3 feet away from others </li></ul><ul><li>Residents with symptoms of respiratory infection should be discouraged from using common areas where feasible. </li></ul>
    11. 11. Standard Precautions <ul><li>Wear gloves if hand contact with respiratory secretions or potentially contaminated surfaces is anticipated. </li></ul><ul><li>Wear a gown if soiling of clothes with a resident’s respiratory secretions is anticipated. </li></ul><ul><li>Change gloves and gowns after each resident encounter </li></ul><ul><li>Decontaminate hands before and after touching the resident </li></ul><ul><li>When hands are visibly soiled or contaminated with respiratory secretions, wash hands with soap and water. </li></ul><ul><li>If hands are not visibly soiled , use an alcohol-based hand rub for routinely decontaminating hands. </li></ul>
    12. 12. Droplet Precautions <ul><li>Place resident into a private room , </li></ul><ul><ul><li>OR cohort suspected influenza residents with other residents suspected of having influenza; cohort confirmed influenza residents with other residents confirmed to have influenza. </li></ul></ul><ul><li>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. </li></ul><ul><li>If resident movement or transport is necessary, have the resident wear a surgical or procedure mask . </li></ul>
    13. 13. Influenza Vaccine <ul><li>Two types of vaccines protect against influenza </li></ul><ul><ul><li>“ Flu shot&quot; - killed virus injectable vaccine </li></ul></ul><ul><ul><li>Nasal-spray - weakened live viruses (5 - 49 years) </li></ul></ul><ul><li>Viruses </li></ul><ul><ul><li>One A (H3N2) virus, one A (H1N1) virus, and one B virus </li></ul></ul><ul><li>Both flu vaccines cause antibodies </li></ul><ul><li>Timing </li></ul><ul><ul><li>Best to get vaccinated in October or November, influenza peaks between late December and early March </li></ul></ul><ul><li>Immunity </li></ul><ul><ul><li>Takes about two weeks after vaccination </li></ul></ul><ul><li>Can I still get sick? </li></ul><ul><ul><li>Vaccination may prevent disease or reduce severity </li></ul></ul>
    14. 14. Vaccination <ul><li>Health-care personnel and all residents of long-term care facilities should be encouraged to receive annual influenza vaccination </li></ul><ul><ul><li>The National Healthy People 2010 goal for annual influenza vaccination long-term care residents is 90%. </li></ul></ul><ul><ul><li>Vaccination is the primary measure to </li></ul></ul><ul><ul><ul><li>Prevent influenza </li></ul></ul></ul><ul><ul><ul><li>Limit transmission </li></ul></ul></ul><ul><ul><ul><li>Prevent complications from influenza in long-term care facilities </li></ul></ul></ul><ul><ul><li>Vaccination of elderly persons may not prevent infection, but can reduce serious complications from influenza </li></ul></ul>
    15. 15. Summary <ul><li>Influenza is a serious viral illness </li></ul><ul><li>Long-term care residents are at high risk of death or illness </li></ul><ul><li>Long-term care staff are at risk for illness or transmission </li></ul><ul><li>Contact precautions and r espiratory hygiene help reduce transmission </li></ul><ul><li>Vaccination is vital! </li></ul>
    16. 16. CDC Resources <ul><li>Questions & Answers: Flu Vaccine </li></ul><ul><ul><li> </li></ul></ul><ul><li>Infection Control Measures for Preventing and Controlling Influenza Transmission in Long-Term Care Facilities </li></ul><ul><ul><li> </li></ul></ul>
    17. 17. THANKS!
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