Flu season: An opportunity for training

The policies and procedures at nursing homes regarding influenza and infection prevention vary greatly across the country, and that’s dangerous, said Jasmine Travers, RN, PhD candidate and researcher at the Columbia School of Nursing's Center for Health Policy. Certain policies and administrative strategies can increase flu vaccine rates among residents and staff, while other factors can hinder them, she told attendees of this week’s Long-Term Living webinar, "Flu season is coming: Prevention techniques to keep residents healthy."

Medicare and Medicaid will pay for flu vaccines for seniors, yet barely half of the 872 nursing homes Travers and her team surveyed had succeeded in getting at least 75 percent of their residents vaccinated, said Travers, who has spent the past two years serving as a research assistant on a National Institutes of Health-funded study titled, "Prevention of Nosocomial Infections: Comparative Effectiveness in Nursing Homes."

During a typical flu season, the case number peak in December and February but can start as early as August and can last well into March. Older adults are at much higher risk of serious complications from the flu than younger people because their immune systems don’t react as quickly or as powerfully to fight off germs and infections.

The Centers for Medicare and Medicaid Services (CMS) requires that all residents are offered the influenza vaccination, and their acceptance or refusal must be documented.

So, what strategies can increase resident vaccine prevalence? Posters in the hallways? Educational speakers? Informational material for families? All of the above, Travers said. Both the Centers for Disease Control and Prevention and the National Council on Aging hold robust annual flu campaigns and provide free online resources and poster materials for nursing homes and senior living communities to use for resident and family education.

Policies need to be in place for delineating and tracking the subject of staff vaccinations, too, she said. Most of the nursing homes in the study (78 percent) had a policy of requiring a declination statement from staff who refused vaccination. A further 38 percent required staff to get a flu vaccine, while 26 percent required unvaccinated staff to use a mask at work.

Improve your flu mission

Travers suggests several ways facilities can improve their flu-related missions:

  • Strengthen the immunization infrastructure: Add training, continuing education, stewardship
  • Improve access to vaccines: Use standing orders, vaccination tracking
  • Increase demand for vaccines: Reach out to families and staff to assess their knowledge, attitudes and beliefs about the flu
  • Improve documentation: GDocument resident decisions about the flu vaccine and get flu-related info into the electronic heath record.

Facilities need to be willing to invest in infection control training, since "Not providing financial resources for training was associated with an infection citation," Travers warned. Poorly trained staff also can spread misinformation and bad habits concerning the flu and other infections, she added. At least one interviewee at each nursing home in the survey offered information that conflicted with accepted infection control practices or was not factual, she said. A lack of education and training can cause staff to overreact, underreact or even completely undermine infection control practices. For example, Travers said, one interviewee related that residents who are placed in a isolation room are dressed in isolation gowns, but “they’re free to come out of their room and to socialize.”

Standard procedures are a problem across the country, Travers noted. “We found that the methods and processes used to collect information about infection and to train staff varied widely.” This includes information about the flu vaccines themselves, where myths and misunderstandings run the gamut from believing the vaccine will prevent all illness to viewing the vaccine as an evil-doer that will cause illness.

Yet the significant risks and complications associated with the flu mean seniors need access to factual information and frequent messaging about the importance of vaccinations. “We would expect that meeting vaccination expectations for our residents would be instinctive,” Travers said. “But everything is easier said than done.”

Topics: Articles , Clinical , Infection control , Risk Management