Preparation and Management of Influenza Outbreaks in Multiple Long Term Care Centers

ISSUE: The VA Maryland Health Care System experienced multiple influenza and influenza like outbreaks on 4 units during February, 2005. Despite a shortage of vaccine last year, the VA received full shipment. Eighty-five to 100% of the affected patients had received influenza vaccinations. Fifty to 79% of the staff had been vaccinated. The outbreak affected 23 patients and 11 employees at two separate long term care sites with four different units involved. Some veterans continued to experience influenza like symptoms even though they were vaccinated for influenza and received antiviral prophylaxis. Most of the outbreaks began on a Friday and peaked over the weekend. The infection control staff was challenged in many ways. The nursing homes are located 42 miles apart. Information from nursing staff regarding symptomatic cases was found to be inconsistent. There was difficulty in obtaining viral cultures from the patients and staff. The pharmacist may not be physically on site. Some of the antiviral medications were not on formulary and needed authorization from on-call supervisors. Medications had to be received from an outside source. PROJECT: In preparation for the 2005-06 season, the infection control staff/hospital epidemiology staff utilized the VA Influenza Tool Kit to promote influenza vaccinations amongst patients and staff. This kit includes a website, literature, posters, buttons and stickers promoting influenza vaccinations. In addition, viral cultures and posters on obtaining cultures have been made available to the staff. “Cover you Cough” signage has been posted in all the nursing homes. Surgical masks are on the unit stock carts. Nursing home influenza season or outbreak signage has been developed. Antiviral medication for influenza is available at each of the nursing home sites. RESULTS: Infection control has the educational tools including posters and antiviral medications secured in the event of an outbreak of influenza or influenza like cases. There is 24 hour coverage with nurse managers and nursing supervisors that was not available at all sites a year ago. Nursing home directors and supervisors have blackberry pagers that provide access for off shift communication. LESSONS LEARNED: The VAMHCS is not unique in that a coordinated approach is necessary for handling influenza outbreaks. Many disciplines should be involved including the nurse managers, supervisors, nursing home directors, pharmacist and the nursing home staff. The planning should be done in the early summer in conjunction with influenza vaccination promotional campaigns.