Influenza Preparedness

Transcription

1 Influenza Preparedness Prevention and Detection of Outbreaks Niamh McDonnell, Infection Prevention and Control Nurse Managing an Outbreak of Influenza Key Infection Prevention and Control Measures Patricia Coughlan Infection Prevention and Control Nurse

2 Prevention and Detection of Influenza Outbreaks Aide Memoir Season

3 Outline Guidelines & Documentation circulated Prerequisites Planning & Education Requirements for prevention - Actions Residents and Staff Vaccination Records What supplies are needed? Monitoring of staff illness Requirements for detection - Actions Recognition Case definition of influenza like illness Definition of influenza like illness outbreak Reporting Guidelines

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5 Outbreaks Respiratory Outbreaks 2017/2018 Season 223 influenza/acute respiratory infection (ARI) outbreaks notified to HPSC, 198 associated with Influenza 156 of these were reported in residential care facilities or other residential care settings 36 of these outbreaks were reported in acute hospitals 44 outbreaks notified in Cork and Kerry - NH (14), CH(6), MH( 3), DS (1) Other (1) Morbidity & Mortality 4680-confirmed influenza hospitalised cases highest age specific rate in those 65yrs and older with a median age of 63 yrs 188 critical care admissions 83 of these were over 65, 30 were years of age 222 deaths were notified to HPSC median age 81 yrs Influenza Surveillance in Ireland Weekly Report Influenza Week 20 (14th 20 th May 2018)

6 Be Prepared -Planning & Education Written policies on immunisation, IPC and Outbreak Management related to influenza Education for staff at induction and on going to include influenza Staff should receive education re Influenza (signs & symptoms) and the essential role of vaccination have a high index of suspicion for influenza during flu season be able to recognise and report potential cases and clusters be familiar with and have access to recommended PPE have access to details for their local Infection Prevention & Control staff (where available) and local Department of Public Health Nominate a senior manager to co-ordinate all actions and communication in the event of a suspected or actual outbreak to Public Health

7 The Aide Memoir

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9 Requirements for prevention (1) Resident Vaccination Has flu vaccine been offered to all residents throughout the flu season i.e. from September to the end of April? Ideal time for flu vaccination is Sept/Oct. If residents are not vaccinated at this time, the vaccine can be given until the end of April. In Disability Services vaccination is strongly recommended for children with any condition that can compromise respiratory function especially those attending special schools and day centres.

10 Requirements for prevention (2) Resident Vaccination Respites& Admissions Is advice re flu vaccination provided to respite admissions from September to the end of April? Ideally flu vaccination should be given 2 weeks prior to admission Are all new /respite residents vaccinated, ideally 2 weeks prior to admission? If not vaccinated, is vaccine offered as soon as possible after admission?

11 Planned Respite Care Application form for Respite Care in Cork Community Hospitals To protect long term care residents and prevent outbreaks

12 Nursing Transfer Letter

13 Nursing Care Plan

14 Involving Residents & Families Used in St Finbarrs Hospital and other locations Letter sent in Sept Requesting not to visit units if they have flu like illness in the preceding 2 days Asking cooperation with visiting restrictions where a unit is experiencing symptoms of flu Encourage to use the hand hygiene facilities Advised re respiratory hygiene & cough etiquette

15 Requirements for prevention (3) Staff Vaccination Was flu vaccination promoted amongst staff at the start of the flu season? Records Is a record of staff vaccination available? Is a record of resident seasonal flu vaccination available? Is a record of resident pneumococcal vaccination available? Where?

16 Sample Resident Records

17 Sample Staff Records

18 Requirements for prevention (4) Supplies Is there a supply of 2 viral swabs available to take a throat swab in the event of an outbreak on the advice of Department of Public Health? List of sites where swabs are is held by DPH, if used will be replaced by post Discard pack from 2017/2018 Season Is there ready quick access to antiviral medication (Tamiflu) through the normal channels/pharmacy provider if needed in the event of an outbreak? Are sufficient supplies of surgical face masks (with ties) and eye protection of the correct standard available?

19 MASK FACE TYPE II DISPOSABLE FACE MASK TIE ON MASK SURGICAL TYPE IIR DISPOSABLE FLUID RESISTANT/ANTI-FOG WITH VISOR

20 Requirements for prevention (5) Surveillance Monitoring Is staff absenteeism monitored for influenza like illness (ILI) and for unusual patterns i.e. more than expected staff absent 3 or more cases of ILI in a 72 hour period

21 Managing an Outbreak of Influenza Key Infection Prevention and Control Measures Patricia Coughlan, Cork & Kerry Disability Services

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23 Case Definition of Influenza Like Illness (ILI) Sudden onset of symptoms And At least one of the following four systemic symptoms: Fever or feverishness Malaise Headache Myalgia (muscle pains) And At least one of the following three respiratory symptoms: Cough Sore throat Shortness of breath

24 Influenza in the Elderly In older adults, symptoms may initially be very subtle and difficult to recognise. Elderly residents may present only with cough, fatigue and confusion. fever response may be more blunted. Influenza may present in the elderly patient as an exacerbation of an underlying condition If an increased number of residents become unwell over a short period of time with respiratory illness, influenza should be suspected.

25 Definition of Influenza/Influenza like illness (ILI) Outbreak Three or more cases (amongst residents and/or staff) of influenza like illness (ILI) or influenza or respiratory illness within the same 72 hour period in the RCF, which meet the same clinical case definition and where an epidemiological link can be established.

26 Detection of Influenza outbreak (1-4) Inform the local medical team/attending GP for an appropriate diagnosis to be made If cases are confirmed the GP confirming the suspected outbreak notifies the Department of Public Health at / Department of Public Health will undertake a risk assessment and establish an outbreak control team if deemed appropriate advise on appropriate clinical specimens to be taken Decide re antiviral treatment and chemoprophylaxis

27 Viral Swabs Pre-addressed postage box to the National Virus Reference Lab 2 Viral swabs Instructions for Throat Swab to test for Influenza NVRL Request form with Respiratory Viral Suite Results sent to Dept Public Health

28 Instructions for Taking a Viral Throat Swab Clean hands, clean gloves Rub the swab over the tonsillarfossa or any area with visible exudate Avoid touching the tongue or mouth with the swab Carefully place the swab into the bottle and snap off the excess stick, secure the green cap on the bottle Remove gloves, clean hands Complete the form and add details to swab bottle name, DOB, clinical details, date & time swab was taken. If postage is delayed store in a cool dry place, ideally in a fridge at 4 C

29 Detection of Influenza outbreak (1-4) Inform your Infection Prevention & Control Nurse where available Agree a communication strategy Nominate a person to act as liaison with the Dept of Public Health and the Infection Prevention & Control Nurse

30 Detection of Influenza outbreak (5-6) In addition to Standard Precautions, implement Droplet Precautions as advised See Section 3 and Section 6 of the Infection Prevention and Control Guidelines, HSE South, Refer to Checklist for Residential Care Facilities on the Prevention, Detection and Control of Influenza-like Illness and Influenza Outbreaks, 2018/2019

31 If possible cases of influenza are identified: Make a list of residents and staff with symptoms (use a template): Name/DOB Date of first symptoms (onset) Symptoms - fever, cough, fatigue Vaccination status Consider Layout of the facility (location of cases) and possible links between affected residents Timeline 3 affected within 72 hours If there is more than one GP attending the facility, ensure all are aware of other potential affected residents/staff.

32 Accurate information is essential as this will guide Public Health response

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34 Under Resources Influenza Button

35 Infection Control Measures (1) In addition to Standard Precautions, implement Droplet Precautions immediately for symptomatic cases in healthcare settings do not wait for laboratory results Patient Placement in RCF Place patient in a single room or cohort with similar patients Maintain a distance 1 metre between infectious patient and others Wear surgical masks within 1 metre of care Limit patient movement

36 Infection Prevention and Control Precautions Standard Precautions Hand Hygiene Respiratory Hygiene and Cough Etiquette Patient Placement Protective Clothing Cleaning of the Environment Care of Client Care Equipment Care with Laundry Dealing with spills of body fluids safely Care and disposal of sharps Dealing with needle stick injury or blood or body fluid exposures Staff Health, hygiene and staff immunisations Healthcare risk waste PLUS -Droplet Precautions Additional Protective Clothing Patient Placement Cleaning of the Environment Care of Client Care Equipment

37 PPE for routine care for suspected or confirmed influenza case. 1. Surgical mask. 2. Wear gloves/apron/gown/goggles if risk of contact with blood, body fluids, mucous membranes or non-intact skin anticipated as per Standard Precautions PPE for an aerosol generating procedure (AGP) and if remaining in or entering the patient s room within one hour after cessation of the AGP: 1. FFP2 or FFP3 respirator (correctly fitted), goggles, long sleeved disposable gown, gloves. 2. AGP intubation, tracheostomy insertion, ventilation Nebulisation is no longer considered an AGP but patients receiving nebulisation should be placed in a single room.

38 Sequence* for Donning PPE 1. Gown / Apron first 2. Mask 3. Goggles or face shield (if required) 4. Gloves *Combination of PPE will affect sequence be practical

39 How to Don a Mask Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit INFO RE PPE ON CONTRACT

40 Sequence for Removing PPE Remove Gloves first and perform hand hygiene Face shield or goggles (if required) Gown Remember the outside aspect of PPE is considered Mask contaminated

41 Removing a Mask Untie the bottom, then top, tie Remove from face Discard Hand Hygiene

42 Infection Control Measures (2) Management of admissions/transfers during an outbreak Transfers to acute facility -inform the ambulance/admitting facility/infection control team in advance of the outbreak admission of new residents to RCF not generally recommended Non urgent transfers to another facility generally not recommended.

43 Includes 1. Transfer of Resident diagnosed with ILI from Acute services back to a RCF criteria to be met outlined 2. Transfer of resident hospitalised for reasons not related to ILI to a RCF experiencing an outbreak based on assessment of risk of exposure 3. Transfer of patient with close contacting to case(s) of influenza to a RCF criteria to be met outlined 4. Duration of Precautions for RCF residents with respiratory viral infections risk factor for prolonged shedding outlined

44 Infection Control Measures (2) Additional measures within the facility Restrict movement between affected and unaffected areas Consider rescheduling non urgent appointments Limit visitors as much as possible Excluded symptomatic visitors & all children Essential Visitors Instruct to use hand hygiene facilities Visit one resident only and exit immediately after visiting Appropriate signage

45 Link with Section 18 Admissions, Transfers & Discharges

46 Respiratory Hygiene & Cough Etiquette CHECK NEW POSTERS What is it? Element of Standard Precautions (2007) Advising Control of respiratory secretions Hand hygiene after contact with respiratory secretions Spatial separation >3 ftof persons with respiratory infection Visual cue to remind people Should be in place at all time Emphasise during influenza season Signage, provide facilities Consider visitors, residents

47 Infection Control Measures (3) Environmental cleaning and disinfection Clean with detergent and water Disinfect with 1,000ppm available chlorine Or Combined cleaner & disinfectant Rinse and dry Emphasis on frequently touched surfaces and surfaces in close proximity to the affected residents Dedicate care equipment or clean and disinfect between affected residents

48 Infection Control Measures (4) In relation to staff recommended that Staff/volunteer absenteeism is monitor All staff aware of action to take if ill Ill staff should stay away from work for at least 5 days and until they are well enough to return written policy in place Limit staff movement especially if areas are unaffected within the facility Vaccinated staff to work in affected area Asymptomatic unvaccinated staff should wait one incubation period (3 days) prior to working in a non-outbreak facility. Asymptomatic vaccinated staff have no restrictions working at other facilities

49 Infection Control Measures (5) On-going surveillance of ill pts/staff & maintain line list On-going communication with Dept Public Health, Infection Prevention Control Nurse Appropriate signage for visitors Duration of precautions 7 days following symptom onset or longer as advised Precautions required whilst people are symptomatic Advise should be sought regarding those who residents with risk factors An influenza outbreak is declared over eight days after the onset of symptoms in the last new case

50 Key Messages Vaccination of healthcare staff, patients, residents and visitors remains the cornerstone of flu prevention strategies Be prepared Record of staff and resident flu vaccination Record of pneumococcal vaccine Supplies of the correct standard available PPE, swabs, Know who to contact Dept. Public Health, Infection Prevention & Control Know how to access antiviral drugs Continuous surveillance for ILI amongst residents and staff PREPARATION IS KEY BE WINTER READY!

51 Web resources Health Protection Surveillance Centre Advice on Aerosol Generating Procedures. oncontroladvice/file,3625,en.pdf Cork Kerry Community Healthcare Guidelines & Resources eing/infectcont/sth/resources/influenza.html