Managing influenza outbreaks in aged-care facilities

The flu season begins in May and ends around October with a peak occurring from July to September. Residents of aged-care facilities (ACF) are particularly vulnerable to influenza. Their closed communal environment makes it easy for flu to spread, and underlying diseases such as congestive heart failure, obstructive lung disease or kidney disease put them at risk of serious complications. Public Health Units play a key role in assisting ACFs in reducing the impact of flu outbreaks.

In 2014, in response to concerns related to delays in outbreak recognition, influenza testing and administration of antivirals, the South Western Sydney Public Health Unit commenced annual influenza outbreak preparedness surveys among South Western Sydney-based ACFs. According to the surveys, data flu vaccination rates tend to be high among residents (90%) but much lower among staff (<30%). The surveys also found that the majority of ACFs were well informed about outbreak management and most facilities had processes in place such as signage restricting access, adequate stocks of personal protective equipment and environmental cleaning protocols. However, the surveys also found there was some uncertainty relating to antiviral prescription for flu and more education was required to improve staff’s ability to determine the start and end of outbreaks.

The 2017 flu season has been a particularly large one and has highlighted the fact that the following challenges to outbreak management remain:

• Flu symptoms can be difficult to recognise in the elderly and delays in testing, treatment and prophylaxis may still occur.
• Aged-care staff may carry infection from one facility to another, if they work in different facilities.
• Isolation measures can be hindered by relatives who wish to continue visiting during an outbreak.
• Pharmacies may not always carry adequate stocks of Tamiflu.
• ACFs may have to deal with an outbreak of viral gastroenteritis within the same period.

Advice on managing an outbreak

The following advice was recently issued to ACF directors by NSW Health:

• Ensure all residents and staff are vaccinated with this year’s influenza vaccine.
• Use influenza signage at key locations (such as posters at entrances, waiting areas and wards), and posters to promote respiratory and hand hygiene.
• Isolate residents with influenza-like illness by placing beds more than two metres apart, or use between-bed curtains and space beds at least 1 metre apart, or use single rooms if available.
• Ensure staff use protective equipment such as gowns and gloves when caring for infected residents, change to clean equipment and undertake hand hygiene before caring for other residents.
• Promote hand and respiratory hygiene, and cough etiquette.
• Encourage the use of surgical masks by residents with influenza-like illness.
• Promptly investigate and control respiratory illness outbreaks.
• Report suspected influenza outbreaks to your local public health unit.

During outbreaks:

• Treat residents with influenza early. Early treatment — ideally within 48 hours — with influenza antiviral medicines (eg, oseltamivir, zanamivir) helps to protect people at most risk of severe outcomes.
• Patients who have recovered after hospitalisation from influenza are likely to be immune to the strain circulating in your facility and should be discharged back to your facility as soon as clinically indicated.
• If an outbreak of influenza is declared in your facility, giving preventative medication to all residents not yet infected can help control the outbreak. However, to be effective the preventative treatment needs to commence as soon as possible, and should be given to all unaffected residents.
• Increase hygiene measures — especially hand hygiene, personal protective equipment and environmental cleaning.
• Isolate or cohort affected residents.
• Limit staff and visitor movement into affected areas.
• Suspend all group activities.

See: A Practical Guide to assist in the Prevention and Management of Influenza Outbreaks in Residential Care Facilities in Australia at: http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-flu-guidelines.htm.

For further information on flu epidemics, see http://www.flutracking.net/.

*Leng Boonwaat is currently the Communicable Diseases Coordinator for the South Western Sydney Local Health District, Public Health Unit. His role is to coordinate surveillance of and public health response to notifiable communicable diseases including outbreak management. An additional role is to ensure data entered into the Notifiable Conditions Information System is accurate and complete. Leng has a background in research and project management related to bloodborne viruses, sexual health and other communicable diseases. He holds a Master of Public Health and has also recently completed a Master of Environmental Management.

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