Guidelines for the Prevention, Control and Public …

1 Guidelines for the prevention , Control and Public health Management of Influenza Outbreaks in Residential Care Facilities in Australia March 2017 2 RCF_Guidelines Acknowledgements: This practical guide was developed a by the Working Group on Influenza Outbreaks in Residential Care Facilities on behalf of the Communicable Diseases Network of Australia (CDNA). It was endorsed by CDNA on 1 March 2017. The document builds on previous work by CDNA, and updates the Guidelines for the prevention and Control of Influenza Outbreaks in Residential Care Facilities in Australia 2009. The working group responsible for developing these Guidelines includes: Prof Paul Van Buynder (Chair), Gold Coast Public health Unit, Queensland health ; Dr Ranil Appuhamy, ACT health ; Prof Robert Booy, New South Wales health ; John Coram, Commonwealth Department of Social Services; Dr Alexandra Greig, Commonwealth Department of health ; Dr Sue Hunt, Commonwealth Department of Social Services; A/Prof Jodie McVernon, University of Melbourne; Dr Tony Merritt, New South Wales health ; Dr Jessica Rotty, Department of health & Human Services, Victoria; Dr Douglas Shaw, Department of health , South Australia; and Dr Sean Tobin, health Protection NSW, NSW health .

2 Mrs Joy Copland, Technical Writer 2016, South Australia. The working group would like to acknowledge the significant work undertaken by the members of previous working group: Dr Margaret Young, Wide Bay Public health Unit, Queensland health (Chair); Dr Rodney Jilek, Clinical Adviser, Department of health Sue Johnston, Wide Bay Public health Unit, Queensland health ; Dr Andrew Langley, Sunshine Coast Public health Unit, Queensland health ; Diane Lovatt, Public health Unit, South East Sydney and Illawarra Area health Service, NSW health ; Christine Mohr, Brisbane Southside Public health Unit, Queensland health ; Anandhi Raj, Department of health and Ageing; Beth Sainty-Gale, Department of health and Ageing; and Dr Brett Sutton, Department of health & Human Services, Victoria.

3 Disclaimer: These Guidelines are provided to assist Public health authorities, residential care services and carers by providing best practice information for the prevention and management of influenza outbreaks in residential care facilities. These Guidelines capture the knowledge of experienced professionals, build on past research efforts, and provide advice on best evidence-based practice at the time of completion. The Guidelines are necessarily general and readers should not rely solely on the information contained within. The Guidelines are not intended to be a substitute for advice from other relevant sources and experts. These Guidelines are intended for information purposes only. The membership of the Communicable Diseases Network Australia (CDNA) and the Commonwealth of Australia ( the Commonwealth ), as represented by the Department of health , does not warrant or assume any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, or process disclosed at the time of viewing by interested parties.

4 The CDNA and the Commonwealth expressly disclaim all and any liability to any person, 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. 3 RCF_Guidelines Table of Contents Section 1: Preface .. 5 Purpose of the Guidelines : .. 5 Preparation of 5 Using the Guidelines .. 5 Target audience .. 5 The Nature of Residential Care .. 5 Related legislation .. 6 Definitions of influenza-like illness (ILI) and influenza .. 6 Notification .. 6 Section 2: Influenza .. 7 Description .. 7 Symptoms and signs .. 7 Transmission, incubation and communicability.

5 8 Complications and people at increased risk of complications .. 8 Section 3: Vaccination .. 9 Vaccine .. 9 Seasonal vaccination program for residents and staff .. 9 Residents .. 10 Staff .. 10 Vaccination policies .. 10 Staff vaccination strategies .. 11 Vaccination of family members and regular visitors .. 11 Section 4: Recognising influenza-like illness and outbreaks .. 12 Influenza surveillance .. 12 Definition of influenza-like illness (ILI) and influenza .. 12 Case definition of influenza-like illness (ILI) .. 13 Definition of confirmed case of influenza:.. 13 Testing (including point-of-care tests) .. 13 National surveillance case & laboratory definitions for influenza.

6 14 Response to a single case of ILI or influenza in a resident .. 14 Response to a single case of ILI or influenza in a member of staff .. 14 outbreak 14 Section 5: Infection Control (Controlling the spread of influenza) .. 16 Infection Control measures to prevent spread of influenza: .. 16 Hand hygiene .. 17 Respiratory hygiene and cough etiquette .. 17 Personal protective equipment (PPE) .. 17 Surgical face masks .. 17 Gloves and gown .. 18 Eye protection .. 18 Environmental measures .. 18 Exclusion of staff .. 19 Rationale for allowing staff on antivirals to return to work .. 19 Isolation and cohorting .. 19 Resident placement .. 19 Staff .. 20 Droplet precaution sign.

7 20 4 RCF_Guidelines Resident movement during an outbreak .. 20 New admissions .. 20 Re-admission of residents who have had influenza .. 21 Re-admission of residents without influenza .. 21 Non-infected residents .. 21 Transfers .. 21 Visitor restriction and signage .. 21 Education and training .. 22 Section 6: outbreak management .. 23 Preparing for influenza outbreaks .. 23 RCF response to an outbreak of ILI .. 24 Notifications .. 24 Implement preliminary infection Control measures .. 25 Testing of residents with ILI .. 26 Collate information onto a line list .. 26 Confirm and declare an influenza outbreak .. 27 Forming an outbreak management team .. 27 Infection Control during an 28 Vaccination during an outbreak .

8 28 Antiviral medication during an outbreak .. 29 Monitoring the outbreak .. 30 Concluding the outbreak .. 31 Declaring the outbreak over .. 31 Communication .. 31 Organising a debrief after the outbreak .. 31 Appendices .. 33 Appendix 1 Standard precautions .. 33 Appendix 2 Environmental cleaning .. 41 Appendix 3 Signage for use in an influenza outbreak .. 43 Appendix 4 Resident transfer advice form .. 46 Appendix 5 Pre-season letter for residential care facilities .. 47 Appendix 6 Testing for influenza fact sheet to Section .. 48 Appendix 7 Flow chart for initial outbreak response .. 49 Appendix 8 Swab collection procedure .. 49 Appendix 9 outbreak preparedness checklist - before an outbreak occurs.

9 52 Appendix 10 outbreak Management Team tasks during an influenza outbreak .. 54 Appendix 11 RCF outbreak Management .. 56 Appendix 12 Infection Control checklist for outbreaks in RCFs .. 59 Appendix 13 Example line lists for Influenza Outbreaks .. 62 Appendix 14 Example of initial RCF report to a PHU of an influenza outbreak .. 64 Appendix 15 Contact details for regional Public health authorities .. 65 Appendix 16 Antiviral medications & antiviral prophylaxis decision tool .. 66 Appendix 17 Letter - use of antivirals for influenza outbreak .. 70 Appendix 18 Antiviral dosages .. 72 Appendix 19 Patient information on Tamiflu (oseltamivir) .. 74 References: .. 75 5 RCF_Guidelines Section 1: Preface Purpose of the Guidelines : Influenza is an important issue in residential care.

10 Residents, particularly the elderly, are often vulnerable to influenza due to co-morbidities and/or advanced age, and the environment of communal living facilitates the spread of respiratory agents. The purpose of this document is to provide national best practice Guidelines for, preparing for, preventing, identifying and managing outbreaks of influenza in residential care facilities (RCFs) in Australia. The Communicable Diseases Network Australia (CDNA) have also reviewed the CDNA Influenza Guidelines for Public health Units which contains more detail in relation to the Public health management of influenza. Preparation of Guidelines A multi-jurisdictional working group of the CDNA prepared these Guidelines .