Infection Control Feature: Stuffy Situation

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Flu shots, proper hand hygiene and even 'sneeze etiquette' can make a big difference in reducing the spread of the flu

Germophobes must be having a hard time summoning the courage to read a newspaper these days with all the ramped-up coverage of diseases. Consider the following developments in just the last couple of months:

• Methicillin-resistant Staphylococcus aureus (MRSA) outbreaks are on the rise and spreading outside healthcare institutions.

• An infection linked to Legionnaire's disease is believed to have caused the deaths of two New York nursing home residents.

• Threats of West Nile Virus – a mosquito-borne pathogen lethal to children and the elderly – remain omnipresent.

• Resistant strains of Clostridium difficile, or C-diff, have been reported in Canada.

• The threat of an avian influenza pandemic continues.

On top of everything, the regular flu season has arrived. And while that bug is seen mostly as an inconvenience compared to the above threats, infection control specialists say it is a mistake to take seasonal flu lightly.

Not that long-term care facility administrators do. On the contrary. They are keenly aware that their residents are among those at the greatest risk of serious complications from the flu.

"They are very aware and very concerned," said Pat Rosenbaum, RN, infection control practitioner and board member for the Association for Professionals in Infection Control and Epidemiology. "They have done a great job publicizing the importance of immunizations – flu programs are a big part of what an infection control practitioner does in long-term care."

Procedurally, facilities have streamlined the immunization process by getting permission at the time a resident is admitted. This process alone has saved countless hours of staff time, Rosenbaum said.

"Getting permission for each resident to be vaccinated every year has been a formidable challenge in the past," she said. "But now many facilities get approval upon admission, which has helped a lot. It saves the tremendous amount of energy it takes to track down each resident's family members every year."

Immunizations don't end with residents, either. In fact, getting employees vaccinated is at least as important, and sometimes more difficult to do, Rosenbaum said.
"Use creativity to get the staff immunized," she suggests. "Some facilities will have raffles for employees that get shots, which is a good incentive."

Flu shots are just one piece of the staff-hygiene equation, however.

"Equally important to flu immunization is the establishment and adherence to policies related to healthy work practices in healthcare settings," says Lucille Levine, RN, a consultant for Stratham, NH-Based Disposables Delivered. "Hand washing, respiratory hygiene and not succumbing to the pressure of going to work when ill are also vital."

The perception that sick employees are dedicated troupers whose determination should be admired is actually harmful, Levine contends.

"The expectations and pressure for caregivers to cover additional shifts during flu-like illness exacerbate an epidemic," she said. "Instead, they should be quarantined, as should outside visitors."

High senior mortality

The Atlanta-based Centers for Disease Control and Prevention reports that an average 36,000 Americans die from flu-related complications each year. Mortality is highest among the elderly. Experts believe hospitalizations due to flu complications are highest for infants and seniors.

The flu threat diminishes significantly with immunization, however. CDC officials say when the match between the vaccine and circulating flu strain is close, vaccination can be 30% to 70% effective for seniors living outside nursing homes. Within nursing homes, the CDC maintains that the flu shot can be 50% to 60% effective in preventing hospitalization or pneumonia, and 80% effective in preventing death from the flu.

Taking your best shot

Disease specialists contend there should be plenty of flu vaccine available for the 2007-08 flu season. Even so, providers should be aware that use of two popular antivirals, amantadine and rimantadine, are each being discouraged by the CDC because the most common flu strain, Influenza A, has built up a resistance to them.

Flu shots are an effective weapon against infection, but Levine concedes that they are not a magic bullet.

"In fact, flu shots typically provide protection against three strains of influenza virus which are anticipated to predominate the flu season based upon prevalence and virulence of viruses during the southern hemisphere's winter," she said. "The concept of universal precautions needs to be practiced. Flu shots may provide a false sense of security for some. There are many aggressive bacterial illnesses and viruses that pose a daily threat much greater than the flu."

While medical science has made strides in developing effective vaccines for flu prevention, "good old-fashioned etiquette" remains a reliable tactic in preventing the spread of disease, Rosenbaum said.

Because the flu is most commonly spread by air or droplet, methods such as sneezing into the crook of the arm (rather than an uncovered hand) might be crude, but they are effective, Levine agrees.

Boosting hand hygiene

The introduction of alcohol-based sanitizing gels as an alternative to soap and water hand washing has greatly improved compliance among staff, infection control specialists agree.

This is a significant step forward in the fight against pathogenic outbreaks, aid Patty Taylor, RN, vice president of healthcare marketing for Akron, OH-based GOJO Industries.