Respiratory Outbreak Management and Vaccination
Influenza is a significant cause of morbidity and mortality in the elderly. Clinical attack rates may reach up to 70% of long-term care home residents, with case fatality rates up to 30%. Respiratory outbreaks occur in long-term care homes and retirement homes throughout the year. Such outbreaks can lead to substantial morbidity and mortality and are disruptive and costly. Long-term care and retirement homes often have elderly residents who may have chronic illnesses which weaken their immune systems, putting them more at risk of developing severe illness and complications. Infections also can be more easily transmitted in institutional environments, thus increasing the importance of early implementation of control measures. Early detection and timely implementation of outbreak control measures is essential to prevent further transmission of the infection to others, thereby reducing the length and impact of an outbreak.
Annual influenza vaccination of both residents and staff is the cornerstone for prevention of institutional outbreaks. Despite its clear benefits, vaccination does not offer complete protection against influenza viruses, and outbreaks can occur even if vaccination rates are greater than 80%. Antigenic drifts, shifts, and imperfect matching between the vaccine and circulating strains limit vaccine effectiveness. It is now well recognized that staff immunization is also important in reducing the overall number of outbreaks within long-term care facilities, as well as influenza-associated morbidity and mortality of residents. A focused quality improvement strategy based on education and worker-targeted incentives successfully increased staff immunization rates from 26% to 43% in recent years.
This highlights the importance of improving staff education and prompt outbreak identification. Long-term care facilities should focus on quality improvement initiatives by increasing educational opportunities, enhancing timely communication, and improving outbreak identification procedures. The ongoing education of staff, volunteers, residents, residents’ families and visitors about infection and outbreak prevention and related strategies is part of a robust IPAC program. Additionally, early recognition of cases signalling suspected outbreaks and swift action are essential for effective management. Timely specimen collection, communication and the implementation of appropriate control measures have the potential to make a significant impact in the course of the outbreak that will benefit both residents and staff. IPAC measures are to be implemented as soon as an outbreak is suspected. All staff shall be notified quickly of the outbreak and supplies (e.g. alcohol based hand rub, PPE, including gowns, face/eye protection, gloves, surgical masks, etc.) should be made available as necessary. In addition to Routine Practices, all residents symptomatic with an ARI should be placed on Droplet/Contact Precautions as soon as possible after symptoms are identified. Asymptomatic residents should be cared for using Routine Practices and carefully monitored for any change in their symptoms.
At IPAC Consulting, Outbreak Management is our specialty! We have helped numerous home’s control and isolate their outbreak and get all control measures into place to prevent further one’s from happening. Follow the link to our website to learn more about how we can keep all your staff and residents safe!
