Better health and ageing for all Australians
CDNA logo

Guidelines for the Prevention and Control of Influenza Outbreaks in Residential Care Facilities for Public Health Units in Australia

Appendix 6: Influenza & Pneumococcal Immunisation Survey

Up to Historical publications

| TOC |next page

Table of contents

Complete this survey and return it to the Public Health Unit. (Fax Number________________
Telephone Number____________________)

Name of Manager/Contact Person at Facility ____________________________________

Name and type of Residential Care Facility
 
Address
Telephone
Fax
       
Number of Residents by Unit/Section
Total
  
Number of Staff by Unit/Section
Total
  

 

  Influenza vaccination
(Current season) 		Pneumococcal vaccination
(within past 5 years)
No. residents vaccinated    
No. residents not vaccinated    
No. residents vaccination status unknown    
No. staff vaccinated  
N/A
No. staff unvaccinated  
No. staff vaccination status unknown  

| TOC |next page

Table of Contents
Guidelines for the Prevention and Control of Influenza Outbreaks in Residential Care Facilities for Public Health Units in Australia
  Disclaimer
  Acknowledgements
  Preface
  How to use this document
  Summary Flow Chart
  Chapter 1: Introduction
   1.1 Influenza
   1.2 Linkages with other documents and the internet
  Chapter 2: Preventing Outbreaks
   2.1 Vaccination
   2.2 Infection Control Precautions
  Chapter 3: Outbreak and Case Definitions
   3.1 Introduction
   3.2 Respiratory Disease Outbreak Definition
   3.3 Case definition
   3.4 Outcome definitions
  Chapter 4: Investigation and Management of Outbreaks
   4.1 Assess the Suspected Outbreak
   4.2 Outbreak Investigation and Management Team
   4.3 The Investigation
   4.4 Diagnostic tests
   4.5 Documents for communication with the facility
   4.6 Outbreak control measures
   4.7 Monitoring the outbreak
   4.8 Declare that the outbreak is over
   4.9 Debriefing
  Chapter 5: References
  Appendices
   Appendix 1: Environmental Cleaning
   Appendix 2: Respiratory Outbreak Control Measures
   Appendix 3: Checklist for Public Health Unit for Investigation and Management of Outbreaks
   Appendix 4: Respiratory Outbreak Line Listing - Residents ONLY
   Appendix 5: Part A Respiratory Outbreak Line Listing Form - Staff ONLY
   Appendix 6: Influenza & Pneumococcal Immunisation Survey
   Appendix 7: Sample Collection Guide*
   Appendix 8: Guidelines for Taking Nasal and Throat Swabs
   Appendix 9: Respiratory outbreak transfer notification
   Appendix 10: Visitor Restriction Sign - Facility
   Appendix 11: Visitor Restriction Sign - Room
   Appendix 12: Antiviral medications for treatment and prophylaxis of influenza
   Appendix 13: Respiratory illness/Influenza outbreak alert letter to RCF Manager
   Appendix 14: Respiratory illness/Influenza outbreak alert letter to medical practitioner
   Appendix 15: Glossary and List of Abbreviations