Managing an Influenza Outbreak in a Long-Term Care Facility, CDC Guidelines
Definition: When there is a confirmed or suspected influenza outbreak (2 or more ill residents)
A confirmed outbreak = When there are 2 or more laboratory-confirmed cases of influenza A in a long-term care facility.
A suspected outbreak = When there are 2 or more ill residents with influenza A symptoms and one of them has been confirmed to be influenza.
-Even if it’s not influenza season, influenza testing should occur when any resident has signs and symptoms that could be due to influenza *, and especially when two residents or more develop respiratory illness within 72 hours of each other
-In order of priority, the following influenza tests are recommended: reverse transcription polymerase chain reaction (RT-PCR); immunofluorescence; rapid influenza diagnostic tests.
-Because of the possibility of false negative results during influenza season, if influenza is suspected and immunofluorescence or rapid influenza diagnostic test results are negative, perform confirmatory testing using RT-PCR or viral culture.
-Implement daily active surveillance for respiratory illness among ill residents, health care personnel and visitors to the facility.
-Implement Standard and Droplet Precautions for all residents with suspected or confirmed influenza.
-Administer influenza antiviral treatment and chemoprophylaxis to residents and health care personnel according to current recommendations.
-All long-term care facility residents who have confirmed or suspected influenza should receive antiviral treatment immediately.
-Rx: Oseltamivir (Tamiflu), Zanamivir, or peramivir. Give twice daily for 5 days. Longer tx can be considered for patients who remain severely ill after 5 days of treatment.
**Chemoprophylaxis for all residents who are asymptomatic and treatment for all residents who are symptomatic, regardless of laboratory confirmation of infection or vaccination status.
All staff should receive chemoprophylaxis regardless of whether they have had direct patient contact with an infected resident or have received the vaccine.
It’s recommended to request restriction of visitation, however, because of patient’s rights, it can’t be strictly enforced.
Amantadine and rimantadine are NOT recommended for use because of high levels of antiviral resistance among circulating influenza A viruses.
Reference
https://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm