Influenza (Flu)

Influenza Outbreaks: Long-Term Care

Influenza-Like Illness (ILI): Documented fever AND cough and/or sore throat in the absence of another cause.

Suspected outbreak: Three or more cases of acute influenza-like illness occurring within 48 to 72 hours, in residents who are in close proximity to each other (e.g., in the same area of the facility) or one case of influenza is confirmed by any testing method (i.e. including rapid tests).

Suspected Outbreaks

If an outbreak of influenza is suspected

Report suspected or confirmed outbreaks to MDH at 651- 201-5414 or 1-877-676-5414 (toll-free).

Monitor residents for influenza-like illness

Instruct staff to be alert to signs/symptoms of influenza-like illness (fever, cough, sore throat, etc.) among residents and report resident illness to supervisors immediately.
Confine residents with influenza-like illness and their exposed roommates to their rooms or on one unit (e.g., segregated) for five days following the onset of symptoms.
Develop a line list of symptomatic residents. (See enclosed MDH Influenza-Like Illness Line List for Long-Term Care Facilities).

Monitor staff for influenza-like illness

Instruct staff to notify their supervisor if they become ill at work.
Ill staff should cover their cough with tissues, leave the work area, and make arrangements to go home.
Supervisors should make alternative staffing arrangements.
Ensure that ill staff do not work;
Staff who work in resident living/care areas should remain out of work for seven days after symptom onset or 24 hours after resolution of fever – whichever is longer.
Monitor staff absenteeism for influenza-like illness.
Discontinue floating of staff to other units where possible.

Outbreak Management

When an influenza outbreak is suspected or confirmed, take the following steps to monitor residents and staff and to prevention transmission.

Implement daily active surveillance for respiratory illness among all residents and staff until at least one week after the last confirmed influenza case occurred.
Implement Standard AND Droplet Precautions in the care of any resident with influenza-like illness. (see Infection Prevention and Control section)
- Standard Precautions must be used when providing care to all residents – regardless of whether they have influenza-like illness or not.
Confine symptomatic residents with suspected or confirmed influenza and their exposed roommates to their rooms or on one unit (i.e., cohorted) for five days (seasonal influenza) or seven days (H1N1 novel influenza) following the onset of symptoms.
- Assign staff to work on only one unit, if possible.
Confine the first symptomatic resident and exposed roommate to their room, restrict them from common activities, and serve meals in their rooms.
- If other residents become symptomatic, cancel common activities and serve all meals in resident rooms. If residents are ill on specific wards, do not move patients or staff to other units, or admit new residents to the units with symptomatic residents.
To maintain the residents' ability to socialize and have access to rehabilitation opportunities during periods when influenza infections are unlikely and no influenza is suspected or confirmed, residents with symptoms of respiratory infections can be permitted to participate in group meals and activities if they can be placed three to about six feet from other residents and can adhere to respiratory hygiene/cough etiquette.
Limit visitation and exclude ill visitors via posted notices.
Monitor staff absenteeism due to respiratory symptoms and exclude those with influenza-like symptoms from patient care.
Restrict staff movement from areas of the facility having outbreaks to areas without patients with influenza.
Consider limiting new admissions to the affected unit or to the facility – depending on the number of ill residents and ill staff.
Administer influenza antiviral chemoprophylaxis and treatment (See: Antiviral Medications for Treatment and Prevention section) to residents and/or staff according to current recommendations, based on MDH laboratory test results.
Residents receiving antiviral treatment for influenza should continue to be confined until treatment is completed because residents may still be infectious and rarely may be shedding antiviral resistant viruses