Thursday, September 21, 2017

Preventing Flu in Long-Term Care Facilities

Clare Gentry, MD, a Houston infectious disease physician
Member, TMA Committee on Infectious Diseases

We’re just past the dog days of summer, longing for cooler weather and welcoming the start of football season. By now, the flu vaccine is already on its way to local communities, getting ready for the kickoff of seasonal influenza (flu) vaccination efforts. Some specific groups of people — including our elderly family, friends, neighbors, and others living in long-term care facilities (and the people around them) — should plan now to get vaccinated against this disease.

While flu season officially runs from October through May, the flu virus doesn’t always follow calendar rules. The highest rates of infection during the past decade have occurred as early as September/October and as late as January/February. In recent years, Texas’ flu season has peaked in December and January.

Though experts debate the best time people should get a flu shot, the Centers for Disease Control and Prevention (CDC) and the Texas Department of State Health Services (DSHS) continue to recommend all eligible people receive flu vaccine as soon as it becomes available in the community. An annual flu vaccination is recommended for anyone 6 months of age and older. 

While it may be difficult to predict exactly when flu season will strike, two things hold true each year:  
  1. Residents of long-term care facilities (LTCFs), such as nursing homes and assisted living centers, are consistently at higher risk of complications from influenza, such as pneumonia and bronchitis.
  2. Flu vaccine can decrease rates of hospitalization and death in these people. Nearly 70 percent of hospitalizations from flu-related illness are in people who are over age 65. And most (up to 85 percent) flu-related deaths are among the elderly.
Residents of LTCFs can contract influenza from new residents, health care workers (HCWs), and visitors. These people should get vaccinated against flu to provide greater protection to residents. Protecting those we care about and care for in LCTFs truly is a community effort. 

Residents of LTCFs

It should go without saying that residents of LCTFs should be vaccinated to protect against flu each year. Even in years when vaccine has been less effective, vaccinated individuals had lower rates of hospitalization and death than nonvaccinated adults. 

Several flu vaccines are available for people over age 65, including a high-dose vaccination. Ask your doctor about which one is right for you. And be sure you’re up to date on all vaccinations recommended for adults, including a shot to prevent pneumococcal disease

Residents also can contribute to the spread of flu. Residents entering a LTCF for the first time or returning after hospitalization might have been exposed to flu without knowing it. Facilities can help prevent the spread of flu by:
  • Screening new or returning residents for signs and symptoms of flu,
  • Documenting residents’ vaccination status, and
  • Offering (and encouraging) flu vaccination at admission. 
Staff should be aware of atypical symptoms in elderly or chronically ill patients. Older patients may not exhibit typical signs of fever, cough, or nasal congestion with flu. Instead, changes in appetite or energy levels or increased sleepiness can be some of the first signs of infection. Families of LTCF residents can help ensure relatives get their annual flu vaccine and maintain accurate vaccination records.

Health Care Workers in LTCFs

Vaccination of health care workers is a critical part of any effort to prevent flu and its complications in LTCF residents. In fact, many facilities now mandate flu vaccine for all health care workers. Why? Multiple studies have shown that vaccination of health care workers in LTCFs can decrease the number and severity of flu cases in the facilities’ residents. 

Facilities should make every effort to vaccinate workers and document employees’ vaccination status. If a HCW shows signs or symptoms of flu, he or she should be tested for flu and stay home from work until symptoms resolve. Families of LTCF residents should inquire about vaccination rates of workers and be aware CDC has set a goal of 90-percent vaccination coverage for HCWs across the country by the year 2020.

The Society for Healthcare Epidemiology of America (SHEA) has long advocated for mandatory influenza vaccination of all HCWs. In their most recent position paper, SHEA experts classified influenza vaccination as “a core patient and health care provider safety practice” that should be “a condition of both initial and continued employment.” The Texas Medical Association also urges 100 percent flu vaccination for health care workers. 

In addition to flu, HCWs should stay current on all recommended vaccinations to protect themselves and the people they care for. 

Family and Friends of LTCF Residents 

Visitors to LCTFs should take action to prevent unknowingly passing the flu on to their loved one living there. Though CDC recommends flu vaccination for everyone over the age of 6 months, flu vaccination rates in Texas typically are less than 50 percent. Adults with relatives living in LTCFs should get flu shots to protect their loved ones. During peak flu season, facilities may elect to limit the number of visitors and may prohibit residents from gathering in common areas. 

As flu season approaches, it is important to remember that flu prevention, especially with regard to LTCF residents, is a community effort. Why not take the step to protect yourself and your loved ones this flu season? 

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