Preparations for the Upcoming Flu Season
While the coronavirus is a previously unfamiliar enemy, an old menace—the flu season—is about to make its usual fall appearance.
Denise Winzeler, RN-BSN
9/1/2020
All eyes and resources in the long term care profession currently
are focused on the COVID-19 pandemic, and rightfully so. This virus has
spread through facilities like nothing seen before.
Unlike COVID-19, the flu season arrives like clockwork on a yearly
basis. Unfortunately, in addition to the ongoing pandemic, flu season is
looming just around the corner. Now more than ever, facilities need to
be proactive in protecting their residents.
This article will spotlight four areas for facilities to focus on for
influenza prevention and control this fall, while also remaining in
substantial compliance with the Focused Infection Control Survey from
the Centers for Medicare & Medicaid Services.
Personal Protective Equipment
PPE is crucial in preventing the spread of viruses such as
influenza and the coronavirus. According to the Centers for Disease
Control and Prevention (CDC), health care personnel (HCP) need to
implement standard precautions when caring for residents with influenza.
These include:
- Hand hygiene;
- Glove use for any contact with potentially infectious material; and
- Gown use for any patient-care activity when contact with blood, body
fluids, secretions (including respiratory), or excretions is
anticipated.
Moreover, HCP and facilities also must implement droplet
precautions. Because these entail the addition of facemasks and eye
protection, facility leadership needs to ensure the building has enough
PPE on hand for staff to wear when caring for residents with influenza.
Due to COVID-19, some facilities may struggle to maintain PPE
stocks. CDC offers on its website guidance for optimizing PPE, along
with a burn rate calculator for facilities facing shortages. Not only
does the facility need adequate PPE to prevent and reduce the spread of
influenza, but surveyors will also be reviewing PPE stock to determine
if it is adequate.
If PPE is in short supply, surveyors will also review steps the
facility took to address the shortage. If a facility does not already
have a procedure in place for monitoring PPE par levels (the amount of
PPE on hand), it should immediately initiate one to ensure staff have
the PPE needed.
Facilities also need to ensure HCP are competent in the performance
of PPE utilization. PPE utilization is a large focus of the new Focused
Infection Control Survey and is one of the top two citations facilities
are receiving. The Occupational Safety and Health Administration
requires that each HCP knows the following regarding PPE:
- When it is necessary;
- What kind is necessary;
- How to properly put it on, adjust, wear, and take it off;
- The limitations of the equipment; and
- Proper care, maintenance, useful life, and disposal of the equipment.
Facility leadership should conduct competency observations of staff
prior to influenza season and provide ongoing, just-in-time education
when a caregiver is observed in noncompliance.
Vaccination
The influenza vaccine is an essential part of protecting residents.
CDC recommends an annual influenza vaccine for all eligible persons
aged six months and older.
Appendix PP of the State Operations Manual, under F-tag 883,
provides the guidance that surveyors will apply. The facility must
develop policies and procedures to ensure that:
- Each resident is offered an influenza immunization from Oct. 1
through March 31 annually, unless the immunization is medically
contraindicated, or the resident has already been immunized during this
time period. The facility should secure the supply from its pharmacy by
the end of September or as soon thereafter as possible.
- Each resident, or his or her representative, receives education on
potential side effects of the vaccine. This should be completed when
obtaining consent at least one week prior to administration of the
vaccine. Facilities should have a plan in place for this, especially if
there are restrictions on visitation.
- The resident or the resident’s representative has the opportunity to
refuse immunization. Vaccine administrations and refusals alike should
be documented in the medical record.
- Prior to administering the influenza vaccine, the facility should:
- Consider whether the facility has been in touch with its pharmacy to
pre-order enough of the current influenza vaccine for residents and
employees. If not, managers need to do so immediately.
- Review current influenza education tools to ensure they are current.
- Review current influenza screening tools to ensure they are current.
- Review current influenza consent forms to ensure they are current.
- Review staffing to ensure enough staff are on hand to administer the
vaccines and monitor the residents according to facility policy.
Testing
CDC says influenza testing should occur in the facility when
residents show signs and symptoms of influenza-like illness. Although
COVID-19 and influenza share many similarities, CDC guidance emphasizes
key differences that may assist the facility and physician in
determining if an influenza test is warranted.
The facility should ensure there are enough influenza test kits in-house prior to the influenza season in case they are needed.
Education
- Education of staff is a very important piece of the infection
control puzzle. Facilities should begin influenza education now, and
include, at a minimum, the following:
- Facility policy and procedures on isolation precautions and cohorting;
- Hand hygiene—education should be combined with verification of competency;
- PPE utilization and donning/doffing—education should be combined with verification of competency;
- Facility policy and procedure on influenza vaccination of residents, including but not limited to:
Consents;
Education and screening of residents/resident representatives;
Administration of vaccine;
Monitoring of residents post-vaccination;
- Signs and symptoms of influenza; and
- Facility policy and procedure for influenza testing.
Regardless of a facility’s current situation, flu season is coming.
Focusing on these key areas will help prepare the facility for the
2020-2021 influenza season—and may also help with ongoing coronavirus
preparedness and response. With targeted efforts, started now,
facilities can avoid being overwhelmed by the rapidly approaching
influenza season.
Denise Winzeler, RN-BSN, LNHA, DNS-CT, QCP, is curriculum
development specialist for the American Association of Directors of
Nursing Services (AADNS). She can be reached at dwinzeler@AAPACN.org.