Developed by Public Health England, North West, Cheshire and Merseyside
Contents
1. Purpose of this Resource Pack 2
2. Key Contact Details 2
3. Key resources included in this pack 3
4. Key Messages 3
5. Key Facts about Influenza 4
What is Influenza? 4
What is Influenza like illness/Acute Respiratory Infection? 4
Who is affected by Influenza? 5
Why is influenza an important issue for care homes? 5
6. Preventing Flu: Vaccination for residents and Staff 6
The Flu vaccine 6
Eligible groups 6
Effectiveness 6
Myth busting 7
The importance of vaccinating residents 8
The importance of vaccinating staff members 8
7. A Single suspected Case of Flu: Actions Required 9
Suspected case in a Resident: 10
A flowchart showing actions to take if a single case of flu is suspected 10
Suspected Case in Member of Staff 11
8. Flu Outbreaks 11
When to suspect an outbreak 11
Actions to take when an influenza outbreak is suspected 13
Infection Prevention and Control during an outbreak 14
Hand Hygiene 14
Cough Etiquette 14
Personal Protective Equipment 15
Isolation 15
Environmental cleaning 15
Staff Management 16
Movement of residents in and out of the care home 16
ROLES AND RESPONSIBILITIES/ACTION CARDS 17
Appendix 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
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 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.
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 NurseMonday – Friday (0900- 1700) / Contact Number
Liverpool / 0151 295 3036
Knowsley / 01925 664851
Warrington, Halton & St Helens / 01744 457 314/ 01744 457312 (new contact number)
Central & East Cheshire / 01889 571 837
West 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 – 1700) / 0344 225 0562 – Option 1
Out of Hours Contact / ‘Public Health England first on call’ via:
The Contact People – 0151 434 4819
Useful Numbers
Care home to fill details of local pharmacy
Usual Pharmacy used by home
3. Key resources included in this pack
ü Seasonal influenza planning check list for care homes – appendix i
ü Template for list of residents in home including the result for kidney function (e GFR) – appendix iii
ü Template for daily log of new cases during an outbreak – appendix iv
ü How to handwash (World Health Organisation) – appendix v
ü When to handwash: The five moments of hand hygiene (World Health Organisation) – appendix vi
ü Poster: Catch it bin it kill it (NHS England) – appendix vii
ü Poster: Information for visitors and residents
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
· 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.
· 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 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 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:
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 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.
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 age
Individuals with underlying chronic health conditions
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 immunity
e.g. following chemotherapy
Pregnant women
Children under 6 months of age
Morbid obesity (class III obesity)*
*https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/456568/2904394_Green_Book_Chapter_19_v10_0.pdf)
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.
· 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.
· 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.
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-illness
https://www.gov.uk/government/collections/seasonal-influenza-guidance-data-and-analysis
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 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.
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
· health and social care workers who are in direct contact with patients or service users (vaccination should be offered by employer)
Effectiveness
Recent 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.
Myth busting
Myth 1: The flu vaccine can give you influenzaNone 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 effects
Most 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.
Myth 3: I had the vaccine last year; I don’t need it again this year
The 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 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.
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 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
· 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 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.