Ebola Guidelines and Information Resources
While long-term and post-acute care providers are not among those considered frontline healthcare providers dealing with emerging cases of Ebola, it is important for providers to seek information and resources that are available, in the event of an exposure or epidemic. Currently, the best information and resources can be found through your state's Department of Public Health, CDC and other federal agency websites:
Be Prepared for the Next Influenza Season
Did you know that a person can spread the flu one day before they feel the symptoms and five to seven days after becoming sick? A flu-infected person can infect anyone within six feet!
It is no wonder flu outbreaks happen every year. Even so, the flu season is unpredictable in a number of ways. While flu spreads every year, the timing, severity and length of the season varies from one year to another. According to the Centers for Disease Control and Prevention (CDC), flu activity most commonly peaks in the U.S. in January or February. However, seasonal flu activity can begin as early as October and continues to occur as late as May.
While everyone should begin preparing now to limit the spread of influenza viruses, it is especially important for senior living facilities, since people 65 years and older are at greater risk of serious complications from the flu compared to young, healthy adults. It is estimated that 90 percent of seasonal influenza-related deaths and more than 60 percent of hospitalizations in the U.S. each year occur in people 65 years and older.
To prevent outbreaks, all senior living facility residents and healthcare personnel should be vaccinated against influenza. An informed consent is required to implement a standing order for vaccination. People should begin getting vaccinated soon after the flu vaccine becomes available, ideally by October, to ensure that as many people as possible are protected before flu season begins. It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against the flu.
Since October 2005, the Centers for Medicare and Medicaid Services (CMS) has required nursing homes participating in Medicare and Medicaid programs to offer all residents influenza and pneumococcal vaccines and to document the results. According to requirements, each resident is to be vaccinated unless contraindicated medically, the resident or legal representative refuses vaccination or the vaccine is not available because of storage. This information is to be reported as part of the CMS Minimum Data Set, which tracks nursing home health parameters.
When there is influenza activity in the local community, active daily surveillance for influenza illness should be conducted among all new and current residents, staff and visitors of senior living facilities, and should be continued until the end of influenza season.
Once an outbreak has been identified in the facility, prevention and control measures should be implemented immediately. Once a single laboratory-confirmed case of influenza has been identified, it is likely there are other cases among exposed persons and Standard and Droplet Precautions should be instituted without delay.
- Wearing gloves if hand contact with respiratory secretions or potentially contaminated surfaces is anticipated;
- Wearing a gown if soiling of clothes with a resident's respiratory secretions is anticipated;
- Changing gloves and gowns after each resident encounter and performing hand hygiene; and
- Performing hand hygiene before and after touching the resident and their environment, or after touching the resident's respiratory secretions, whether or not gloves are worn. Gloves do not replace the need for performing hand hygiene.
- Placing ill residents in a private room. If a private room is not available, place (cohort) residents suspected of having influenza with one another;
- Wear a facemask (e.g. surgical or procedure mask) upon entering the resident's room; remove the facemask when leaving the resident's room and dispose of it in a waste container;
- If resident movement or transport is necessary, have the resident wear a facemask, if possible; and
- Communicate information about residents with suspected, probable, or confirmed influenza to appropriate personnel before transferring them to other departments.
These precautions are part of the overall infection control strategy to protect against influenza in healthcare settings and should be used along with other infection control measures. These include screening employees and visitors, limiting the number of large group activities in the facility and serving all meals in resident rooms, if possible, when the outbreak is widespread (involving multiple units of the facility).
All residents who have confirmed or suspected influenza should receive antiviral treatment immediately without awaiting confirmatory testing. Antiviral treatment works best when started within the first two days of symptoms. However, these medications can help when given after 48 hours to those who are very sick, such as those who are hospitalized or those who have progressive illness. Having preapproved orders from physicians or plans to obtain orders for antiviral medications on short notice can substantially expedite administration of antiviral medications. In addition, all eligible residents in the entire facility, not just the affected unit, should receive chemoprophylaxis as soon as an influenza outbreak is identified. When at least two patients are ill within 72 hours of each other and at least one resident has laboratory-confirmed influenza, the facility should promptly initiate antiviral chemoprophylaxis to all non-ill residents, regardless of whether they received influenza vaccination during the previous fall. Again, an informed consent is required to implement a standing order. The CDC recommends antiviral chemoprophylaxis for a minimum of two weeks, and continuing the treatment for at least seven to 10 days after the last known case was identified.
Bennett, S. (2013, May). Managing the next flu season. LTL Magazine, 10-11.
Retrieved September 11, 2014 from http://www.cdc.gov/flu/about/season/flu-season-2014-2015.htm
Retrieved September 11, 2014 from http://www.cdc.gov/flu/professionals/2012-2013-guidance-geriatricians.htm
Retrieved September 11, 2014 from http://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm