by Ivan Obreza
Senior Clinical Advisor, Diversey Australia & New Zealand
Flu season in Australia extends from May to October and peaks in July, which is why residents of aged care facilities are particularly vulnerable to influenza throughout this month. Their living environment – where contact with others is encouraged – makes it easy for the influenza virus to spread. In addition, the frailties associated with advanced age, together with co-morbidities such as cardiac and renal disease, exacerbate the risk of serious complications.
The most challenging aspect is that flu symptoms can be difficult to recognise in the elderly as respiratory symptoms may be masked by fever and generally feeling unwell. As a result, delays in diagnosis and treatment may occur.
Implementing the right process internally is vital. Staff may carry the influenza virus from one area to another, which is why compliance with hand hygiene standards as well as the use of appropriate disinfection with a TGA registered product is fundamental to reduce environmental surface contamination. Further to this, there are simple ways staff members can reduce the chances and that is by simply becoming more aware of regularly touched surfaces such as bedrails, switches, remotes, door handles and table tops.
Plus it is important to remember that during peak periods staff may have to deal with an outbreak of viral gastroenteritis within the same timeframe. Norovirus, which is the root cause of gastroenteritis in aged care, persists longer on environmental surfaces in colder weather. This means the risk of gastroenteritis may be somewhat higher during flu season. However, the same basic management principles apply: proper hand hygiene and effective disinfection.
Managing an influenza outbreak adds a level of complexity to an already challenging environment so NSW Health recommends the following approach:
• Ensure all residents and staff are vaccinated with the latest influenza vaccine.
• Use influenza warning signs at key locations.
• Isolate symptomatic residents by placing beds more than two metres apart (separated by a curtain if possible). Preferably, use single rooms where possible.
• Ensure that staff use protective equipment such as gowns and gloves when caring for infected residents.
• Perform hand hygiene before and after caring for other residents.
• Promote hand hygiene and cough etiquette.
• Encourage the use of surgical masks by symptomatic residents.
• Promptly investigate and control respiratory illness outbreaks.
• Report suspected influenza outbreaks to your local public health unit.
Residents with influenza need to be treated early — ideally within 48 hours – with anti-viral medications such as Oseltamivir and Zanamivir to help protect people at the highest risk of severe outcomes.
Residents who have been hospitalised and who have recovered from influenza are likely to be immune to the strain circulating in the facility they came from. Therefore they should ideally be discharged back to the facility as soon as clinically indicated.
If an outbreak of influenza is declared in your facility, giving preventative medication to all residents who are not yet infected can help control the outbreak. To be effective however, the preventative treatment needs to commence as soon as possible. Notably, it should be given to all unaffected residents.
Although it is necessary to increase hygiene measures through hand hygiene and environmental cleaning, you need to be aware that chlorine bleach is associated with respiratory distress and adult-onset respiratory disease and may irritate some residents. A non-bleach disinfectant containing either quaternary ammonium or accelerated hydrogen peroxide (AHP) should be considered. In addition, microfibre offers a good safety net for cleaning processes if the application of a safe disinfectant is not uniform.
Other simple preventative measures include isolating affected residents, limiting staff and visitor movement into affected areas and suspending all group activities. Further to this, it is important that all staff with coughs and colds are encouraged to stay away from work.
Influenza is a serious, life-threatening disease in aged care. We are not yet at the stage in medical science where we can prevent it totally, but we certainly have the knowledge to mitigate the risk of contamination.
See: A Practical Guide to assist in the Prevention and Management of Influenza Outbreaks in Residential Care Facilities in Australia at: http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-flu-guidelines.htm* Ivan Obreza is an infection prevention consultant and the senior clinical advisor for Diversey Care, Australia. www.diverseyvericlean.com.au