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Nursing Homes and the Flu

Guidelines for Preventing An Epidemic

By

Nursing Homes and the Flu
Photo © Andersen Ross, Getty Images

There is no worse place to introduce a flu epidemic than in a health care setting. And nursing homes and the flu could be a deadly combination. Here are things to keep in mind for preventing and/or containing the spread of flu in your facility.

Staff Vaccinations Not Mandatory
Flu vaccinations for health care workers are not mandatory and in fact one study suggests they have no effect. In a Canadian-led study Dr. Roger Thomas of the University of Calgary found no decrease in influenza (the flu); no decrease in incidences of or death from pneumonia. It should be noted that Dr. Jefferson, a British epidemiologist, has earned a reputation as a scientific dissident for his outspoken criticism of flu vaccination.

According to a New York Times article, federal health officials say that only about 42 percent of all health care workers get an annual flu shot. That is little better than the overall national average of 33 percent and far below the 65 to 70 percent rate for the elderly. In New York, the State Health Department took the radical step of having all hospital, home health and hospice workers get seasonal and swine flu vaccinations.

It is unclear whether the non-vaccination of staff contributes to an increase in flu cases by residents who have had flu shots.

Non-Pharmaceutical Intervention Could Aid Prevention Efforts
In an Arizona State University study, researchers offered a road map that could serve as a first line of defense for the pandemic flu in the absence of wide-spread availability of vaccines to contain it.

Five types of Non-Pharmaceutical Interventions (NPIs) were identified. They included:

  • screening visitors and staff who leave and then return to the facility
  • isolating symptomatic residents
  • placing restrictions on visitors
  • modifying work schedules
  • precautions taken by staff and visitors to reduce their risk of infection, like washing hands and using protective masks

"The biggest surprise in our study was identifying the critical role that staff plays in controlling the spread and preventing the introduction of disease in the facilities," said lead author Miriam Nuo. Chronic understaffing, lack of regular work hours and schedules for caregivers, as well as other basic benefits, like paid sick days contribute to not being able to control a flu outbreak effectively she contends.

Researchers concluded that multiple days on-site preceded by isolation for several days at home would not only contribute to care consistency at the facility but also would prevent the introduction of the flu by the healthcare workers themselves.

Stricken employees who are given time to recover at home (and are paid for it so they do not feel a financial need to rush back to work) become immune, become fully available for further service and no longer represent a threat for introducing the virus.

Centers for Disease Control and Prevention (CDC) Recommendations
Actually CDC recommendations mirror some of the recommendations in the ASU study above.

  • use of antiviral drugs for treatment to control outbreaks
  • establishing cohorts of patients with confirmed or suspected influenza
  • re-offering influenza vaccinations to unvaccinated staff and patients
  • restricting staff movement between wards or buildings
  • restricting contact between ill staff or visitors and patients.

The CDC recommends having preapproved orders from physicians or plans to obtain orders for antiviral medications on short notice as this can substantially expedite administration of antiviral medications should an outbreak occur.

Appropriate drug treatment should be administered to all eligible residents, regardless of whether they received influenza vaccinations during the previous fall, and should continue for a minimum of 2 weeks. Unvaccinated staff members who provide care to persons at high risk should also be considered for treatment.

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