When you suspect that flu is circulating in your facility
1. Treat ill residents promptly and empirically
Clinical judgment is an important factor in treatment decisions for patients presenting with influenza-like illness. Prompt empiric antiviral treatment with influenza antiviral medications is recommended while results of definitive diagnostic tests are pending, or if diagnostic testing is not possible, for patients with clinically suspected influenza illness who have:
- Illness requiring hospitalization,
- Progressive, severe, or complicated illness, regardless of previous health status, and/or
- Increased risk for severe disease.
Antiviral treatment, when clinically indicated, should not be delayed pending definitive laboratory confirmation of influenza. Influenza antiviral medications are most effective when initiated within the first two days of illness, but these medications may also provide benefits for severely ill patients when initiated even after two days. Guidance on use of antivirals may change depending upon resistance data.
- See our page on antiviral drug recommendations
- See CDC’s latest recommendations on antiviral use
- See CDC’s Influenza Antiviral Medications: Summary for Clinicians
2. Test promptly for influenza and other causes of febrile respiratory illness
Respiratory specimens should ideally be collected as early as possible (ideally within three days after illness onset, when influenza viral shedding is highest). See information about influenza testing.
3. Isolate and/or cohort ill patients
Restrict staff floating and consider limiting resident activities within the facility. Exclude symptomatic staff and patients until at least 24 hours after they no longer have a fever.
4. Immediately report clusters via faxed teleform
5. Use droplet precautions
Also, use standard precautions when caring for patients with suspected or confirmed seasonal influenza.
6. Conduct daily active surveillance and testing for new illness and cases
Healthcare professionals can use the MDPH sample Influenza-like-illness Line List as a template for tracking influenza-like illness (ILI) among patients and staff in your facility.
Educate staff about the signs and symptoms of influenza-like illness.
7. Encourage respiratory hygiene, cough etiquette, and hand hygiene
Provide staff reminders, or retraining if necessary. Post visual alerts (in appropriate languages) at the entrance to the facility. Posters, brochures, and fact sheets promoting cough etiquette and handwashing in multiple languages are available from the Massachusetts Health Promotion Clearinghouse.
8. Use antiviral agents for outbreak control
Used in conjunction with vaccination and behavioral measures, including droplet precautions and cohorting of ill residents, antiviral agents are a key component of outbreak control in long-term care facilities and other institutional settings.
9. Offer vaccine to unvaccinated staff
Also offer chemoprophylaxis to staff if they care for persons at high risk for complications.
10. Immediately report…
Unusual or unusually severe cases, suspected and confirmed pediatric flu-related deaths, deaths in pregnant women, and suspected cases of novel or variant flu, as described below under “Influenza Reporting.”
Vaccination of residents
- Vaccinate residents against flu when vaccine is available.
- Vaccinate residents admitted from September through March on admission if prior vaccine is not documented.
- Ensure that written policies include annual flu vaccination, and pneumococcal vaccines (PPSV23 and PCV13), shingrix, and Tdap vaccination for residents.
- Include Vaccine Information Statements (VIS) for PPSV23, PCV13, Tdap, shingles vaccine (Shingrix), and flu vaccines in the admission packet. Visit the IAC site for Vaccine Information Statements (VISs) for all vaccines in many languages.
- Obtain consent for vaccination from the resident or family member on admission.
- Implement standing orders to administer flu, PCV13, PPSV23, shingrix, and Tdap vaccines.
- Use chart audits to ensure that there is documentation in every chart that the resident has been offered PPSV23, PCV13, shingrix, Tdap vaccines and the annual influenza vaccine.
- Consider residents with uncertain immunization histories as NOT immunized and vaccinate accordingly. The benefits of vaccination far outweigh any concerns about revaccination.
- Doses of PCV13 and PPSV23 should be administered in a series and not on the same day. (If given at the same time, or at shorter than the recommended interval, those doses do not need to be repeated.). Other routine vaccines for adults are safe and effective when administered simultaneously in separate syringes at different anatomical sites.
Vaccination of staff
- Use a systematic approach to vaccination, with checklists, to increase immunization levels:
- Vaccinate all staff against influenza every year.
- CDC, the Advisory Committee on Immunization Practices (ACIP), MDPH, and the Healthcare Infection Control Practices Advisory Committee (HICPAC), recommend that all U.S. health care workers get vaccinated annually against influenza.
- As a condition of licensure, DPH regulations require health care facilities to offer free-of-charge, annual influenza vaccine to all personnel (full and part-time employees, contracted employees, volunteers, house staff and students), and document receipt of influenza vaccine administered and declination of immunization.
- Licensed facilities are also required to report information to DPH documenting compliance with the vaccination requirement, in accordance with reporting and data collection guidelines of the Commissioner (105 CMR).
- Health care workers include (but are not limited to), physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, laundry, security, maintenance, administrative, billing, and volunteers) not directly involved in patient care, but potentially exposed to infectious agents that can be transmitted to and from health care workers and patients.
- Health care facilities include hospitals, ambulatory surgical centers, dialysis centers, clinics, nursing homes, rest homes, and adult day health programs
- The long-term care facility and adult day health program regulations are available at the following links:
People with neurological and neuromuscular conditions
Children and adults with neurological and neuromuscular conditions (listed below) are at increased risk of complication from influenza. These conditions can compromise respiratory function, and handling of secretions, and increase the risk of aspiration. We recommend that everyone six months of age and older with these conditions to receive yearly influenza vaccinations.
Congregate housing for those with neurological and neuromuscular conditions
People residing in group housing should receive flu vaccine as soon as it is available. Likewise, staff should also be vaccinated. In addition, when outbreaks of influenza-like illness occur in a group home or day program serving vulnerable populations, healthcare providers should be immediately notified and should consider rapid antiviral treatment of ill individuals, as well as antiviral prophylaxis of individuals who were exposed.
Neurological and neuromuscular conditions at risk
- Disorders of the brain
- Disorders of the spinal cord
- Disorders of the peripheral nerve
- Disorders of the muscle including:
- Cerebral palsy
- Epilepsy (seizure disorders)
- Intellectual disability (mental retardation)
- Moderate–to-severe developmental delay
- Muscular dystrophy
- Spinal cord injury