Influenza Resource pack

Developed by Public Health England, North West, Cheshire and Merseyside

1

Contents1. Purpose of this Resource Pack..........................................................................................................2

2

2. Key Contact Details...........................................................................................................................23. Key resources included in this pack.................................................................................................34. Key Messages....................................................................................................................................35. Key Facts about Influenza.................................................................................................................4

What is Influenza?.............................................................................................................................4What is Influenza like illness/Acute Respiratory Infection?..............................................................4Who is affected by Influenza?............................................................................................................5Why is influenza an important issue for care homes?.......................................................................5

6. Preventing Flu: Vaccination for residents and Staff.........................................................................6The Flu vaccine.................................................................................................................................6

3

Eligible groups..................................................................................................................................6Effectiveness.....................................................................................................................................6Myth busting.....................................................................................................................................7The importance of vaccinating residents..........................................................................................8The importance of vaccinating staff members..................................................................................8

7. A Single suspected Case of Flu: Actions Required...........................................................................9Suspected case in a Resident:.........................................................................................................10A flowchart showing actions to take if a single case of flu is suspected.........................................10Suspected Case in Member of Staff................................................................................................11

8. Flu Outbreaks..................................................................................................................................11

4

When to suspect an outbreak..........................................................................................................11Actions to take when an influenza outbreak is suspected..............................................................13Infection Prevention and Control during an outbreak....................................................................14

Hand Hygiene..............................................................................................................................14Cough Etiquette...........................................................................................................................14Personal Protective Equipment...................................................................................................15Isolation.......................................................................................................................................15Environmental cleaning...............................................................................................................15Staff Management.......................................................................................................................16

Movement of residents in and out of the care home.......................................................................16

5

ROLES AND RESPONSIBILITIES/ACTION CARDS........................................................................17Appendix..............................................................................................................................................19

i. PRE-INFLUENZA SEASON CHECKLIST.........................................................................................ii. Information to be completed by team members from each Home:.................................................iii. LIST OF RESIDENTS (To be prepared at the beginning of the flu season and updated as needed):...............................................................................................................................................iv. LIST OF RESIDENTS WITH SUSPECTED/CONFIRMED INFLUENZA INFECTION.....................v. How to Handwash...........................................................................................................................vi. The Five Moments of Hand Hygiene..............................................................................................vii. Catch it, Bin it, Kill it campaign....................................................................................................

6

viii. Further information on flu............................................................................................................

1. Purpose of this Resource Pack

Many care homes will have experienced cases and outbreaks of influenza, and will be aware of the potentially serious and life-threatening implications for vulnerable residents. In addition, measures such as resident isolation and closing

7

the care home to new admissions may stretch the resources of care homes and will present practical challenges to ensure the necessary infection prevention measures are taken. Outbreaks can be difficult and complicated to manage. It is important that care homes are aware of what to do when a case or outbreak is suspected, and who to turn to, to obtain adequate advice and support.

This document will provide you with all you need to know to protect residents and staff against influenza. It contains some basic information on the influenza virus, and provides guidance on what to do when there is a suspected case or outbreak of influenza in the care home.

8

The principles outlined in this resource pack also apply to other Acute Respiratory Infections or influenza-like illnesses.

2. Key Contact Details

Community Infection Control Nurse

Monday – Friday (0900- 1700)Contact Number

Liverpool 0151 295 3036Knowsley 01925 664851

9

Warrington, Halton & St Helens 01744 457 314/ 01744 457312 (new contact number)

Central & East Cheshire 01889 571 837West Cheshire (08:00 – 18:00 Mon-

Fri)01244 397 700

Wirral 0151 604 7750

Public Health England North West ;Cheshire and Merseyside Health Protection Team

Monday – Friday (0900 – 0344 225 0562 – Option 1

10

1700)Out of Hours Contact ‘Public Health England first on call’ via:

The Contact People – 0151 434 4819

Useful NumbersCare home to fill details of local

pharmacyUsual Pharmacy used by home

11

3. Key resources included in this pack Seasonal influenza planning check list for care homes – appendix i Template for list of residents in home including the result for kidney

function (e GFR) – appendix iii Template for daily log of new cases during an outbreak – appendix iv How to handwash (World Health Organisation) – appendix v

12

When to handwash: The five moments of hand hygiene (World Health Organisation) – appendix vi

Poster: Catch it bin it kill it (NHS England) – appendix vii Poster: Information for visitors and residents

13

4. Key Messages

Flu is not just a bad cold; it can be a serious illness in certain groups of people, including those aged sixty-five and over

14

The Flu vaccine is the best way to protect people against flu: eligible residents and staff must be offered the seasonal flu vaccine each year.

Good infection control practice is essential to limit the spread of flu, particularly once a case occurs in a care home. Good practice includes excellent hand hygiene, preferably with soap and water, before and after resident contact and after contact with their surroundings, and enhanced cleaning using general purpose detergent and hot water on frequently touched surfaces.

15

Residents who are ill with symptoms of flu must be reviewed by their GP

Staff who are ill with symptoms of flu should stay off work until they are symptom-free, or for at least five days after the appearance of symptoms

Suspected outbreaks of flu or flu-like illness must be notified to the local Community Infection Control Team in hours, or the Public Health

16

England, North West, Cheshire and Merseyside Health Protection team out of hours (see key contact details)

5. Key Facts about Influenza

What is Influenza?The flu (short for influenza) is a viral infection of the respiratory system (mouth, nose, airways, and lungs). It occurs mostly in the winter, which is why it is sometimes called ‘seasonal flu’. It is passed from person to person directly through coughs and sneezes (droplet spread), through contact, e.g. kissing or

17

shaking hands and also when a person gets the virus on their hands after touching surfaces or objects contaminated with the virus.

Signs and symptoms of influenza illness:

Myalgia (muscle pain)

Malaise/LethargyRunny Nose

CoughSore Throat

FeverHeadache

18

For most healthy people influenza infection causes fever, headache, sore throat, joint pain and fatigue, with recovery time ranging from two to seven days. However, for some, especially older people, pregnant women, and people with underlying health conditions, it can cause serious, even life-threatening complications and death. Please refer to the table on the next page for a complete list of ‘at risk groups’ for influenza infection.

There are three types of influenza virus that cause Flu - A, B and C, and different types of strains within these groups. .You may have heard of influenza branded with names such as ‘H3N2’, or H1N1. This term refers to the different strains of

19

influenza A virus. Each winter different strains of influenza virus circulate, with one or two strains usually dominating.

What is Influenza like illness/Acute Respiratory Infection?Influenza-like illnesses (ILI), also known as an Acute Respiratory Infection (ARI), describes illnesses that look like flu but can be caused by a variety of infections including influenza, respiratory syncytial virus or parainfluenza virus. ILI/ARI is passed from person to person, so the infection control recommendations outlined in this resource pack apply to all cases and outbreaks of influenza-like illnesses.

20

Who is affected by Influenza?Everybody can be affected by the influenza virus. There are some people who, if infected with influenza, are at a higher risk of serious complications than individuals in the general population (see table below).

At Risk GroupsOlder people >65 years of ageIndividuals with underlying chronic health conditions

21

e.g. chronic lung disease, ischaemic heart disease, diabetes mellitus, obesity, liver disease, learning disability (for full list please see table 19.4 in ’The Green Book’, chapter 19*:Individuals with reduced immunitye.g. following chemotherapyPregnant womenChildren under 6 months of ageMorbid obesity (class III obesity)*

*https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/456568/2904394_Green_Book_Chapter_19_v10_0.pdf)

22

Influenza outbreaks can have severe impact on care homes residents because:

Care home residents are likely to be more vulnerable to flu due to their age or underlying medical conditions.

Elderly residents are more likely to die from flu or suffer with severe symptoms or complications of flu, and therefore are more likely to require hospitalisation.

23

Care homes residents and staff are likely to spend a lot of time together; therefore flu can spread rapidly in care homes, particularly if stringent infection control measures are not implemented.

Impact on care homes and services in general:

Larger resources required to implement infection control recommendations,

The potential for having to close to new admissions and the impact of this on other health care facilities.

24

The potential impact on reputation, particularly where there are severe cases or deaths and any concerns over whether or not duty of care was met by the care home management and staff.

Why is influenza an important issue for care homes?The 2014/15 flu season saw particularly high numbers of outbreaks of flu and flu-like Illness in care homes throughout the country. A total of fifty-five care homes reported outbreaks in the North West and thirty-four of those in homes were within the Cheshire and Merseyside area.

25

Further information on flu can be found at: http://www.nhs.uk/conditions/Flu/Pages/Introduction.aspx

http://patient.info/health/influenza-and-flu-like-illnesshttps://www.gov.uk/government/collections/seasonal-influenza-guidance-data-

and-analysis

26

6. Preventing Flu: Vaccination for residents and Staff

The Flu vaccine Flu vaccine is the most effective way to prevent influenza and its complications.

Each year, the World Health Organisation monitors the epidemiology of influenza across the world and makes recommendations on which virus strains to include in vaccines for the forthcoming season.

There are two main types of vaccine available: an inactivated one which is given by injection and a live one which is given by nasal application. All eligible adults

27

age 18 years and over are offered the inactivated vaccine which is usually injected into the deltoid muscle of the arm.

Most inactivated flu vaccines contain two subtypes of Influenza A and one type B virus, this is known as a trivalent vaccine, but there is also a quadrivalent vaccine available which contains two subtypes of Influenza A and both B virus types.

It can take around two weeks following vaccination for a protective immune response to be achieved so the ideal time to vaccinate would be between September and early November.

28

Eligible groups

For the 2017/18 flu season, the following people are eligible for flu vaccination:

age 65 years and over age 6 months or older in clinical risk groups (see table on previous page) pregnant women Children aged 2,3 and 4 and those in reception and years 1, 2, 3 & 4 those in long-stay residential homes carers and household contacts of immunocompromised individuals

29

health and social care workers who are in direct contact with patients or service users (vaccination should be offered by employer)

EffectivenessRecent estimates suggest that influenza vaccine has an overall effectiveness against confirmed disease of 59% in adults aged 18 – 65 years. Protection may be lower in those aged 65 years and over, however, immunisation has been shown to reduce the risk of bronchopneumonia, hospital admissions and mortality.

30

Myth busting

Myth 1: The flu vaccine can give you influenza

31

None of the influenza vaccines can cause clinical influenza in those that are vaccinated. This is because the vaccine used for adults does not contain any live virus; it contains killed virus only.

Myth 2: The flu vaccine has bad side effectsMost people have no side effects at all - some complain of pain and a small swelling at the injection site, and a fever. Any other side effects are mild.

32

Myth 3: I had the vaccine last year; I don’t need it again this yearThe flu vaccine does not give lifelong protection against flu. Each year the circulating flu virus changes so the components of the vaccine will be different from last year.

Myth 4: Flu is only a mild illness – why do I need to get vaccinated?In healthy individuals it is true that influenza may only cause mild symptoms. However if you are in a high risk group, the consequences of influenza infection

33

are much more severe. The influenza vaccine has been shown to reduce severity of disease in high risk groups. For healthy individuals offered the vaccine for other reasons (e.g. individual is in a caring role or is a contact of an immunocompromised individual), the main purpose of the vaccination is to protect the transmission of the virus to vulnerable individuals, and to reduce the numbers of days that healthy carers are incapacitated by the virus.

Myth 5: I had the vaccine last year and I still contracted influenza – it must not work.

34

The main reasons for experiencing flu-like symptoms following influenza vaccine are;

There are other viruses and bacteria that cause influenza-like illness and may mimic influenza. The influenza vaccine does not protect against ILI not caused by influenza.

It takes up to two weeks after influenza vaccination to form an adequate immune response. If you are exposed to the influenza virus within two weeks of being vaccinated, you may still be infected. This can be avoided by timely vaccination before the start of the flu season

It is possible that a mismatch between circulating flu virus and the

35

vaccine strain can lead the vaccine to be less effective. Mismatch, however, is uncommon.

Vaccines are not 100% effective, and do not guarantee immunity to individual cases, especially in older individuals (see ‘vaccine effectiveness’ in previous section.

The importance of vaccinating residents The aim of vaccination is to protect this vulnerable group who are at risk

of serious illness or death should they develop influenza

36

It is less likely that there will be an outbreak in a care home where everyone is vaccinated and this will also contribute to the protection of vulnerable patients who may have a suboptimal response to their own vaccination

The importance of vaccinating staff members• Frontline health and social care workers have a duty of care to protect

their patients and service users from infection. This is echoed in the General Medical Council’s ‘Good Medical Practice’ (2013) document, who

37

advises immunisation ‘against common serious communicable disease, unless otherwise contraindicated,’ to protect both patients and colleagues.

• In addition to protection of patients and colleagues, the vaccine offers protection against transmission of the flu virus to friends and family members.

• Vaccination of frontline workers also helps reduce the level of sickness absences and can help ensure that the NHS and care services are able to continue operating over the winter period.

• Staff members should be offered the influenza vaccine by their employer and should have the vaccine as soon as possible. (This will ensure that they

38

are protected from flu and that they do not transmit the virus to those they care for at work or to their family)

Access to the vaccineResidents: GP/Pharmacist

Health and social care workers with risk factors:

GP/Pharmacist

Health and social care workers without risk factors:

Employer/Occupational Health

39

40

7. A Single suspected Case of Flu: Actions Required

When to suspect flu/ILI

41

oral (mouth)temperature of 37.8° or more

PLUS any of the following:

• new onset or acute worsening of one or more respiratory symptoms• cough (with or without sputum) hoarseness nasal discharge or congestion

42

shortness of breath• sore throat• wheezing• sneezing• chest pain

OR

(in older people) an acute deterioration in physical or mental ability without other known cause

43

NOTE:• In older people, flu can often present without a fever.• Flu can sometimes cause a milder illness than expected: the severity

can depend on the type of flu strain causing the illness and whether or not the infected person has been vaccinated. A milder infection can also be experienced if a person has already been infected with a similar strain of the influenza virus.

• People with chest infections can have flu at the same time as the chest infection: ‘co-infection’ is not uncommon during the flu season,

44

especially in high-risk groups

Key message: If you suspect flu or an influenza-like illness, ask for a clinical review by a doctor.

45

Suspected case in a Resident:

A flowchart showing actions to take if a single case of flu is suspected

Resident displaying Signs/Symptoms of ARI/ILI/Influenza

Protect Case

GP assessment of case

+/ - investigations (sputum sample/nose&throat

swab)

Supportive management

rest, keep warm, plenty of fluids

Treatment, e.g antivirals

as deemed appropriate by GP

Protect Other Residents

Isolate ill resident

Stringnent infection control measures

hand hygiene,Respiratory hygiene,

PPE for Staff Environmental cleaning

(see 'infection control' in section 8 for further information on infection

control procedures)

46

47

Suspected Case in Member of StaffSymptomatic staff should be excluded from the home until fully recovered and at least five days after the onset of their symptoms.

48

8. Flu Outbreaks

When to suspect an outbreak

49

50

Public Health England Guidance defines an outbreak as two or more cases arising within the same forty-eight hour period, or three or more cases arising within the seventy-two hour period, where there is a link, (for example, all cases are in the same unit/area of the care home).

51

If the residents in your home fulfil all three of the above criteria, you may have an outbreak of influenza-like illness in your home. A fast response is essential to contain the infection and to limit the spread of the virus. We advise immediate adherence to the steps outlined in the next section (overleaf).

52

Actions to take when an influenza outbreak is suspected

53

54

Infection Prevention and Control during an outbreak

The meticulous use of infection control procedures such as isolation and cohort nursing are fundamental in limiting the transmission of the virus. Local risk assessments for required levels of infection control should be performed.

Care Home to Contact

GP

General Practitioner (GP) must assess each symptomatic resident and advise on immediate managementGP to Liaise with local Health Protection Team to assist with risk assessment during a potential outbreak of influenza

Care Home to Contact

ICN (during office

Hours)

Report suspected outbreak to the Community Infection Control Nurse (CICN)CICN will assess the situation and liaise with GP/local Health Protrction Team CICN will advise on infection control measuresCICN will assist with sample collection and processing (on advice of Local Health Protection Team)CICN will maintain contact with the home until outbreak is declared over

Care Home to Contact Local HPT (out of hours)

Local Health Protection Team should be contacted if case is suspected out of hoursLocal Health Protection Team will liaise with GP/CICN to assess the likelyhood of influenza infectionIf an outbreak is declared, an outbreak control team may be set up by Local Health Protection TeamLocal Health Protection Team will liaise with CICN to ensure appropriate infection control measures are in place, and advise on further investigations required, e.g. swabs etc.If the outbreak is determined likely to be caused by Influenz virus, Local Health Protection Team will trigger the use of antivirals for treatment/prophylaxis as appropriate

Care Home to

Document

Ensure checklist (see appendix i) is completed, including list of residents (see appendix iii)Ensure list of residents with suspected ARI/ILI (see appendix) are kept up-to-dateCopies of updated list are shared with CICN/Local Health Authority as required

Care Home to

Implement Advice

Care Home should ensure advice of GP/CICN/Local Health Protection Team is implementedEnsure prescribed medications (including antivirals) are given in a timely manner

55

Stringent attention to hand and respiratory hygiene should also be observed.

A visual sign at the entrance to the home is a useful way of raising awareness of the situation and provides opportunity to offer advice to residents and visitors on the signs and symptoms of influenza, encouraging good hand hygiene and cough etiquette and to discourage those who are ill from visiting the home. Please see appendix for example of signs you may wish to display in the event of an outbreak.

You will find below a summary of the infection control procedures required in the event of an outbreak. It is good practice to reasonably adhere to these guidelines

56

even when an outbreak is not suspected. Your Community Infection Control Team will remain a vital support and will act as a catalyst for communications and actions supported by Public Health England, your local authority, and your Clinical Commissioning Group.

Hand Hygiene Thorough hand washing using the hand washing method as shown in the

appendix Wash hands using soap and warm water, or if not possible, disinfect with

70% alcohol hand rub

57

Placing hand rub dispensers at the residents’ bedsides for use by visitors and staff should be considered if safe to do so (it is advisable to carry out a risk assessment before introducing alcohol gels into the workplace)

Hands must be disinfected before and after contact with residents, see five moments of hand hygiene in appendix for more information

Cough EtiquetteWhen an outbreak of influenza is being considered, respiratory hygiene/cough etiquette is essential and must be implemented

58

Using supportive materials such as the ‘catch it bin it kill it’ poster displayed in the appendix will encourage residents and visitors to practice good cough etiquette

Ensure provisions are available for all residents and visitors (including communal areas) to implement the correct cough etiquette

Provide adequate supply of tissues in resident rooms and communal areas

Provide adequate supply of alcohol-based hand rubs in rooms and communal areas

Provide no-touch receptacles for used tissue disposal

59

Encourage symptomatic individuals to sit at least 3 feet away from others if possible, to prevent airborne transmission of the virus

Discourage residents who are symptomatic to use communal areas if possible

Personal Protective Equipment Staff should use single-use plastic aprons and gloves when dealing with

patients (Note: wearing gloves does not obviate the need for hand hygiene) Surgical masks:

60

Masks should be worn by care staff attending to the personal care needs of affected residents, or if working within three feet of an affected person. This is particularly important during nebuliser administration.

Masks should be removed be removed on leaving the residents room and disposed of as clinical waste

Masks can be obtained from your usual PPE suppliers All staff should perform hand washing immediately after de-masking, as

per standard infection control precautions

61

Isolation If possible, symptomatic residents should be cared for in single rooms until

fully recovered and at least five days after the onset of symptoms This is particularly important for symptomatic residents who are at

higher risk of shedding the virus for long periods of time, such as those with other major medical conditions, or who have a weakened immune system: such residents should be prioritised for isolation

If isolation is not possible, then cohort suspected flu residents with other residents suspected of having flu.

62

At the very least, symptomatic residents should be cared for in areas well away from asymptomatic residents (e.g. by separating residents on separate floors, or in separate wings of the residence)

Environmental cleaningCare homes should have in place a Decontamination Policy and Cleaning Schedule.

Colour coding of cleaning equipment (cloths, mops, gloves etc.) is advised to prevent cross contamination

63

Increased frequency of cleaning with a minimal daily cleaning of horizontal surfaces (e.g. lockers, window ledges, shared equipment) in all areas

Attention should be paid to cleaning of hand contact surfaces (e.g. door handles, handrails and wheelchair arms), ensuring regular cleaning with detergent and hot water followed by 1000 ppm of available chlorine or disinfectant

Resident’s clothes, linen and soft furnishings should be thoroughly washed on a regular basis, all rooms kept clean, including TV remote controls, handles and light switches. More frequent cleaning of surfaces such as lockers, tables & chairs, televisions and floors is required, especially those located within 3 feet of asymptomatic patients.

64

Hoists, lifting aids, baths and showers should also be thoroughly cleaned between residents.

Staff Management Symptomatic staff and visitors should be excluded from the home until fully

recovered and at least five days after the onset of their symptoms If possible, staff who work with symptomatic residents should not work

with asymptomatic residents. This arrangement should be continued for the duration of the outbreak.

65

Agency and temporary staff who are exposed to symptomatic residents during the outbreak should be advised not to work elsewhere (e.g. in a local acute care hospital). They must report the exposure to their employer/occupational health department.

Uniforms should be laundered at place of work if possible, and should not be worn when travelling between home and place of work. Uniforms should be washed separately from other items

66

Visitors Symptomatic visitors should be excluded from the home until fully

recovered and at least five days after the onset of their symptoms Children and adults vulnerable to infection should be discouraged from

visiting during an outbreak Visitor access to symptomatic resident should be kept to a minimum where

possible Visitors should follow the cough etiquette and respiratory hygiene

recommendations as outlined above

67

Movement of residents in and out of the care home The care home may need to close wholly or in part to new admissions

- The local infection control team or your local Health Protection Team can advise on this

Transfer of residents to hospitals or other institutions should be avoided unless clinically necessary/ medical emergency and advised by GP

Re-arrange non-urgent hospital/clinic appointments if possible (following discussion with GP_

Inform the hospital in advance should a resident require admission to hospital during an outbreak

68

Inform visiting health professionals of outbreak and rearrange non-urgent visits to the home

Residents should not transfer to other homes or attend external activities A careful risk assessment is required for the care home accepting residents

discharged from hospital back to the care home whilst the outbreak is ongoing.

- The local infection control team or your local Health Protection Team can advise on this

69

Your local PHE Health Protection team will assess when the outbreak is over. This usually corresponds to approximately five days after the onset of the most recent case.

ROLES AND RESPONSIBILITIES/ACTION CARDSShown in the table below is a summary of roles and responsibilities of all parties involved during an influenza outbreak.

70

Care Home PRIOR TO OUTBREAK: Residents should be registered with a GP and an

appointment or home visit should be arranged for vaccination as soon as the surgery receives their vaccine stock (which is usually around September each year). This way they will be protected and have developed their immune response before the virus starts circulating in the community

Nominate an appropriate member of staff to act as an influenza outbreak co-ordinator

Familiarisation with Flu Resource Pack

71

Ensure resident details (including up to date eGFR/creatinine and immunisation status) form completed and kept up to date.

Ensure useful telephone numbers table (at the beginning of this resource pack) filled in as needed

Have system in place to allow rapid assessment of consent for patients with dementia (involving the GP, care home staff and family members) to weigh all the pros and cons of treatment/prophylaxis

During An Outbreak

72

If you suspect you might have an outbreak contact the Community Infection Control Team (during work hours)/ Health Protection Team (out of hours) immediately

Ensure GP review of ill residents Adhere to infection control principles as advised by

community infection control teams Work with ICNs to ensure acquisition of appropriate

patient samples Keep a log of new cases (see template) and share with

ICN/PHE as required.

73

All residents should be monitored daily for elevated temperatures and respiratory symptoms. Any resident displaying signs/symptoms of ILI/ARI should be reported and assessed by a GP as soon as possible.

Take necessary steps to ensure all prescribed antiviral medications are collected and given in a timely manner.

74

Public Health England

PRIOR TO OUTBREAK Ensure flu resource pack is complete, up-to-date, and is

delivered to all care homes in the area (via local authority)

Ensure availability of viral swabs/mechanism for transporting to lab is in place

During an Outbreak Undertake risk assessment in conjunction with

GP/community infection control teams. Declare outbreak of influenza where appropriate Set up an Outbreak Control Team if appropriate

75

Advice on sampling and control measures Trigger special measures regarding the use of antivirals

for treatment and/or prophylaxis where appropriate Declare the outbreak over

GP PRIOR TO OUTBREAK Provide patient information (e.g. immunisation status

and recent e GFR ) to care homes at start of influenza season to facilitate the filling in of the List of Residents

76

form, as outlined in the annexeDuring an Outbreak

Review your patients in the care home Advise tests and management for cases as appropriate Liaise with and support the local Public Health

England team to assess likelihood the outbreak being caused by Influenza

Prescribe antiviral treatment for residents with diagnosis of influenza

GP (or other provider as per local arrangements) to prescribe prophylactic antiviral therapy for residents of

77

care home, following risk assessment and recommendation by PHE

Community Infection Control Team

PRIOR TO OUTBREAK Ensure Flu Pack is distributed to care homes Support Infection control training within care homes

During Outbreak Visit home, obtain details on :number of cases, onset of

illness, symptoms, in order to make an appropriate risk

78

assessment Provide infection control advice to care home Facilitate the taking of respiratory swabs Liaise with PHE to provide a consistent response to

outbreaks of influenza

Your IPC team will remain a vital support and will act as a catalyst for communications and actions supported by Public Health England, your local authority and your Clinical Commissioning Group.

79

Appendix

i. PRE-INFLUENZA SEASON CHECKLIST

Task

Complete

(tick)

Date complet

edVaccination of all eligible residentsVaccination of all eligible staffAppointment of flu outbreak co-ordinator

80

Familiarisation with Flu Resource Pack (all staff)Familiarisation with up-to-date infection control procedures (all staff)Ensure sufficient supply of soap/alcohol hand rub and paper towels are available (in all communal areas) in case of an outbreak, where demand for hand washing equipment will be higher

81

Ensure sufficient supply of PPE are available in case of an outbreak, where demand for PPE equipment will be higherEnsure sufficient supply of detergent and cleaning supplies are available in case of an outbreak, where demand for cleaning supplies will be higherEnsure system is in place for appropriate linen management

82

Ensure system is in place for appropriate clinical waste management (including availability of foot-operated bins)Resident details (including up to date eGFR/creatinine and immunisation status) form completed, by flu outbreak co-ordinator if appropriateUseful telephone numbers table (at the beginning of this resource pack) filled in

83

as needed

We recommend full completion of the above tasks prior to the start of the influenza season. This will ensure a streamlined response in the event of an outbreak, and will help your care home manage an outbreak more effectively.

ii. Information to be completed by team members from each Home:In the event of an influenza outbreak, the tables on the next pages will help ensure that management of the outbreak runs as smoothly as possible. It ensures that salient information is recorded in the same place and will be easily accessible in the event of an influenza outbreak in the home.

Table 1) List of Residents The details asked for include a list of all the residents in the home, along with details of their GPs so they may be contacted if influenza is suspected in that patient. Most residents will be offered an influenza vaccine - it is important to know not only who has had the vaccine, but also how long ago they have had the vaccine. Please note that influenza vaccination in previous years does not have to be recorded. Finally, we ask that you complete the creatinine/eGFR section of the table to assist in the calculation of the correct doses of antiviral medication, if needed. The creatinine/eGFR is tested for on routine blood tests. The GP should be able to provide details of the most recent creatinine or eGFR level.

Table 2) List of Residents with Suspected/Confirmed Influenza InfectionThe last table is a list of patients with suspected or confirmed influenza infection. We ask you to use this form in the case of influenza/suspected influenza cases in your home. You may be asked to fax a copy of this list to PHE England in the event of a suspected/confirmed outbreak (fax No. 0151 708 8417). The information in table 2 will be used by Public Health England to monitor local spread of the influenza infection.

We thank you for taking the time to compete the tables below.

Name of Home

Type of Home Residential/Nursing/Other (please state)

Manager

Person completing list of residents

(overleaf)Date of completion

of listDate list updated

iii. LIST OF RESIDENTS (To be prepared at the beginning of the flu season and updated as needed):

Room Number

Name of Resident

Date of

BirthSignificant Medical

conditions GPInfluenza Vaccine(Y/N and

date)

Kidney Function if known to have Renal impairment (eGFR/Creatinine clearance)

Date of last

blood test

Name

Address

Tel No.

Name

Address

Tel No.

Name

Address

Tel No.

Name

Address

Tel No.

Room Number

Name of Resident

Date of

BirthSignificant Medical

conditions GPInfluenza Vaccine(Y/N and

date)

Kidney Function if known to have

Renal impairment (eGFR/

Creatinine clearance)

Date of last

blood test

Name

Address

Tel No.

Name

Address

Tel No.

Name

Address

Tel No.

Name

Address

Tel No.

iv. LIST OF RESIDENTS WITH SUSPECTED/CONFIRMED INFLUENZA INFECTION

LIST OF RESIDENTS WITH SUSPECTED/CONFIRMED INFLUENZA INFECTION

Room Onset of sympto eGF

v. How to Handwash

vi. The Five Moments of Hand Hygiene

vii. Catch it, Bin it, Kill it campaign

ix. Further information on flu

NHS patient information on influenza:http://www.nhs.uk/conditions/Flu/Pages/Introduction.aspx

Information on influenza & influenza-like illness:http://patient.info/health/influenza-and-flu-like-illness

Public Health England ‘Green book’ on vaccination and infectious disease – chapter 19 (influenza):https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/456568/2904394_Green_Book_Chapter_19_v10_0.pdf

Public Health England Health Protection: detailed advice on influenza/ILI in care homes:https://www.gov.uk/government/publications/acute-respiratory-disease-managing-outbreaks-in-care-homes

Public Health England, pandemic flu overview:https://www.gov.uk/guidance/pandemic-flu

NOTICE

We are presently experiencing an outbreak of influenza like symptoms within the care home. After seeking specialist advice, it is recommended that visitors should refrain from entering at present unless absolutely necessary.

In particular, we would advise that children, pregnant women and those particularly vulnerable to infection do not visit at the present time.

If you would like further information regarding this issue then please contact the home by telephone.

As soon as this problem is deemed to be over, visiting will return to normal.

MANAGEMENT AND STAFF APPRECIATE YOUR HELP IN THIS MATTER

Signed __________________________

Date ___________________________