Guidelines for preventing respiratory illness in older adults aged 60 years and above living in long-term care: A rapid review of clinical practice guidelines

Patricia Rios; Amruta Radhakrishnan; Sonia M. Thomas; Nazia Darvesh; Sharon E. Straus; Andrea C. Tricco

The RCF should provide ongoing education to staff, residents and volunteers, and opportunistic education to regular visitors (e.g. residents' families) about outbreak prevention, infection control and related policies. Topics for staff (some apply to residents) include: • Personal hygiene, particularly hand hygiene, sneeze and cough etiquette. 6.1 Preparing for influenza outbreaks Seasonal influenza typically peaks over winter and early spring, although sporadic cases occur year-round. Outbreaks of influenza are not uncommon in RCFs. To protect the health of staff and residents and to ensure the RCF is well prepared to manage an outbreak of influenza, it is important to consider the following actions: • Plan for a possible outbreak: 200 a. Develop easily accessible internal policies and procedures on infection control and an outbreak management plan. A copy of these guidelines and the Influ-Info Kit produced by the Department of Social Services should be used as references.27 b. Include a medical practitioner (or equivalent) in the development of the outbreak management plan; this is essential for consideration of use of antiviral medications. c. Acquire adequate stocks of materials such as personal protective equipment (PPE) and cleaning materials (refer to Appendices 1 and 2). Consider having an outbreak kit / box specifically for use in an outbreak. d. Ensure RCF staff know the symptoms and signs of influenza, and are trained in infection control procedures for use of PPE (Appendix 1). e. Policies supporting use of antiviral drugs for prophylaxis should reflect the reduced effectiveness of antivirals with either delays in implementation or low levels of compliance, and a response option for poor compliance. f. If there is an intention to use influenza antivirals for prophylaxis in the management of outbreaks, RCFs may develop processes with attending GPs for antiviral prescriptions/ standing orders prior to the influenza season (see 6.2.9), as to be effective antiviral medication must be used in a widespread fashion at the same time. g. For residents with renal failure, GP assessment of the renal function is needed before or soon after prophylaxis commences (Appendix 16). Note. Legislation relating to the use of standing drug orders may differ between jurisdictions. • Develop a systematic method for detecting and recording residents in the facility who develop symptoms of ILI, such as fever or cough. An ILI detection system may include increased frequency of temperature observation during winter and methods to alert the responsible clinician of symptomatic residents. • Maintain a functional system for the timely detection of potential influenza outbreaks (3 residents/staff with ILI within 3 days) in the RCF. This may be a daily summary of all ILI records. Ensure daily hand-over time for ILI monitoring and outbreak detection for those assigned to this important task. • Early in the year, plan to ensure at least 95% of staff and residents are vaccinated (refer to Section 3: Vaccination). Encourage staff, family members and regular visitors such as hairdressers etc., volunteers, allied health and support workers to be vaccinated. This helps keep them healthy and reduces the likelihood of influenza being brought into the facility. • Keep vaccination records for staff and residents up-to-date, and ensure they are easily accessible when needed for an outbreak response.