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Influ-Info Influenza Kit for Aged Care

This kit has been provided to assist care managers to implement influenza control planning.

You may download this document in PDF format:

PDF printable version of Influ-Info Influenza Kit for Aged Care (PDF 798 KB)

Disclaimer

This publication and all its component parts are provided to assist residential aged care services and carers in making decisions about the prevention and control of influenza. Any policies and practices dealing with the prevention and control of influenza in a residential care service should be developed in the context of relevant legislation, codes of practice and other professional standards, policies and guidelines relevant to the practice setting, together with appropriate advice on legal care issues.

The Australian Government and the authors expressly disclaim all and any liability to any person, whether a purchaser of this publication or not, in respect of anything and of the consequences of anything done or omitted to be done by any person in reliance, whether in whole or in part, upon the whole or any part of the contents of this publication.

1. General

General Information for residential aged care homes

Influenza is a notifiable disease in most states and territories if laboratory confirmed.

(National Notifiable Diseases Surveillance System) ICG*A2-2

Definition [ICG* 28-17]

• An acute, highly infectious respiratory viral infection.
• Two major types (A and B) affect humans.
• Vaccine against both types is available annually (mid-February).
• Usually seasonal in occurrence, from mid-autumn to late winter in southern Australia. Generally has an earlier appearance in northern Australia from late February with a second cluster of cases in August/September/October.
• Spread by droplets from coughs or sneezes.
• Initial symptoms may be similar to those of other respiratory infections.
• Symptoms develop rapidly, 1–3 days after infection.
• Individuals are usually infectious for 3–4 days after infection and may be infectious 1–2 days before symptoms appear.

High risk groups [ICG* 28-18, NHMRC: The Australian Immunisation Handbook 8th edition pp171–175]

• Those aged 65 years of age and over.
• Those with chronic debilitating disease/s.
• Aboriginal and Torres Strait Islanders 50 years of age and over.
• Residents of long-term care establishments eg residential aged care homes.

Legislation

Under the Aged Care Act 1997 42-1 (1)(c) all Australian Government funded residential aged care services must be accredited in order to remain eligible for funding. [Aged Care Act 1997]

Under the Quality of Care Principles, Schedule Two, Accreditation Standards, homes must meet
44 expected outcomes relating to quality of care and quality of life. [Aged Care Principles 1997]
4.7 — Infection Control requires homes to have an effective infection control program.
4.2 — Regulatory Compliance requires that the organisation’s management has systems in place to identify and ensure compliance in infection control. [See Standards and Guidelines for Residential Aged Care Services]

These requirements complement state and territory legislation. It is the responsibility of facility management to identify relevant state/territory regulations and ensure ongoing compliance with these.
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2. Prevention

Prevention of infection and spread of influenza in residential aged care homes

Successful infection control is based on good hygiene around a range of practices that arise from identifying and implementing risk management of the hazards ICG*2-1

Precautions [ICG*1-2, ICG*8-2, ICG*10]

Vaccination (unless medical or conscientious exemption provided) for high risk groups [ICG*10-4, ICG* 38-4, NHMRC: The Australian Immunisation Handbook 8th edition, pp 171–175]

Residents

• Influenza annually.
• Pneumococcus as recommended.

Staff

• Influenza annually (recommended).

NB: The vaccine takes approximately two weeks after vaccination to become effective and usually protects recipients against the annually specified types of influenza.

Standard practices [ICG*2-3, ICG* 12-3]

• Personal hygiene, particularly handwashing.
• Appropriate handling and disposal of sharps and clinical waste.
• Appropriate processing of reusable equipment.
• Appropriate environmental cleaning.
• Appropriate laundry and food handling processes.

Infectious disease control team [ICG*3-1, ICG*6-1, ICG*7-1, ICG*38-2]

• Identify and minimize potential infection risks.
• Identify suitable isolation areas.
• Communication with staff, residents and visitors.
• Liaise with GPs, state/territory Public Health Unit, local hospitals, etc.
• Maintain and document vaccination schedules.
• Identify and document possible infection outbreaks.
• Initiate precautions.
• Coordinate protective measures.

Isolation room checklist [ICG*11-2, ICG*11-6, see sheet R1]

• Hand-wash basin in room (hands-free operation if possible).*
• Single-use towelling.
• Ensuite bathroom (shower, toilet, hand-wash basin). *
• Door on room with door self-closer (if possible).
• Minimum 1 metre separation between beds in multi-bed rooms.†
• Suitable container/s for safe disposal of tissues, gloves, masks, single-use towelling etc.
• Room restriction signs.
• Independent air conditioner/filter system if available.

* If hand washing facilities are not readily available, provide alcohol-based hand wash.
† If an appropriate single room is not available, room sharing by residents with the same infection is acceptable.

Wash and Dry Hands Before and After Contact with Affected Residents
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3. Identification

Outbreak identification in a residential aged care home

Identification of potential episode

1. Symptoms of influenza [ICG*28-172]

Rapid onset of:

• Fever/chills
• Tiredness/Exhaustion
• Cough
• Headache
• Muscle and joint pain
• Sore throat
• Stuffy/runny nose

Symptoms in the elderly may also include:

• Loss of appetite
• Onset or increase of confusion
• Shortness of breath
• Increasing Chronic Obstructive Airways Disease symptoms

2. Precautions should commence as soon as the first resident shows influenza-like symptoms

Seek medical advice immediately symptoms appear

• Appropriate swabs collected and forwarded for analysis (affected residents and staff) as directed by Medical Officer/s — see Collection:6.
• Notify all visiting GPs of influenza-like symptoms in the home.
• Increase hygiene measures.
• Warn visitors of risk.
• Curtail group activities.

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3. Manage residents who are ill [ICG*2-5, see sheets R1, R5, R6, R7]

• In individual rooms, multi-bed rooms†, unit or wing.
• Dedicated staffing where possible/practicable.
• Dedicated equipment.
• Appropriate signage.
• Transfer to hospital if condition warrants.

† If an appropriate single room is not available, room sharing by residents with the same infection is acceptable.

4. Document [ICG*38-2]

• Details of residents/staff exhibiting symptoms.
• Onset date of influenza-like illness for each.
• Symptoms — any three of: fever, cough, muscle and joint pain, tiredness/exhaustion.
• Contacts — identify where possible, (e.g. staff member, visitor) to identify ‘at risk’ groups.

5. Confirmed influenza [See sheets R3, R4, R5]

• State/territory Public Health Unit notified (usually by Medical Officer or Pathology).
• Advise your state/territory Health Department aged care unit and the Commonwealth Department of Health and Ageing state/territory office.
• Notify residents’ relatives/representatives, local hospital, all staff, GPs, allied health workers, etc.

Isolation room checklist [ICG*11-2, ICG*11-6, see sheet R1]

• Hand-wash basin in room (hands-free operation if possible).*
• Single-use towelling.
• Ensuite bathroom (shower, toilet, hand-wash basin).*
• Door on room with door self-closer (if possible).
• Minimum 1 metre separation between beds in multi-bed rooms.†
• Suitable container/s for safe disposal of tissues, gloves, masks, single-use towelling etc.
• Room restriction signs.
• Independent air conditioner/filter system if available.

* If hand washing facilities are not readily available, provide alcohol-based hand wash.
† If an appropriate single room is not available, room sharing by residents with the same infection is acceptable.

Wash and Dry Hands Before and After Contact with Affected Residents
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4. Management

Outbreak Management in residential aged care

Prevent Spread [ICG*2-5, see sheet R1]

1. Isolate residents who are ill if not already isolated

• In individual rooms, multi-bed rooms†, unit or wing.
• Dedicated staffing where possible/practicable.
• Dedicated equipment.
• Appropriate signage.
• Transfer to hospital if condition warrants.

† If an appropriate single room is not available, room sharing by residents with the same infection is acceptable.

2. Restrict contact [ICG*28-19, see sheet R3, R4]

• Infected staff excluded from work for the period during which they are infectious, as determined by a medical practitioner.
• Staff movement into restricted area/s limited.
• Visitors kept to minimum, short duration, warned of risk factors.
• Curtail social contacts/group activities for non-infected residents.
• Restrict new/re-admissions.

3. Increase personal protective measures [ICG*12-3, ICG*13-2, ICG*13-4, ICG*13-5, see sheet R2, R3]

• Maintain existing hand hygiene before and after contact with each resident.
• Wear gloves if contact with respiratory secretions or potentially contaminated surfaces is likely. Change gloves and wash hands after contact with each resident.
• Wear masks appropriate for respiratory infection on entering room or working within one metre of the resident. Remove mask when leaving each room and dispose of correctly. Do not reuse masks.
• Wear gowns if soiling of clothes with respiratory secretions is likely. Do not reuse gowns.

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4. Environment [ICG*18-1, ICG*15-1, ICG* 16-2]

• Enhance cleaning measures, especially of frequently touched surfaces, with neutral detergent.
• Appropriate disposal units for tissues, etc.
• Appropriate cleaning processes for reusable items.

5. Medical management [see sheet R7]

• Antiviral medication as prescribed by GP/s.
• Immunisation for those without current vaccination.
• Transfer to hospital if condition warrants.

6. Seek specialist advice [see Contacts:5]

Isolation room checklist [ICG*11-2, ICG*11-6, See sheet R1]

• Hand-wash basin in room (hands-free operation if possible).*
• Single-use towelling.
• Ensuite bathroom (shower, toilet, hand-wash basin).*
• Door on room with door self-closer (if possible).
• Minimum 1 metre separation between beds in multi-bed rooms.†
• Suitable container/s for safe disposal of tissues, gloves, masks, single-use towelling etc.
• Room restriction signs.
• Independent air conditioner/filter system if available.

* If hand washing facilities are not readily available, provide alcohol-based hand wash.
† If an appropriate single room is not available, room sharing by residents with the same infection is acceptable.

Wash and Dry Hands Before and After Contact with Affected Residents
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5. Contacts

Who to contact for assistance with and notification of a suspected outbreak of influenza

Disclaimer: Updated contact details supersedes contact details contained within both the downloadable and the hard copy kit.

Queensland

Southern Population Health Unit Network

Contact	Phone	Fax.
Brisbane Southside	Ph: 07 3000 9148	Fax: 07 3000 9121
Gold Coast	Ph: 07 5668 3700	Fax: 07 5562 1649
Darling Downs	Ph: 07 4631 9888	Fax: 07 4639 4722
South West	Ph: 07 4656 8100	Fax: 07 4654 2615
West Moreton	Ph: 07 3413 1200	Fax: 07 3413 1201

Central Population Health Unit Network

Contact	Phone	Fax.
Brisbane Northside	Ph: 07 3 624 1111	Fax: 07 3624 1159
Moreton Bay	Ph: 07 3142 1800	Fax: 07 3142 1824
Sunshine Coast	Ph: 07 5409 6600	Fax: 07 5443 5488
Wide Bay	Ph: 07 4184 1800	Fax: 07 4120 6009
Rockhampton	Ph: 07 4920 6989	Fax: 07 4920 6865
Bundaberg	Ph: 07 4150 2780	Fax: 07 4150 2729
Longreach	Ph: 07 4652 6000	Fax: 07 4652 6099

Tropical Population Health Unit Network

Contact	Phone	Fax.
Mackay	Ph: 07 4911 0400	Fax: 07 4885 6610
Townsville	Ph: 07 4753 9000	Fax: 07 4753 9001
Mt Isa and Gulf	Ph: 07 4744 9100	Fax: 07 4745 4573
Cairns	Ph: 07 4226 5555	Fax: 07 4031 1440

New South Wales

Greater Southern AHS Centre for Population Health

Contact	Phone	Fax.
Goulburn Office	Ph: 02 4824 1840 Fax: 02 4824 1831/4822 5038	A/Hrs: 02 6080 8900 (diverts to Albury Base Hospital) - Ask for Public Health Officer on call)
Albury Office	Ph: 02 6080 8900 Fax: 02 6080 8999	A/Hrs: 02 6080 8900 (diverts to Albury Base Hospital) - Ask for Public Health Officer on call

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Greater Western AHS Centre for Population Health

Contact	Phone	Fax.
Broken Hill Office	Ph: 08 8080 1499 Fax: 08 8080 1683 / 1196	A/Hrs: 08 8080 1333 (Broken Hill Base Hospital) - Ask for Public Health Officer on call.
Dubbo Office	Ph: 02 6841 5569 Fax: 02 6841 5571	A/Hrs: 02 6885 8666 (Dubbo Base Hospital) - Ask for Public Health Officer on call.
Bathurst Office	Ph: 02 6339 5601 Fax: 02 6339 5173	A/Hrs: mob. 0428 400 526 - Ask for Public Health Officer on call

Hunter / New England AHS, Hunter Population Health

Contact	Phone	Fax.
Newcastle Office	Ph: 02 4924 6477 Fax: 02 4924 6490/4922 3164	A/Hrs: 02 4924 6477 (diverts to John Hunter Hospital) - Ask for Public Health Officer on call
Tamworth Office	Ph: 02 6764 8000 Fax: 02 6766 3890	A/Hrs: 02 6764 8000 (diverts to Tamworth Base Hospital) – Ask for Public Health Officer on call

North Coast AHS Public Health Unit

Contact	Phone	Fax.
Port Macquarie Office	Ph: 02 6588 2750 Fax: 02 6588 2837	A/Hrs: mob. 04017 244 966 or 0407 904 208 - Ask for Public Health Officer on call.
Lismore office	Ph: 02 6620 7585 Fax: 02 6622 2151 or 02 6620 2252	A/Hrs: 132222 Pager no: 397635. If no answer :- Mobile: 0417 244 966 or 0407 904 208

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Northern Sydney / Central Coast AHS Public Health Unit

Contact	Phone	Fax.
Hornsby Office	Ph: 02 9477 9400 Fax: 02 9482 1650 / 1358	A/Hrs: 02 9477 9123 (Hornsby Hospital) – Ask for Public Health Officer on call
Gosford Office	Ph: 02 4349 4845 Fax: 02 4349 4850	A/Hrs: 02 4320 2111 (Gosford Hospital) – ask for Public Health Officer on call

South Eastern Sydney / Illawarra AHS Public Health Unit

Contact	Phone	Fax.
Randwick Office	Ph: 02 9382 8333 Fax: 02 9382 8334 / 8314	A/Hrs: 02 9382 2222 (Prince of Wales Hospital) – Ask for Public Health Nurse on call
Matraville Office	Ph: 02 9311 2707 Fax: 02 9700 3747 (s)	Ph: 02 9311 2707
Wollongong Office	Ph: 02 4221 6700 Fax: 02 4221 6722 / 6759	A/Hrs: 02 4222 5000 (Wollongong Hospital) – Ask for Public Health Officer on call

Sydney South West AHS Public Health Unit

Contact	Phone	Fax.
Eastern Zone (Camperdown Office) For Liverpool Area, call the Camperdown Office	Ph: 02 9515 9420 Fax: 02 9515 9440 / 9467	A/Hrs: 02 9515 6111 (Royal Prince Alfred Hospital) - Ask for Public Health Officer on call

Sydney West AHS Centre for Population Health

Contact	Phone	Fax.
Penrith Office	Ph: 02 4734 2022 Fax: 02 4734 3300 / 3444	A/Hrs: 02 9845 5555 (Westmead Hospital) – Ask for Public Health Officer on call
Parramatta Office	Ph: 02 9840 3603 Fax: 02 9840 3608 / 3591	A/Hrs: 02 9845 5555 (Westmead Hospital) – Ask for Public Health Officer on call

Victoria

Contact	Phone	Fax.
Communicable Disease Prevention and Control Unit	Ph: 1300 651 160	-

Tasmania

Contact	Phone	Fax.
Public and Environmental Health Service	Ph: 1800 671 738 – Free call	-

South Australia

Contact	Phone	Fax.
Communicable Diseases Control Branch	Ph: 1300 232 272	Fax: 08 8226 7187

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6. Collection

Swab collection instructions

• Nose (left and right nostrils) and throat swabs for respiratory outbreaks should only be taken from residents with acute symptoms (onset within the preceding 72 hours) and preferably from a resident with the most classical clinical presentation of the illness suspected. Samples from 8 to 10 people should ideally be collected. See collection instructions below.
• The specimens should be packaged in a small cool bag (with ice bricks) for transport to the pathology laboratory.

Swab collection procedure

Gloves and a Mask (with eye protection) should be worn when collecting nose and throat swabs

Nose

• Tilt the patient’s head back gently, with one hand, and steady the patient’s chin. With the other hand, insert the cotton bud end of the dry sterile swab into the patient’s right nostril. The swab should be rubbed vigorously against the turbinate in the nostril to ensure the swab contains cells as well as mucous from the nostril. Withdraw the swab from the nostril.
• Remove the cap from the tube of transport medium. Break off (or cut with scissors) the end of the swab’s plastic shaft, ensuring that the entire swab can be sealed within the tube. Loosely recap the tube. Discard the remaining end of the swab.
• Repeat the procedure with a new dry sterile swab in the patient’s left nostril. Place the swab in the same tube of viral transport medium with the other swab.

Swab collection procedure

Gloves and a Mask (with eye protection) should be worn when collecting nose and throat swabs

Throat

• To perform the throat swab, remove another swab from the packaging and ask the patient to open his/her mouth and stick out their tongue. Use a wooden spatula to press the tongue downward to the floor of the mouth. This will avoid contamination of the swab with saliva. Firmly swab both of the tonsillar arches and the posterior naso-oropharynx, without touching the sides of the mouth.
• Remove the swab, which should be thoroughly wet with throat secretions. Remove the cap from the same tube as contains the two nose swabs and break off the shaft as before. Now firmly screw the cap back on the tube. Discard the end of the swab.

Label the transport media with the patient’s full name, date of birth, type and date of collection.

Place the transport media in the plastic bag provided, and complete the request form (making sure to include the name of your facility). Refrigerate the specimen until it is sent to the lab.

Masks should NOT be touched during wear and should NOT be worn around the neck at any time. When the masks are removed they should be handled by the ties only. Both gloves and masks should be disposed of in an infectious waste bag.

Wash and Dry Hands before and after the procedure!
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Influenza Sheet R1

Isolation Room Checklist

• Hand-wash basin in room (hands-free operation if possible).*
• Single-use towelling.
• Ensuite bathroom (shower, toilet, hand-wash basin).*
• Door on room with door self-closer (if possible).
• Minimum 1 metre separation between beds in multi-bed rooms.†
• Suitable container/s for safe disposal of tissues, gloves, masks, single-use towelling etc.
• Room restriction signs.
• Independent air conditioner/filter system or aircon inlet/outlet for the room to be filtered with a HEPA filter.

* If hand washing facilities are not readily available, provide alcohol-based hand wash.
† If an appropriate single room is not available, room sharing by residents with the same infection is acceptable.

Influenza Sheet R2

Wash Your Hands

1. Remove jewellery.
2. Wet your hands thoroughly.
3. Apply soap from the dispenser.
4. Lather vigorously for 10–15 seconds.
5. Rinse under running water.
6. Do NOT touch taps with clean hands —use a towel to turn taps off.
7. Pat your hands dry, using a paper towel.
8. Dispose of the towel in the appropriate container.

Do NOT reuse towels.
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Influenza Sheet R3

Attention All Staff

There are currently a number of cases of respiratory illness/influenza at this facility.

We are trying to prevent this illness from spreading.

If you have symptoms of any respiratory illness now (fever, sore throat, cough, muscle and joint pain, tiredness/exhaustion) you should see your doctor immediately and not return to work until you are free of symptoms or until your doctor advises that you are fit to return to work.

There is a risk that you will acquire this respiratory illness/influenza unless you take precautions.

• Arrange for an influenza vaccination if you have not already had one this year.
• Wash your hands with soap and water before and after contact with each resident, or use alcohol-based hand wash if washing facilities are not nearby.
• If you are working with those residents who are sick, avoid contact with other residents and staff working in other areas.
• Wear gloves if contact with respiratory secretions or potentially contaminated surfaces is likely. Change gloves and wash hands after contact with each resident. Dispose of gloves in the appropriate container. Do not reuse gloves.
• Wear masks appropriate for respiratory infection on entering room or working within one metre of the resident. Remove mask when leaving each room and dispose of in the appropriate container. Do not reuse masks.
• Wear gowns if soiling of clothes with respiratory secretions is likely. Remove gown before leaving the room and place in the appropriate container. Do not reuse gowns.

Thank you for your co-operation
Sincerely

Manager/DoN
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Influenza Sheet R4

Influenza Information - for family and visitors

Influenza is a highly infectious virus. It spreads through droplets caused by sneezing or coughing. Symptoms develop rapidly one to three days after contact with an infectious person. Individuals are infectious for three to four days after infection and may transmit the virus one to two days before the onset of symptoms.
Influenza is a particular risk of serious illness and death to:

• people 65 years of age and over;
• Aborigines and Torres Strait Islanders 50 years of age and over; and
• residents in long term health care facilities such as residential aged care homes.

Influenza can be prevented, or the severity of the illness reduced, by immunisation with the current vaccine each year. Vaccine is available free of charge to those 65 years of age or over and Aborigines and Torres Strait Islanders 50 years of age or over and 15–50-year-olds considered to be at high risk of complications and death, because they have heart disease, lung disease, kidney disease, severe asthma or diabetes, have an immune compromising condition or are heavy drinkers.

It is recommended that all residents in long term health care, people who visit them and health care staff receive the annual influenza vaccination to minimise the risk of infection to themselves and others.

It is strongly recommended that you see your doctor immediately AND do not visit a resident of a long term care facility, if you have been in contact with people with influenza-like symptoms or if you have three or more of the following symptoms:

Rapid onset of:

• Fever/chills
• Tiredness/exhaustion
• Cough
• Headache
• Muscle and joint pain
• Sore throat
• Stuffy/runny nose

Symptoms in the elderly may also include:

• Loss of appetite
• Onset or increase of confusion
• Shortness of breath
• Increasing Chronic Obstructive Airways Disease symptoms

If there are suspected cases of influenza in a long term care facility that you visit, you can reduce the risk of infection to yourself and others by:

• washing your hands thoroughly with soap and water before you enter a resident’s room;
• minimising physical contact with the residents and staff;
• covering your mouth if you cough or sneeze;
• keeping your visit short;
• only visiting one resident each time you visit; and
• washing your hands thoroughly with soap and water as soon as you leave the resident’s room.

If the resident you are visiting has influenza-like symptoms, you should wear a face mask appropriate for respiratory protection during your visit. Not all masks are suitable for this purpose. You should discuss this with a pharmacist if you are purchasing these. You should also check with staff that the resident’s doctor has been notified.
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Influenza Sheet R5

Attention All Visitors

There have been a number of cases of respiratory illness/influenza at this facility recently. We are trying to prevent this illness from spreading.

Visitors are advised that there is a risk of acquiring this respiratory illness/influenza by visiting this facility at this time.

If you have recently been ill, have symptoms of any respiratory illness now (fever, sore throat, cough, muscle and joint pain, tiredness/exhaustion) or have been in contact with someone who is ill we strongly advise you not to enter this facility.

If you choose to visit at this time, please visit only the resident you have come to see, wash your hands with soap and water before and after the visit and then leave as soon as possible.

Thank you for your co-operation
Sincerely
Manager/DoN

Influenza Sheet R6

Attention All Visitors

Please check at reception before entering this room

Thank you
Manager/DoN
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Influenza Sheet R6

Resident Transfer Advice
To:

Please be advised that ________________________________________ is being transferred from a facility where there is a suspected/confirmed influenza outbreak. Please ensure that appropriate infection control precautions are taken upon receipt of this resident.

At the time of transfer, this resident:
was confirmed with
suspected of
had no symptoms of
influenza.

This resident has been vaccinated with the current influenza vaccine on _______________

This resident has NOT been vaccinated with the current influenza vaccine BECAUSE OF:
allergy
medication conflict
conscientious objection
other _______________________________

Resident is taking the antiviral medication _______________________________________
Start date ______________________ Dose of the medication ________________________

For further information, contact __________________________________________ of__________________________________________ on _____________________________

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