Requirements for Prevention and Detection of Influenza Outbreaks Aide Memoire Season

Transcription

1 Requirements for Prevention and Detection of Influenza Outbreaks Aide Memoire Season Liz Forde, Cork Community Services Patricia Coughlan, Cork & Kerry Disability Services

2 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

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4 Respiratory Outbreaks 2014/2015 Season 114 acute respiratory outbreaks reported to HPSC 89 associated with Influenza 17 No pathogen detected 83% ( 95 of 114) of these outbreaks were in residential care facilities/community hospital units mainly for the elderly/those with intellectual disabilities. 978 Hospitalised,53 admissions to CCU, 41 deaths associated with Influenza Influenza Surveillance in Ireland Weekly Report Influenza Week (11th 17th May 2015)

5 Planning & Education Ensure all staff Receive education re Influenza (signs & symptoms) and the essential role of vaccination have a high index of suspicion for influenza during flu season recognise and report potential cases and clusters are familiar with and have access to recommended infection control measures have contact details for their local Infection Prevention & Control staff (where available) and local Public Health department Nominate a senior manager to co-ordinate all actions and communication in the event of a suspected or actual outbreak to Public Health

6 The Aide Memoire

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8 Requirements for prevention (1) 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.

9 Requirements for prevention (2) 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?

10 Requirements for prevention (3) Staff Vaccination Was flu vaccination promoted amongst staff at the start of the flu season? How? 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?

11 Requirements for prevention (4) 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 a Consultant in Public Health? List of sites where swabs are is held by DPH Is there access to antiviral medication (Tamiflu) within 24 hours in place with the facility pharmacy if needed in the event of an outbreak? Are supplies of surgical face masks and eye protection available? Are they the correct standard?

12 MASK FACE TYPE II DISPOSABLE FACE MASK TIE ON MASK SURGICAL TYPE IIR DISPOSABLE FLUID RESISTANT/ANTI-FOG WITH VISOR

13 Requirements for prevention (5) 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 hr period?

14 Outline Guidelines & Documentation circulated 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

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16 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 breath

17 Influenza 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 If an increased number of residents become unwell over a short period of time with respiratory illness, influenza should be suspected.

18 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.

19 Detection of Influenza outbreak (1-4) If suspected, request attending GP to confirm diagnosis If confirmed, inform the Dept of Public Health 021/ or 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 Nose and throat viral swabs for ILI suite Decide re antiviral treatment and chemoprophylaxis Agree a communication strategy

20 Viral 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

21 Detection of Influenza outbreak (5-6) 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, 2012 Refer to Checklist for Residential Care Facilities on the Prevention, Detection and Control of Influenza-like Illness and Influenza Outbreaks, 2014/2015

22 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.

23 Accurate information is essential as this will guide Public Health response

24 Report to Department of Public Health Temp

25 Residents Affected 3 patients symptomatic within 72 hours Reported to DPH

26 Residents affected Cont d

27 2 nd Ward Residents affected

28 Staff Affected

29 Consequences One ward closed from 17 th Feb to 3 rd March 14 residents and 8 staff affected Learning Second ward affected 24 th to 4 th March 24 th Feb 2 residents in one 4 bedded room 1 resident placed in SR Second resident with no continued cough, sneezing & remained by bedside Sensible management of visiting

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31 Infection Control Measures (1) In addition to Standard Precautions, implement Droplet Precautions immediately for symptomatic cases in healthcare settings do not wait for laboratory results Patient Placement Place patient in a single room or cohort with similar patients Maintain a distance 1 metre between infectious patient and others Wear surgical masks within 1 metre of care Limit patient movement

32 Infection Control Precautions Standard Precautions Hand Hygiene Respiratory Hygiene and Cough Etiquette Patient Placement Protective Clothing 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 waste Droplet Pracautions Protective Clothing Patient Placement Cleaning of the Environment Care of Client Care Equipment

33 PPE 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

34 Sequence* for Donning PPE 1. Gown / Apron first 2. Mask 3. Goggles or face shield 4. Gloves *Combination of PPE will affect sequence be practical

35 How 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

36 Sequence for Removing PPE 1. Remove Gloves first and perform hand hygiene 2. Face shield or goggles 3. Gown 4. Mask

37 Removing a Mask Untie the bottom, then top, tie Remove from face Discard Hand Hygiene

38 Infection Control Measures (2) Management of admissions/transfers during an outbreak Transfers to acute facility - inform the infection control team in advance of the outbreak admission of new residents to RCF or transfers to another facility generally not recommended during an outbreak Additional measures within the facility Restrict movement between affected and unaffected areas Consider rescheduling non urgent appointments Limit visitors as much as possible Exclude symptomatic visitors & children Essential Visitors Instruct to use hand hygiene facilities Visit one resident only and exit immediately after visiting

39 Respiratory Hygiene & Cough Etiquette- Element of Standard Precautions Should be in place at all time Emphasise during influenza season Signage, provide facilities Consider visitors, residents

40 Infection Control Measures (3) 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 residents

41 Cleaning & Disinfection Bleach-free with a lovely fresh scent.

42 Infection Control Measures (4) Staff Vaccinated staff to care for the ill Exclude ill staff - 5 days post onset of symptoms Limit staff movement 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 facilities

43 Infection Control Measures (5) Ongoing surveillance of ill pts/staff maintain list Communication/signage Duration of precautions 7 days following symptom onset or longer as advised An influenza outbreak is declared over eight days after the onset of symptoms in the last new case

44 Conclusion Influenza outbreaks cause major disruption in healthcare facilities resulting in excess morbidity and mortality particularly among the elderly Vaccination of healthcare staff, patients, residents and carers remains the cornerstone of flu prevention strategies Local Policies and Guidelines for Flu prevention and management PREPARATION IS KEY BE WINTER READY!

45 Key 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 Surgical facemasks available Know who to contact Dept. Public Health Know how to access antiviral drugs Continuous surveillance for ILI PREPARATION IS KEY BE WINTER READY!

46 Leading by Example!

47 Resources Checklist for Residential Care Facilities on the Prevention, Detection and Control of Influenza-like illness and Influenza Outbreaks Public Health Guidelines on the Prevention and management of Influenza Outbreaks in Residential Care Facilities in Ireland 2012/2013 (PHMCDG) HIQA Safety Alert 003/2012.Outbreaks of Influenza in designated centres. Infection control and influenza and some posters: Z/Respiratory/Influenza/SeasonalInfluenza/Infectioncontroladvice/

48 Thank you for your attention Any questions