Influenza Preparedness 2019-2020 - Prevention and Detection of Outbreaks Managing an Outbreak of Influenza Key Infection Prevention and Control ...
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Influenza Preparedness
2019-2020
Prevention and Detection of Outbreaks
&
Managing an Outbreak of Influenza
Key Infection Prevention and Control Measures
Influenza Preparedness 2019-2020
Prevention and Detection of Influenza
Outbreaks
Aide Memoir 2019-2020 Season
Outline
• Guidelines & documentation circulated
• Prerequisites – Planning & Education
• Requirements for prevention - Actions
– Residents and staff vaccination
– Records
– What supplies are needed?
– Monitoring of staff illness
• Requirements for detection - Actions
– Recognition
• Case definition of influenza like illness
• Definition of influenza like illness outbreak
– Reporting
– Guidelines
www.hpsc.ie
Be Prepared - Planning & Education
• Written policies on
immunisation,
IPC and
Outbreak Management related to influenza
• Education for staff at induction and on going to include seasonal influenza
• Staff should
• receive education re influenza (signs & symptoms) and the essential role of
vaccination
• have a high index of suspicion for influenza during flu season
• be able to recognise and report potential cases and clusters
• be familiar with and have access to recommended PPE
• have access to details for their local Infection Prevention & Control staff (where
available) and local Department of Public Health
• Nominate a senior manager to co-ordinate all actions and communication in the
event of a suspected or actual outbreak to Public Health
The Aide Memoir
Requirements for Prevention
• Resident Vaccination
– Has flu vaccine been offered to all residents throughout the
flu season i.e. from September to the end of April?
– Ideal time for flu vaccination is Sept/Oct.
– If residents are not vaccinated at this time, the vaccine can
be given until the end of April.
• In Disability Services vaccination is strongly
recommended for children with any condition that can
compromise respiratory function especially those
attending special schools and day centres.
Requirements for Prevention Resident Vaccination – Respites & Admissions • Is advice re flu vaccination provided to respite admissions from September to the end of April? • Ideally flu vaccination should be given 2 weeks prior to admission • Are all new /respite residents vaccinated, ideally 2 weeks prior to admission? • If not vaccinated, is vaccine offered as soon as possible after admission?
Planned Respite Care
Application form
for Respite Care in
Cork Community
Hospitals page 3
of 4
To protect long term
care residents and
prevent outbreaksNursing Transfer Letter
Nursing Care Plan
Involving Residents & Families
Suggested letter sent in Sept
• Requesting not to visit
units if they have flu like
illness in the preceding 2
days
• Asking cooperation with
visiting restrictions where
a unit is experiencing
symptoms of flu
• Encourage to use the
hand hygiene facilities
• Advised re respiratory
hygiene & cough
etiquetteRequirements for Prevention Staff Vaccination • Was flu vaccination promoted amongst staff at the start of the flu season? Records • Is a record of staff vaccination available? • Is a record of resident seasonal flu vaccination available? • Is a record of resident pneumococcal vaccination available? • Where?
Sample Resident Records
Sample Staff Records
Requirements for Prevention
Supplies
• Is there a supply of 2 viral swabs available to take a throat swab
in the event of an outbreak on the advice of Department of
Public Health?
• List of sites where swabs are is held by DPH , if used will be replaced by
post
• Discard pack from 2018/2019 Season
• Is there ready quick access to antiviral medication (Tamiflu)
through the normal channels/pharmacy provider if needed in
the event of an outbreak?
• Are sufficient supplies of surgical face masks (with ties) and eye
protection of the correct standard available?MASK FACE TYPE II DISPOSABLE
FACE MASK TIE ON
MASK SURGICAL TYPE IIR
DISPOSABLE
FLUID RESISTANT/ANTI-FOG WITH
VISORRequirements for Prevention Surveillance –Monitoring • Is staff absenteeism monitored for influenza like illness (ILI) and for unusual patterns i.e. – more than expected staff absent – 3 or more cases of ILI in a 72 hour period
Managing an Outbreak of Influenza Key Infection Prevention and Control Measures
Case Definition of Influenza Like Illness (ILI)
Sudden onset of symptoms
And
At least one of the following four systemic symptoms:
• Fever or feverishness
• Malaise
• Headache
• Myalgia (muscle pains)
And
At least one of the following three respiratory symptoms:
• Cough
• Sore throat
• Shortness of breathInfluenza in the Elderly
• In older adults, symptoms may initially be very subtle and
difficult to recognise. Elderly residents may present only with
– cough, fatigue and confusion.
– fever response may be more blunted.
– Influenza may present in the elderly patient as an exacerbation of an
underlying condition.
• Influenza may present in the elderly as an exacerbation of an
underlying medical condition e.g chronic pulmonary or
cardiac disease, asthma or diabetes mellitus.
• If an increased number of residents become unwell over a
short period of time with respiratory illness, influenza should
be suspected.Definition of Influenza/Influenza like
illness (ILI) Outbreak
Three or more cases (amongst residents and/or staff) of
influenza like illness (ILI) or influenza or respiratory illness
• within the same 72 hour period in the RCF,
• which meet the same clinical case definition and
• where an epidemiological link can be established.Detection of Influenza Outbreak
• Inform the local medical team/attending GP for an
appropriate diagnosis to be made
• If cases are confirmed the GP confirming the suspected
outbreak notifies the Department of Public Health at
021-49 27601 / 066 7184542
• Department of Public Health will
• undertake a risk assessment and
• establish an outbreak control team if deemed appropriate
• advise on
appropriate clinical specimens to be taken
Decide re antiviral treatment and chemoprophylaxisViral Swabs • Pre-addressed postage box to the “National Virus Reference Lab” • 2 Viral swabs • Instructions for Throat Swab to test for Influenza • NVRL Request form with “Respiratory Viral Suite” • Results sent to Dept Public Health
Instructions for Taking a Viral Throat Swab
• Clean hands, clean gloves
• Rub the swab over the tonsillar fossa or any
area with visible exudate
• Avoid touching the tongue or mouth with the
swab
• Carefully place the swab into the bottle and
snap off the excess stick , secure the green cap
on the bottle
• Remove gloves, clean hands
• Complete the form and add details to swab
bottle – name, DOB, clinical details, date &
time swab was taken.
• If postage is delayed store in a cool dry place,
ideally in a fridge at 4°CDetection of Influenza Outbreak
• Inform your Infection Prevention & Control
Nurse where available
• Communication within line management
structures and with Influenza lead
• Agree a communication strategy
– Nominate a person to act as liaison with the Dept
of Public Health and the Infection Prevention &
Control NurseDetection of Influenza Outbreak • In addition to Standard Precautions, implement Droplet Precautions as advised – See Section 3 and Section 6 of the Infection Prevention and Control Guidelines, HSE South, 2017 • www.hse.ie/infectioncontrol • Refer to “Checklist for Residential Care Facilities on the Prevention, Detection and Control of Influenza-like Illness and Influenza Outbreaks, 2019/2020”
If possible cases of influenza are identified • Make a list of residents and staff with symptoms (use a template): • Name/DOB • Date of first symptoms (onset) • Symptoms - fever, cough, fatigue • Vaccination status • Consider • Layout of the facility (location of cases) and possible links between affected residents • Timeline – 3 affected within 72 hours • If there is more than one GP attending the facility, ensure all are aware of other potential affected residents/staff.
Accurate information is essential as this will guide Public Health response
Influenza Preparedness 2018-2019
www.hse.ie/infectioncontol
Under Resources – Influenza Button
Influenza Preparedness 2018-2019Infection Control Measures
• In addition to Standard Precautions, implement
Droplet Precautions immediately for symptomatic
cases in healthcare settings
• do not wait for laboratory results
• Resident Placement in LCF
• Place resident in a single room or cohort with similar
patients
• Maintain a distance ≥ 1 metre between infectious
residents and others
• Wear surgical masks within 1 metre of care
• Limit movement of the residentInfection Prevention and Control
Precautions
Standard Precautions PLUS - Droplet Precautions
• Hand Hygiene • Additional Protective Clothing
• Respiratory Hygiene and Cough Etiquette • Patient Placement
• Patient Placement • Cleaning of the Environment
• Protective Clothing • Care of Client Care Equipment
• Cleaning of the Environment
• Care of Client Care Equipment
• Care with Laundry
• Dealing with spills of body fluids safely
• Care and disposal of sharps
• Dealing with needle stick injury or blood
or body fluid exposures
• Staff Health, hygiene and staff
immunisations
• Healthcare risk wastePPE for routine care for suspected or confirmed
influenza case.
1. Surgical mask.
2. Wear gloves/apron/gown/goggles if risk of
contact with blood, body fluids, mucous
membranes or non-intact skin anticipated as
per Standard Precautions
PPE for an aerosol generating procedure (AGP) and
if remaining in or entering the patient’s room
within one hour after cessation of the AGP:
1. FFP2 or FFP3 respirator (correctly fitted),
goggles, long sleeved disposable gown, gloves.
2. AGP – intubation, tracheostomy insertion,
ventilation
Nebulisation is no longer considered an AGP but
patients receiving nebulisation should be placed in
a single room.Sequence* for Donning PPE
1. Gown / Apron first
2. Mask
3. Goggles or face shield (if required)
4. Gloves
*Combination of PPE will affect sequence – be practicalHow to Don a Mask
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with ties or elastic
• Adjust to fit
INFO RE PPE ON CONTRACTSequence for Removing PPE
• Remove Gloves first – and perform hand
hygiene
• Face shield or goggles (if required)
• Gown
Remember the outside aspect of PPE is considered
• Mask contaminatedRemoving a Mask
Untie the bottom, then top,
tie
Remove from face
Discard
Hand HygieneInfection Control Measures
Management of admissions/transfers during an
outbreak
• Transfers
– to acute facility - inform the ambulance/admitting
facility/infection control team in advance of the
outbreak
– admission of new residents to RCF not generally
recommended ( depends on the layout)
– Non –urgent transfers to another facility generally
not recommended.Includes
1. Transfer of Resident diagnosed with ILI from Acute services back
to a RCF – criteria to be met outlined
2. Transfer of resident hospitalised for reasons not related to ILI to a
RCF experiencing an outbreak – based on assessment of risk of
exposure
3. Transfer of patient with close contacting to case(s) of influenza to
a RCF –criteria to be met outlined
4. Duration of Precautions for RCF residents with respiratory viral
infections – risk factor for prolonged shedding outlinedInfection Control Measures
Additional measures within the facility
• Restrict movement between affected and unaffected areas
• Consider rescheduling non urgent appointments
• Limit visitors as much as possible
• Excluded symptomatic visitors & all children
• Essential Visitors –
• Instruct to use hand hygiene facilities
• Visit one resident only and exit immediately after visiting
• Appropriate signageLink with Section 18 Admissions, Transfers & Discharges www.hse.ie/infectioncontrol
Respiratory Hygiene & Cough Etiquette What is it ? • Should be in place at • Element of Standard all time Precautions (2007) Advising • Emphasise during • Control of respiratory influenza season secretions • Hand hygiene after contact • Signage, provide with respiratory secretions facilities • Spatial separation >3 ft of persons with respiratory • Consider visitors, infection • Visual cue to remind residents people
Infection Control Measures
• Environmental cleaning and disinfection
– Clean with detergent and water
– Disinfect with 1,000ppm available chlorine
• Or Combined cleaner & disinfectant
– Rinse and dry
• Emphasis on frequently touched surfaces and surfaces in
close proximity to the affected residents
• Dedicate care equipment or clean and disinfect between
affected residentsGuidelines for the Use of Portable Electric Fans
in Healthcare Setting (HSE)
Influenza Preparedness 2018-2019Infection Control Measures
• In relation to staff recommended that
– Staff/volunteer absenteeism is monitor
– All staff aware of action to take if ill
– Ill staff should stay away from work for at least 5 days and until they are well
enough to return – written policy in place
– Limit staff movement especially if areas are unaffected within the facility
– Vaccinated staff to work in affected area
– Asymptomatic unvaccinated staff should wait one incubation period (3 days)
prior to working in a non-outbreak facility.
– Asymptomatic vaccinated staff have no restrictions working at other facilitiesInfection Control Measures
• On-going surveillance of ill residents/staff & maintain line list
• On-going communication with Dept Public Health, Infection Prevention Control
Nurse
• Appropriate signage for visitors
• Duration of precautions – 7 days following symptom onset or longer as advised
– Precautions required whilst people are symptomatic
– Advise should be sought regarding those who residents with risk factors
• An influenza outbreak is declared ‘over’ eight days after the onset of symptoms in
the last new caseKey Messages
• Vaccination of healthcare staff, patients, residents and visitors remains the
cornerstone of flu prevention strategies
• Be prepared
Record of staff and resident flu vaccination
Record of pneumococcal vaccine
Supplies of the correct standard available – PPE, swabs,
Know who to contact – Dept. Public Health, Infection Prevention & Control
Know how to access antiviral drugs
Continuous surveillance for ILI amongst residents and staff
• PREPARATION IS KEY – BE WINTER READY!Web resources • Health Protection Surveillance Centre Advice on Aerosol Generating Procedures. • https://www.hpsc.ie/a- z/respiratory/influenza/seasonalinfluenza/infectioncontrola dvice/File,3625,en.pdf • 2018 Guidelines for the Use of Portable Electric Fans in Healthcare Settings • https://www.hse.ie/eng/services/list/5/publichealth/public healthdepts/extreme/fan-guidelines.html • Cork Kerry Community Healthcare Guidelines & Resources • https://www.hse.ie/eng/about/who/healthwellbeing/infect cont/sth/resources/influenza.html
Respiratory Outbreaks – 2018/2019
Season
Outbreaks
• 96 influenza/acute respiratory infection (ARI) outbreaks notified to HPSC,
• 66 were associated with Influenza
• 156 of these were reported in residential care facilities or other residential care
settings
• 36 of these outbreaks were reported in acute hospitals
• 44 outbreaks notified in Cork and Kerry - NH (14), CH(6), MH( 3), DS (1)
Other (1)
Morbidity & Mortality
• 3,217- confirmed influenza hospitalised cases
• 132 critical care admissions
• 74 deaths were notified to HPSC – median age 73 yrs
Influenza Surveillance in Ireland – Weekly Report Influenza Week 20
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