CDC releases guidance for long-term care on swine flu infection

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CDC releases guidance for long-term care on swine flu infection
CDC releases guidance for long-term care on swine flu infection
The Centers for Disease Control and Prevention has released interim guidance for healthcare facilities, including long-term care, for care of residents with confirmed or suspected swine flu, also known as the H1N1 virus.

The guidance offers recommendations regarding patient placement, isolation, management of visitors, and surveillance of healthcare professionals, among other guidelines. To date, there have been 109 confirmed cases in the United States and one death.  

Meanwhile, scientists are now predicting that this particular strain of the H1N1 influenza virus will be less harmful than the average winter flu, according to recent news reports. Initial analyses of the current swine flu virus discovered some striking similarities to the influenza virus that wreaked havoc on the world in 1918, killing more than 50 million people. But closer inspection by scientists has found that this H1N1 strain of the flu lacks a great many of the characteristics that made the 1918 strain so deadly, reports the LA Times. For example, even though both strains are of the H1N1 variety, today's swine flu is missing a particular amino acid, which scientists say helps the virus infect the lungs, making it more fatal.

Still, scientists are quick to warn that influenza is notoriously unpredictable, and could mutate into a killer strain at any moment, according to the Times. In 2006, the CDC and the Department of Health and Human Services issued a pandemic preparedness checklist for long-term care facilities. At the time, the deadly avian flu was threatening to wend its own way through the world's population. While that never happened, the groundwork has already been laid for a long-term care response to such a viral outbreak.

See the swine flu guidelines from the CDC at http://www.cdc.gov/swineflu/guidelines_infection_control.htm.

See the 2006 CDC and HHS checklist regarding pandemic preparedness and other information below:

Long-Term Care Pandemic Influenza Planning Checklist


The following includes checklists for long-term care providers prepared by the Department of Health and Human Services and the Centers for Disease Control and Prevention, as well as other information. (Courtesy of the Health Care Council of Illinois (HCCI), the Illinois Council on Long-Term Care, and the Illinois Health Care Association.)

Pandemic Phases


The World Health Organization (WHO) has published the following six classifications or phases for flu preparation:

Interpandemic Period
Phase 1 – No influenza in humans, but present in animals
Phase 2 – No influenza in humans, but substantial risk to humans
Phase 3 – Human infection, but no human-to-human spread
Phase 4 – Small clusters with limited human-to-human spread
Phase 5 – Larger clusters, but human-to-human spread localized
Phase 6 – Pandemic phase: increased and sustained transmission in general population


Long Term Care Pandemic Influenza Planning Checklist

Structure for Planning and Decision Making

1.   ______ Assign one person who will be responsible for preparedness planning

2.   ______ Create a multidisciplinary planning committee.  Members who should be recruited include administration, medical staff, nursing, reception, environmental, and others as determined during this planning phase. 

3.   ______ Incorporate pandemic influenza into your emergency management planning

4.   ______ Identify points of contact in the community such as local and state health departments and provider associations

5.   ______ Create a list of local, regional, or state emergency preparedness groups. Include both bio-terrorism/communicable disease coordinators on the list. Make sure the facility plan coordinates with other pandemic plans 

6.   ______ Create a list of hospital contacts in the event your residents require hospitalization or your facility beds are needed for hospital patients

Elements of an Influenza Pandemic Plan

1.    ______ Assign one person the responsibility for monitoring public health advisories and updating committee members when pandemic influenza is nearing the geographic area.

2.    ______ Develop a written protocol for weekly or daily monitoring of seasonal influenza-like illness in residents and staff.  Remember the symptoms of pandemic influenza are the same initially as seasonal flu

3.    ______ Develop a protocol for the evaluation and diagnosis of residents and/or staff with symptoms

4.    ______ Assess incoming residents for flu-like symptoms and develop a protocol for appropriate placement of and isolation of these residents

5.    ______ Monitor spread of influenza in the facility and use these results to implement preventive interventions

 Facility Communication Plan

1.   ______Identify public health points of contact

2.   ______Assign one person and backup persons to communicate with public health authorities

3.    ______Assign one person to communicate with staff, residents and responsible parties regarding the status of pandemic in facility. Plan how this communication will take place, e.g. phone trees, signs or letters

4.   ______Assign one person to be responsible for inter-facility communication

5.   ______Update all facility contact information. There should be backup names in case

6.   ______Monitor and review of influenza activities in residents and staff  

7.   ______Report unusual cases of influenza-like illness and influenza to the local or state health department

8.   ______Communicate via telephone, facsimile or e-mail with local health department and state health department

9.   ______Assign a facility point person for all external communication to ensure consistency

10.  ______Compile a list of parties the facility will need to maintain communication with for coordination of care

11.  ______Obtain information from regional and local pandemic planning groups

12.  ______Maintain a list or database for residents' regular clinic, physician or dialysis visits in order to cancel non-essential appointments

Plan to Provide Education

1.    ______ Assign a person to coordinate education

2.    ______ Identify educational opportunities for personnel, residents, visitors, and responsible parties. 

3.    ______ Develop language and reading level appropriate materials especially on infection control and droplet precautions

4.    ______ Develop a plan for credentialing and educating of non-facility staff if needed  when the facility reaches a staffing crisis

5.    ______ Obtain informational materials for residents and families.  Make sure they are also language and reading appropriate

Infection Control Plan for Pandemic Influenza

1.    ______Assign one person in charge of infection control who will be available for questions/consultation on infection control measure.

2.    ______ Establish a plan for staff to use recommended swine flu infection control practices for symptomatic residents

3.    ______ Implement respiratory and cough hygiene throughout the facility. Some facilities have respiratory hygiene kiosks where information is available as well as supplies to use.

4.    ______ Develop a plan for cohorting residents.  Decide if the facility will confine all flu residents to one area, close off wings that are affected, or just confine sick residents and their roommates to their rooms.  Will admissions stop when pandemic flu is in the facility? Will visitors be limited?

5.    ______Protection of reception and personnel at initial point of contact

Plan for Addressing Staff Absences

1.    ______ Develop a contingency plan that identifies minimum staffing needs  (Number and categories of personnel needed to keep facility open or take patient overload) and care priorities. Conduct a daily assessment of staffing status

2.    ______ Develop a liberal/non-punitive sick leave policy.  Decide how to handle staff who get sick at work  and those who need to take care of sick family

3.    ______ Educate staff to self-assess and report symptoms that they may be having before reporting to work

4.    ______ Monitor influenza vaccination of staff

5.    ______ Develop a sick leave policy including when to return to work and how to incorporate the care of staff relatives who are ill

6.    ______ Develop policy on staff absenteeism due to school closings and neighborhood quarantines 

Vaccine and Antiviral Plan

1.    ______ Obtain the most current information and guidance on the use, availability, access, and distribution of vaccines and antiviral. These will not be available to everyone and decisions will have to be made with state and local authorities as to targeted groups

2.    ______ Plan on how you will get the vaccine and antivirals when they are distributed. Know the locations and agencies that will be in charge of distribution

3.    ______ Plan on how to administer vaccine, if available, and antiviral medication

Planning for issues related to possible influx of residents if acute facilities are unable to handle increased numbers of patients and supplies

1.    ______ Estimate essential material needs and equipment and how to handle likely supply shortages.  Amount of supplies needed to care for facility residents throughout isolation period. Channels for resources when normal channel resources have been exhausted

2.    ______ Develop strategies to aid hospitals by admitting non-influenza patients

3.    ______ Develop a plan for increased post-mortem care, temporary morgues and expanding community morgue capacity

4.     ______Planning for the stockpiling of at least a week's supply of consumable resources, including medical supplies, when there is evidence that pandemic influenza has reached the United States. 


_____


Education and guidance on Swine Flu

http://www.cdc.gov/swineflu/guidance/

Education on flu activity

www.cdc.gov/flu/weekly/fluactivity.htm

Education on pandemic influenza:
www.cdc.gov/flu/professionals/patiented.htm

Education on infection control and isolation procedures:
www.hhs.gov/pandemicflu/plan/sup4.html

Education on respiratory hygiene/cough etiquette:
www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm

Education on flu diagnosis
www.cdc.gov/flu/professionals/diagnosis


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Courtesy of the Health Care Council of Illinois (HCCI), the Illinois Council on Long-Term Care, and the Illinois Health Care Association