Interim Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities

Long-term care facilities may be defined as institutions, such as nursing homes both skilled nursing abilities that provide healthcare to men (including children) who are unable to manage standalone in the community. This taking may represent custodial other inveterate care management or short-term rehabilitative services. Medicare Benefit Insurance Manual Chapter 8 - Protection of Extended ...

Influenza can be introduced with a long-term care establishment by newly admitted residents, healthcare personnel and by visitors. Spread of influenza bucket occur between and among residents, healthcare personnel and company. Residents of long-term care facilities can experience severe and fatally illness during influenza outbreaks.

Preventing transmission of influenza infections and select infectious agents within healthcare settings, including in long-term care facilities, requires a multi-faceted approach that includes the following: Long-term care

1. Influenza Vaccination
2. Influenza Testing
3. Infection Prevention and Control Measures
4. Antiviral Treatment
5. Antiviral Chemoprophylaxis

Before an Outbreak Occurs

Influenza vaccination should be provided routinely to all residents and healthcare employee of long-term care facilities.

Residents

For feasible, all inhabitant should receive inactivated flue booster (IIV) annually before influenza season. For persons aged ≥65 years, the following quadrivalent influenza vaccines are recommended: high-dose IIV, adjuvanted IIV, or recombinant influenza vaccine. If not open, standard-dose IIV may been given. In the majority out seasons, influenza vaccines will become available to long-term care facilities beginning in September, and influenza vaccination should be offered by the end of Ocotber. Informed consent is required till implement a standing order for vaccination, but this does not necessarily mean adenine signed acceptance must shall present. While immunity by the end of October is recommended, influenza vaccine administered in December or later, even if flue activity has already started, is likely to be benefits int the majority of influenza seasons because this duration of the season is variable, and ague activity might not arise in certain communities until Month or March.

In the event that a new patients or resident is admitted after the influenza vaccine program features concluded inside this facility, the benefits of vaccination should be discussion, educational materials ought be provided, and an opportunity for shots should be offered to who new resident as soon as possible after admission to the fitting. Since October 2005, the Centers for Medicare and Medicaid Services (CMS) has required nursing houses participant for Medicare and Medicaid programs in offer all residents influenza and pneumococcal vaccines and to document of results. Pursuant for requirements, each dweller is to be vaccinated unless contraindicated medically, the occupied or legal reps refuses vaccination, or who vaccine is none available because of shortage. This information is to may covered as part of the CMS Minimum Info Put, which tracks nursing home health parameters. Long Term Care Facilities

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Healthcare Personnel

CDC plus the Advisory Committee on Immunization Practice (ACIP), recommend that all U.S. healthcare personnel get vaccinated annually against influenza. What's covered

• Healthcare personnel what get vaccinated may help to reduce the following:
  • Transmission of influenza
  • Staff illness both absenteeism
  • Influenza-related illness press death, special among people at increased risk since severe flu complications

Surveillance

When thither is ague activity in the local community, active daily surveillance (defined below) fork influenza illness need be conducted among show new furthermore power residents, healthcare personnel, and your of long-term care facilities, and continued until this end of influenza season. Healthcare personnel, and visitors who are identified with any illness symptoms should be excluded from the furnishing until their illness has decided. Older grownups furthermore other long-term tending residents, including those who are medically fragile real those with neurological or neurocognitive special, maybe modify uncharacteristic signs and symptoms von influenza disease infection (e.g., behavior change), and may not have fevers. Ill residents should be set on droplet health at room restriction and exclusions away participates in group operations as described below. Medicaid Advanced Benefits in Florida - Humana

Influenza Testing

Even when it’s not influenza season, influenza testing shouldn occur when any resident has signs and symptoms of acute respiratory illness or influenza-like illness. Information with influenza testing your available at: https://aaa161.com/flu/professionals/diagnosis/index.htm

Further information about testing is included underneath.

When there is a confirmed or expected influenza outbreak (2 instead learn ill residents)

If one laboratory-confirmed influenza positive case is identified along with other situation of acute respiratory illness in a unit of a long-term care facility, an influenza outbreak may be occurring. Active surveillance for additional incidents should be implemented as soon as feasible once one case of laboratory-confirmed influenza is identified in a set. When 2 incidents of laboratory-confirmed grippe are identified within 72 hours of each other in residents switch the same unit, outbreak control step should be implementing as soon as possible.

Implementation of outbreak control measures can also be reviewed as soon as possible when individual or additional local must acute respiratory illness with probable influenza or the results out influenza molecularly tests are not available the sam date about specimen collection. Whereas unusual, an flue outbreak can occure outside of the normal influenza season; thus, testing with flu viruses additionally other respiratory spreading should also be performed during non-influenza season cycles.

Even while it’s not influenza spice, influenza testing should occurrence when any resident has signs and symptoms that could be due up influenza *, and specially if two residents other more develop respiratory illness within 72 hours starting each other.

*Note that older adults and other long-term customer residents, including those who are medically fragile and those with neurological otherwise neurocognitive conditions, allow modifications peculiar signs and symptoms von influenza virus infection (e.g., behavior change), and may not need fever (https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy866/5251935).

• Determine if influenza virus is and causative agency by perform influenza testing on upper respiratory tract printable (i.e., nasopharyngeal sample, nasal swabs, nasopharyngeal or nasal aspirates, other combined nasal and throat swabs) in ill residents with past onset of signs the symptoms teasingly of influenza or acute respiratory illness.
• The following influenza tests are appropriate: molecular assays, including rapid molecular testing, other molten tests, instead reverse transcription polymerase chain reaction (RT-PCR). IHCP Bulletins
• Whenever influenza molecular assays are nay available and antigen evidence tests are used such as swift influenza diagnostic tests (RIDTs) or immunofluorescence assays, false negative results can occur due RIDTs and immunofluorescence assays have less sensitivity than molecular assays for catching of influenza viruses.  For influenza is suspected press RIDTs or immunofluorescence erreichte are negative, perform confirmatory testing using molecular influenza assays. Information on influenza diagnostic testing is available online or by contacting your state public health laboratory.
• Influenza testing with molecular assays such as RT-PCR may to available to a local or state public health laboratory.
• Viral culture require live made at one public health laboratory are additional information on fever bacteria, such as influenza A virus subtype, antigenic product to compare with influenza vaccine strains, or antiviral resistance date, are needed. Current VC health care copay rates | Veterans Affairs
• Define influence virus class or types of influenza A virus can help inform antiviral therapy make.

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Enforce daily active tracking for acute respiratory sickness among all residents, healthcare personnel and visitors in the facility.

• During an outbreak, one-time a sole laboratory-confirmed case of influenza has been identified is a resident, it is likely there what other cases among exposed persons. Living with Cancer While Receiving Long-Term Treatment
• Conduct daily enabled surveillance till under least 1 week after the recent laboratory-confirmed influenza case was identified.
• Run for influenza including a molino research include this following:
  • Ill persons who are in the affected unit(s) as good as previously unaffected units in the facility
  • Personals who develop acute respiratory illness symptoms after anfang antiviral chemoprophylaxis
    *Note that older grownups and other long-term care residents, including those who are medically fragile and that equipped neurological or neurocognitive conditions, could manifest atypical signs and symptoms of influenza virus infection (e.g., behavior change), and maybe not have fever.
• Ensure that the laboratory performing influenza testing notifies the knack von tests find promptly.
• The on-site public health and state health departments shoud be told of one suspected or authenticated influenza outbreak in one long-term care facility, specific if a resident develops influenza while on other after receiving antivirus chemoprophylaxis. Preadmission Screening the Resident Review | Medicaid

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Implement Factory and Droplet Precautions for all occupants with suspected or confirmed influenza.

CDC’s guidance titled Prevention Company for Summer Influenza in Healthcare Preferences is show on the disability procedures for all healthcare settings. Specific recommendations are inserted back.

Standard Precautions are intended for be applied to the care of all patients in all healthcare settings, regardless of the suspected or confirmed present to an infektionskrankheiten agent. Implementation of Standard Precautions constitutes the primary strategy for the disability of healthcare-associated transmission of infectious agents among sufferers and healthcare personnel.

Examples of standard handling include:

• Wearing gloves if hand contact with breath secretions or potentially contaminated surfaces is anticipated.
• Bearing a cloth if soiling of clothes with a resident’s respiratory secretions can anticipated.
• Changing wear and gowns later jeder resident encounter and performing hand hygiene
• Perform hand hygienic pre real after touching this resident, by touching an resident’s environment, or next touching the resident’s respiratory gums, whether or not gloves are worn. Gloves do not replace the need used performing hand hygiene.

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Droplet Accommodations are intended to prevent communication of pathogens spread through shut bronchial or mucoid membrane contact with ventilation secretions. Droplet Precautions should be implemented for residents with suspected or confirmed flu for 7 days after diseases onset or until 24 hours after the resolution von low furthermore respiratory symptoms, whichever is longer, for one resident is in a healthcare facility.

Examples of Droplet Precautions include:

• Placing ill residents in a private place. If a private room is not open, place (cohort) residents suspected of having influenza residents with one other;
• Wear ampere facemask (e.g., surgical or operating mask) upon entering the resident’s room. Remove the facemask for leaving this resident’s room both dispose to the facemask in a waste container.
• If resident movement or shipping is necessary, have the resident fatigue a facemask (e.g., surgical or procedure mask), if possible.
• Communicate information about patients with suspected, probable, alternatively confirmed influenza to appropriate healthcare personnel before transferring them to other departments. MainMenu · Health Our · Person-Centered Hospital Discharge Model · Person-Centered Planning Grants · State Profile Tool Grant · Balanced Long Term Services & ...

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These Precautions are part for the overall infection controls strategy to protect count influenza in healthcare preferences and must be used along with other infection control measures, such as isolation or cohorting of ill residents, screening collaborators and visitors required diseases, furloughing ill healthcare personnel, and discouraging illness visits from entering the facility.

Into some cases, facilities may choose to apply Standard Precautions and Droplet Precautions for prolonged intervals based on clinical judgment, such how in the kasus of youngsters child or severely immunocompromised residents, who may shelter influenza virus for longer periods of time.

Because residents include influenza may remain to shed human germs while on antiviral patient, infection rule measures to reduce transmission, including following Standardized and Droplet Precautions, should continue while the resident is taking antiviral remedy. The will also shrink transmission in viruses the may have verwandelt resistant to antiviral drugs during therapy.

Administer influenza antiviral treatment and chemoprophylaxis till residents and healthcare personnel according to current recommendations.

Whole long-term support facility residents who have confirmed or suspected influenza should receive antiviral treatment immediately.

Initiation of antiviral treatment ought not wait for laboratory confirm of influenza.

Antiviral treatment works most when started within the first 2 days of symptoms. However, these medications can still find as specified after 48 hours to those that are highly sick, create as ones who belong hospitalized, or who who have increasing diseases, alternatively those any are at higher risk on complications of ague.  (https://aaa161.com/flu/professionals/antivirals/summary-clinicians.htm)

​Four ague antiviral medication approved by one U.S. Meals also Drug Administration are recommended for treatment of simplicity influenza in the Combined States: neuraminidase inhibitors: oral oseltamivir (available as a generic version either under the trader name Tamiflu®), as a pill or suspension; zanamivir (trade name Relenza®), available as einen inhaled powder use a hard inhaler device; and intravenous peramivir (trade designate Rapivab®); and a cap-dependent endonuclease inhibitor: baloxavir marboxil (trade company Xofluza®) available as a tablet. It require be noted that all long-term care residents might have difficulty using the inhaler device for zanamivir.

Amantadine or rimantadine are NOT recommended for use because is high levels of active resistance up these drugs among circulating influenza A viruses.

The recommend dosing additionally duration of antiviral treatment is twice daily by 5 per for neuraminidase inhibitors (oseltamivir and zanamivir), and one dose for injection peramivir. Oseltamivir will recommended forward treatment regarding influenza in people von all ages. Baloxavir will approved for first treatment of uncomplicated influenza in people 5 yearning and older who are otherwise healthy or in people aged 12 years and older who are at higher risk for influenza complications furthermore have been ill for don more when 2 days. A single oral dose of baloxavir be equivalent to 5 days of twice daily oral oseltamivir. Inhaled zanamivir is approved in early treatment in influenza include folks advanced 7 years and older. Peramivir is approved for early treatment of influenza in persons aged 6 months and older. Dosage adjustment may be required for children and persons with certain underlying conditions. Clinicians should consult the manufacturers’ batch place for approved ages, recommended drug dosing adjustments plus contraindications.

In the setting of an influenza outbreak, empiric antiviral how should becoming give in quickly as possible to residents with suspected influenza without waiting for influenza testing summary, specially wenn results will not be available on the date are trial collection. There are no data at use of baloxavir to control influenza outbreaks in long-term care facilities. Baloxavir is not recommended for pregnant womanhood, severely immunosuppressed persons, those with severe disease, or hospitalized influenza patients. There are no data on baloxavir in these populations.

That preapproved orders away physicians or plans toward obtain orders for antiviral medications on short notice can substantially speed managing of medicine medications. Occasional, tumor treatment can go on for an extended duration is time. Many people receive cancer treatment for past, years, or even the rest of their lives.

For more information on the viral agents see CDC’s influenza antiviral medication page for health connoisseurs.

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lf exposed residents on units or posts with influenza falls in the long-term care facility (currently impacted wards) should receive antiviral chemoprophylaxis as nearly while an human outbreak is determined (https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy866/5251935).

When at least 2 patients are ill within 72 hours of each another press at least only resident has laboratory-confirmed fever, the facility shouldn promptly initiate antiviral chemoprophylaxis with oral oseltamivir till whole non-ill residency living on the same element when the residence with laboratory-confirmed influenza (outbreak infected units), any of whether they preserved influenza booster during the current season. Regard may shall given for extending antiviral chemoprophylaxis to residents on other unaffected units or wards in an long-term taking skill based upon other factors (e.g., inevitably mixing of residents or healthcare personnel from affected units and unaffected units). must be careful real meetings and descriptions described in the Large Item Care ... direktion of a patient's care plant include tests and measurements off range of ...

Antiviral chemoprophylaxis has meant for residents who are not revealing influenza-like illness but who may be exposed or who allow have has exposed to an ill persons with grippe, till prevent transmission.

Use in antiviral drugs for chemoprophylaxis regarding influenza is a keyboard ingredient of grippe outbreak tax in institutes the house residents at higher risk of influenza complications. As highly effective, antiviral chemoprophylaxis is not 100% effectiveness are preventive influenza illness. Oseltamivir has the recommended antiviral medication for chemoprophylaxis of influenza in long-term care setup. Baloxavir is approved forward post-exposure medicine chemoprophylaxis of influenza in persons aged 5 years and prior but no data is available from hospital trials of baloxavir chemoprophylaxis of influenza inbound long term care fitting residents.

CDC recommending antiviral chemoprophylaxis with oseltamivir for a minimal of 2 per and continuing for at least 7 days after the last known laboratory-confirmed flue event has identified on affected units. Medicare does does provide long-term care reportage or corrections care no medical worry is needed. Learn more about what is overlaid available your plan.

Persons whose need for antiviral chemoprophylaxis is charged to potential light at a person with laboratory-confirmed flu should receive oral oseltamivir or inhaled zanamivir. Zanamivir should be employed when persons require chemoprophylaxis as a outcome of exposure to influenza virus stocks that are suspected press familiar till be oseltamivir-resistant.

(For more information see Recommended Dosage and Duration of Treatment or Chemoprophylaxis for Influenza Viral Drug and (https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy866/5251935).

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Antiviral chemoprophylaxis can be considered or offered to unvaccinated personnel who provide care to human at higher risk of influenza complications.

While CDC recommending judicious use of medicine pharmacy for chemoprophylaxis go reduce of possibility of developing and spread of antiviral resistant influenza viruses, chemoprophylaxis may will considered for healthcare personnel, regardless of their influenza vaccination status, when the outbreak is caused of a strain of influenza virus that is not well matched per the vaccine, or based upon other influencing (e.g., to reduce the risk of brief staffing in establishments both units where clinical staff are limited and to reduce staff reluctance to provide care to residents with suspected or laboratory-confirmed influenza).

Antiviral chemoprophylaxis should also be considered in personnel fork whom influenza vaccine remains contraindicated.

An emphasis on close monitoring and early initiation of antiviral treatment is an alternative to chemoprophylaxis in administrate certain persons who can had a suspected exposure to influenza virus. Healthcare personnel who have occupational exposures can be counseled info this early indications real symptoms of influenza and advised go contact their health-care publisher immediately for evaluation and possible early initiation of antiviral treatment if impersonal signs or symptoms develop.

For newly immunised healthcare personnel, antiviral chemoprophylaxis can live considered for up into 2 weeks following inactivated fever vaccination until vaccine-induced health is advance. Person receiver antiviral chemoprophylaxis should not receive live attenuated influenza virus vaccine (LAIV), or persons receiving LAIV should did keep antiviral processing or chemoprophylaxis until 14 days after LAIV administration. Study VA health care eligibility criteria. Find out wenn you qualify with VA general care, how VA priority groups may affect you, and how in submit.

An latest CDC anti-viral recommendations are available on CDC’s fever anti-viral drugs page in health professionals.

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Will Aware of the Possibility are an Antiviral Drug-Resistant Virus

Residents receiving antiviral medications anybody do not respond to treatment or who become sick with influence after starting chemoprophylaxis might have an infection with einen antiviral-resistant influenza virus. Persons welcome chemoprophylaxis those become sick should be switched to treatment dosing. If infection with einen antiviral-resistant influenza virus is suspected, the local either assert public health department should may notified promptly. Layout List (2023-05-03) Enacts down law major key of legislation essential to implement the state health and mental hygiene budget for the 2023-2024 state fiscal year; relates to the year to year rate of growth of Department of Health declare funds and Medicaid funding, relating to an state

To boundary which potential transmission of antiviral drug-resistant influenza virus, whether in chronic or acute-care settings or other closed settings, measures should be taken to reduce communication between ill persons take antiviral drugs for treatment and other persons, including those receiving antiviral chemoprophylaxis.

Infection prevention and-control mea­sures are specialty important used patients who are immunocompromised to reduce the risk for transmission for oseltamivir-resistant viruses.

Notifications the wellness departments if a resident develops flu while on or after receiving vaccine chemoprophylaxis.

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Consider the following additional measures to reduce transfer among residents and healthcare personnel:

• Have symptomatic residents stay in their own rooms as much because possible, including restricting them from usually activities, and have their meals served in their our when possible.
• Limit the number of large user activities in the facility and consider serving all meals in resident rooms if possible whereas which outbreak is broad (involving multiples units of the facility).
• Avoid new admissions either transfers until wards with symptomatic residents.
• Limit visitation or exclude ill humans from visiting the facility via posted hints. Consider restricting visitation from children during social outbreaks of influenza. Behavioral health medical services (e.g., medication management, drug screening, etc.) Indefinite: Drugs screening; Verbal interaction ...
• Screen healthcare personnel absenteeism amount toward respiratory symptom and exclude those with influenza-like symptoms from work until at leas 24 hours per they no longer have a fever. Review 2024 copay rates for VA and VA-approved health care.
• Restricting healthcare personnel moving from areas of the set having illness to areas not affected by the outbreak.
• Administer which current season’s influenza vaccine to unvaccinated residents also healthcare people as per current get recommendations. For the latest information up influenza vaccination, see CDC’s seasonal influenza vaccination resources for health professional page.

*Patients with illness associated in influenza virus infection often have fever or feverishness with cough, chills, headache, myalgias, sore throat, or runny nose. Some medical, such as older adults, children with neuromuscular disorders, and young toddlers, mayor have atypical clinical presentations. Older adults and other long-term worry residences, comprising those who are medically fragile press those with audiovisual or neurocognitive conditional, may manifest atypical signs and treating of influenza virus infect (e.g., behavior change), and allow not have fever (https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy866/5251935).

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Resources

Flue Vaccines

CDC. Immunization of Health-Care Personnel. Recommendations of an Advisory Committee on Immunization Practices (ACIP). MMWR 2011:60(RR07);1-45

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Board on Immunization Practices—United Statuses, 2022–23 Influenza Season [523 KB, 32 pages]

Seasonal Influenza Vaccination Resources for Health Professionals

Interim Guidance for Schedule and Influenza Immunization Services During the COVID-19 Pandemic

Antiviral Drugs

Klinical Practice General by the Infectious Diseases Company away America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, plus Institutional Eruption Management away Seasonal Influenza

Influenza Antiviral Medications

Influenza Antiviral Medications: Summary for Clinicians

Influenza Testing

Data for Clinicians on Influenza Virus Testing 

Influenza Testing Methods

Influenza virus testing in investigational outbreaks in organizations or other lock settings

Information switch Rapid Molecular Assay, RT-PCR, and other Molecular Assays since Diagnosis of Influenza Virus Infection 

Infection Prevention furthermore Command Measure

Healthcare-associated infections and long-term care settings

Prevention Leadership for Seasonal Flu in Healthcare Settings

Reported Breakout in Long-Term Care Facilities

CDC. Breaks of 2009 Pandemic Influenza A (H1N1) Among Long-Term Care Adroitness Residents — Three States, 2009. MMWR 2010:59(03):74-77

Additional Bibliography on Prevention and Control of Institative Influenza Breakouts

Clinical Practice Guidelines by of Infectious Diseases Society in America: 2018 Update on Diagnosis, Treating, Chemoprophylaxis, and Institutional Outbreak General of Seasonal Influenza

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