Managing the next flu season

By now, hopefully, the flu season of 2012-2013 is only an unpleasant memory. However, we can learn from our history. The past season will be remembered for being one of the worst. In addition to the higher than normal amount of flu cases, another virus arrived on the scene. 

Norovirus was particularly potent in 2012. A strain of norovirus, called GII.4 Sydney, was first identified in Australia the spring of 2011. It spread globally, and is thought to account for the most of the norovirus cases in the United States between September and December 2012. Long-term care (LTC) providers, already struggling with a bad flu season, were also faced with GII.4. While flu viruses and norovirus are two different diseases; the infection control steps to prevent the spread of disease are very similar.

As we know, LTC facilities are at higher risk during flu outbreaks. People 65 years and older are at greater risk of serious complications from influenza compared with young, healthy adults. It's estimated that 90 percent of seasonal influenza-related deaths and more than 60 percent of seasonal influenza-related hospitalizations in the United States each year occur in people 65 years and older.

Elderly residents living in LTC facilities are especially vulnerable to influenza outbreaks which, in this setting, may cause widespread illness with a high fatality rate. To prevent outbreaks, all LTC facility residents and healthcare personnel should be vaccinated against influenza.

In addition, a suspected influenza outbreak should prompt immediate action. Surveillance should be implemented to identify new cases and standard and droplet precautions should be instituted without delay. There are medications, called antivirals which, if used promptly, can decrease flu symptoms. All residents with suspected influenza symptoms should receive antiviral treatment immediately without awaiting confirmatory testing. In addition, all eligible residents facility-wide, not just in the affected unit, should receive chemoprophylaxis as soon as an outbreak is identified.

The Centers for Disease Control and Prevention (CDC) has some excellent tools to help facilities plan for and manage the flu. These can be found at Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities.

The CDC’s Immunization Safety Office also has free continuing education (CME and CE) activities related to flu vaccines. The CME and CE offer includes a discussion with three vaccine safety prevention experts and is appropriate for those who administer influenza vaccines.

Rules to prevent infection

• Wash your hands frequently. Dirty hands spread disease. Hand washing continues to be the most effective way to prevent the spread of disease.
• Cover your mouth when you cough or sneeze. Coughing or sneezing can spread germs through droplets in the air. The recommendation is to cover your mouth with an arm, sleeve or crook of the elbow instead of your hands.
• Have supplies available. Disposable tissues, hand sanitizers, gloves and masks should be readily available for your staff, visitors and residents.
• Don't share personal items. This should go without saying and yet still people will share drinks, lipsticks, towels and other personal care items. One of my pet peeves is finding staff’s drinking cups on handrails throughout the building. How many confused residents have sipped from that cup and returned it to the rail?
• Don’t pick your nose (or your mouth or eyes either). You have heard that old children’s rhyme “You can pick your nose, you can pick your friends but you can’t pick your friend’s nose.” Well, in this case you can’t pick your own nose either. Many germs live in moist, dark, warm environments. Inside your eyes, nose and mouth are as definitely warm, moist, dark places—just the environment germs prefer. Yet look around you. People touch their face frequently, which is why we have to keep referring back to rule 1.              
• Encourage staff and visitors to stay home when they have symptoms of a contagious illness. If a person comes in with signs of illness, send him or her home. 
• Place reminder cards in restrooms. Emphasize the benefits of hand washing with soap and water.
• Clean frequently touched places such as doorknobs, telephone receivers and coffeepot handles. These are called fomites (places that can spread disease).
• Keep up on local news. Your infection control nurse should be aware of school closings related to illness as well as the ill residents in the building. When schools are closed, the children visit grandma with their parents and they don’t leave their germs at home
• Use safe cooking practices. Food-borne illnesses usually come from poor food preparation and dining habits. Germs live on most food, and even more so on foods at room temperature. Refrigeration slows or stops the growth of most germs. Refrigerate foods within two hours of preparation. Use separate cutting boards for raw meats and vegetables. Wash all fruits and vegetables well before eating. Keep the preparation area clean and free of contamination.

Sylvia J. Bennett, RN, BSN, FACDONA, is a nurse consultant at SAVE Medical. She also served as a healthcare supervisor with the Michigan Department of Health. Contact her at Sylvia.bennett@sbcglobal.net.