Influenza-like illness (ILI) can be severe in a residential care facility due to the age and pre-existing health status of the residents, and person-to-person transmission. Vaccination (residents and staff) before the start of the season, which is typically May to October, is the best protection against influenza.
Management of residents with influenza-like symptoms
At this time of year influenza-like illnesses including respiratory syncytial virus (RSV) are common in the community and those illnesses can be easily spread in aged residential care facilities. Adults and older children get milder RSV illness but can pass it on to babies and older people who are more vulnerable to being adversely affected by RSV.
We strongly recommend that people maintain good hand hygiene, stay home if they have any symptoms of a respiratory tract illness.
Respiratory viruses cause the following symptoms: fever (temperature ≥38°C or feeling hot, sweaty, and chills), cough, sore throat, runny or stuffy nose, body aches, headache and fatigue/ tiredness, and sometimes diarrhoea and vomiting.
Controlling RSV at an Aged Residential Care facility
Usual infection control policies and procedures will help to control the spread of influenza-like illnesses and RSV in Aged Residential Care facilities.
Visitor policy
We would encourage facilities to do the following:
- restrict visitors who may have influenza-like symptoms from visiting
- restrict children 12 years old and under from visiting
- facilities may also want to consider limiting visitor numbers in general.
You may wish to use the following poster at your ARC facility:
Information on preventing the spread of influenza-like illness and RSV
- Cover coughs and sneezes with a tissue
- Regularly wash hands with soap and water for at least 20 seconds and dry them thoroughly
- Use an alcohol-based hand sanitiser if hand washing facilities are not available
- Avoid close contact with sick people
- People with underlying medical conditions who are at increased risk of complications are strongly encouraged to avoid contact with sick people and have good hand washing practices
- If correctly worn, masks are valuable to both prevent spread from infected people and reduce the risk of getting infected if you are close to people who may be infectious.
How to recognise an outbreak
It can be difficult to tell when there is an outbreak of ILI compared with the usual background rate of respiratory illnesses. The main symptoms are high temperatures, cough, muscle aches and headache. Elderly or immunocompromised people may have milder or less typical symptoms and may not have a high temperature.
An outbreak is the occurrence of: 3 staff or residents unwell with influenza like illness within 48 hours, or 4 staff or residents within 7 days in the same wing or area should be treated as an outbreak until proven otherwise.
Outbreaks are notifiable to Regional Public Health (RPH). Phone RPH on 04 570 9002 if you suspect your facility has an outbreak.
Reduce the spread
To stop respiratory illness spreading we advise the following:
Infection control
- Allocate the ill person a single room.
- If a single room is not available, cohort with other people who have an ILI.
- Staff caring for ill residents should wear a face mask if the resident is coughing, use gloves and an apron if in contact with the resident’s body fluids and wash their hands regularly.
- Reduce staff cross-over between ill and well residents.
- Staff with ‘flu-like symptoms should not be at work while they are ill and we recommend that they stay off work until 48 hours after the major symptoms have resolved.
- Prevent the spread of germs by ensuring everyone covers their mouth and nose with tissues when coughing and sneezing, and put used tissues in a covered bin or a plastic bag. (If there are no tissues available, cough or sneeze into your upper sleeve – not your hands). Remember to wash hands afterwards.
- Encourage frequent hand washing for all staff and residents (posters are available from RPH). Consider the use of alcohol hand gel to supplement hand washing.
- Discourage people with respiratory symptoms from visiting residents, and infants and others who are at risk of severe illness or complications from visiting.
- Regularly clean surfaces that are frequently touched (e.g. door handles, bench tops, taps).
- Alert a hospital or other facilities to which any resident is transferred or referred of ILI.
- You will need a plan to defer/manage new admissions until the outbreak is over.
- The outbreak is over when there have been 6 days (twice the incubation period for influenza) with no cases of influenza.
- Hand hygiene is very important e.g. covering mouth when coughing or sneezing and hand washing after coughing, sneezing or blowing nose.
Testing and treatment
- Discuss testing for respiratory viruses with the medical officer of health/local laboratory/infectious diseases physician.
- Throat swab taken with a viral swab and placed in VTM (viral transport media) can be tested for influenza viruses by PCR.
- Include other tests considered as appropriate by the person's GP e.g. sputum, serology.
- Discuss treatment with residents GP including treating bacterial infections promptly.
Communication
- Keep residents and their families updated about what is happening and the rationale for the infection control measures. Encourage family and friends to telephone or send messages via email or fax while visiting is restricted.
- Keep GPs who provide care for residents and RPH informed about the situation.
- Advise visitors about the outbreak.
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