When flu fears strike: managing swine flu and seasonal flu in long-term care

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When flu fears strike: managing swine flu and seasonal flu in long-term care
When flu fears strike: managing swine flu and seasonal flu in long-term care
President Obama declared an H1N1 flu national public emergency on Oct. 23, citing an “evolving pandemic” that allegedly has killed more than 1,000 people in the United States alone. He also warned of the flu's potential for overburdening healthcare resources.While medical experts don't dispute that most flu currently circulating (as of mid-November) is indeed the 2009 H1N1 strain—and that H1N1 could worsen what is predicted to be an already active and severe flu season—some believe that the onslaught of “flu mania” reports and talks of global pandemics are generating unwarranted panic and fear that could actually hinder infection prevention and proper treatment.

Providers must “keep their eye on the ball” and remember to take care of core needs during such stressful times, experts emphasize.

To be fair, it's understandable why some seniors housing operators may be exceedingly concerned about the 2009-2010 flu season. First, there is the regular seasonal flu, which leads to the hospitalization of more than 200,000 Americans annually on average, and whose complications claim the lives of some 36,000.

Long-term care providers are also dealing with a close cohort of immunocompromised residents, and are likely fielding questions from concerned residents, family members and staff–some of whom may be running scared because of alarming news reports and even misinformation surrounding H1N1 and this year's flu season.

“The media has helped create some panic,” said Peggy Brenner, director of education and special care programs, ACTS Retirement-Life Communities Inc., West Point, PA. “Flu season should never be taken lightly, but we have to keep a level head. Education is critical. We've found that if we properly educate residents, family members and staff, the panic is diffused. Otherwise, the only information many people hear is from the television. If you're prepared, the approach to this year's flu season really shouldn't be that different.”

Understanding H1N1

This year, a critical first step toward proactive, appropriate flu management is educating staff, residents, family members and other visitors about the differences between H1N1 and the seasonal flu. That primarily means how vaccination priorities differ between the two.

Government health agencies such as the Centers for Disease Control and Prevention and the World Health Organization advocate administering the seasonal flu vaccine each year to healthcare workers and other high-risk individuals, including those age 65 and older.

Unlike the seasonal flu vaccine, however, the H1N1 vaccine is not being targeted toward the senior population.

“The rate of infection for 2009 H1N1 is highest among those 24 years or younger,” explained Dr. Ruth Kandel, director of infection control at Needham, MA-based Hebrew SeniorLife, an eight-site, multi-level senior care system that is affiliated with Harvard Medical School. “Although elderly individuals are at increased risk for complications from the 2009 H1N1 flu, infection so far has been uncommon. While no one knows why this is the case, the thought is that elderly individuals may have some pre-existing immunity based on exposure to similar influenza viruses circulating years ago.”

For this reason, many facilities are limiting the H1N1 vaccine to staff and are providing residents with the option to receive it only if extra doses of vaccine are available. Such is the case for Los Angeles Jewish Home, a multi-level senior living and care facility with more than 1,000 residents.

“The major difference between the H1N1 and the seasonal flu is that we are not vaccinating residents for H1N1,” noted the Los Angeles Jewish Home's medical director, Dr. Rick Smith.

More precautions

Another difference between the 2009 H1N1 and seasonal flu is the CDC recommendation for healthcare workers to wear a fit-tested N95 respirator. Given the increased demand and resulting shortages for the respirator, the CDC has issued a new guideline reviewing alternative protection strategies when there are shortages in the presence of confirmed or suspected H1N1 cases.

“When shortages exist, these respirators should remain available for staff involved in aerosol-generating procedures on individuals with suspected or confirmed 2009 H1N1 influenza, or when taking care of those with other respiratory infections that require this protection, such as tuberculosis,” Kandel said.

The circulation of H1N1 also is leading many operators to re-evaluate their pandemic flu policies–a move supported by many clinical experts.

Karen Merk, clinical consultant for senior living at Briggs Corp., West Des Moines, IA, for example, urges facilities to ask staff and visitors to stay home if they are running a fever or have other flu-like symptoms, and to develop a contingency plan for when employees call in sick.

“Provide education for staff, residents and family members,” Merk said. “Make sure there are policies and procedures in place so influenza can be isolated to one area of the building.”

She also encourages facilities to have plenty of disposable items, such as plates, cups, utensils, garbage bags and gloves, on hand.

ACTS Retirement-Life Communities and Baltimore's Levindale Hebrew Geriatric Center & Hospital have informed their human resources department that there are employees with school-age children who will not be able to come to work if their children acquire the H1N1 flu. They have also stressed that as with previous years, anyone with flu-like symptoms should stay home.

“Our HR department has made addendums to our policy, so those who miss work because of the flu will not have to worry about any punitive [outcomes],” said Barbara Church, Levindale's DON.

Levindale also has conducted a minimum staffing assessment to help ensure adequate staffing levels if a pandemic occurs. Resident cohorting will certainly help facilitate that goal.

“We have a means of isolating residents on one floor, if necessary,” Church noted.

ACTS is preparing for flu season by purchasing more surgical masks with eyeshields, and even disposable resident care products, such as washcloths, to further reduce the risk for cross-contamination.

Infection control is key

While vaccination priorities may differ, experts stressed that stringent adherence to basic infection control practices is perhaps the most effective way to prevent acquiring any type of flu.

“The same five things of benefit to the general population for flu prevention apply to the long-term care population,” reasoned Shelly Padovan, clinical specialist for Alcavis HDC, Gaithersburg, MD, a manufacturer and distributor of infection prevention products. Those top five infection prevention approaches, she pointed out, are keeping hands clean, donning gloves, covering the nose and mouth when coughing or sneezing (and avoiding touching eyes, nose and mouth), staying home when sick, and following vaccination recommendations.

Facilities also may ward off infection by merging basic infection prevention protocols with technology that can offer round-the-clock protection. Systems that work in tandem with a facility's existing air-handling equipment to circulate oxidizers throughout the facility, for example, can assist in eliminating infection-causing microbials from the air and on surfaces.

“We worry about infectious microbials that fill the air when residents and staff sneeze and cough,” explained Lin Cochran, president of AirScrub Systems by Clean Air Systems Engineering Inc., Aiken, SC.

Providers take note

Perhaps the most important flu prevention strategy, however, is facilities' commitment to providing targeted, ongoing education about H1N1 and the seasonal flu. ACTS communities began pushing their comprehensive flu education in the summer and will continue throughout the flu season. The education encompasses flu preparedness, surveillance and detection, response and containment, and communication—and aggressively targets core infection control principles.

“We have in-service coordinators at each facility who educate about the flu and how to prevent it. Vaccination certainly plays a role, but it's important that people understand it's just one component. Following proven infection control practices is critical to flu and other infection prevention,” Brenner said.

ACTS communities display posters from the CDC to encourage adherence to flu prevention strategies. They also feature hand hygiene training videos on the Internet. Hebrew SeniorLife facilities distribute current health information from various agencies and keep residents, staff and visitors informed about the flu.  

With advanced preparation, facilities should be adequately equipped to handle virtually any illness that arises, Brenner explained.

“Almost every year, our communities have a norovirus endemic, but we haven't run into any major problems because we're always prepared,” Brenner said. “We don't expect this year to be any different.”