As Influenza and other serious respiratory illnesses are rapidly spreading in the US (based on the CDC’s FluView Influenza Surveillance Report), we are seeing that the dominant strain appears to be the more severe and highly transmissible Influenza H3N2 subclade (see “Influenza A(H3N2) Subclade K Virus: Threat and Response” in the December 18 edition of JAMA for additional details). This variant is also a partial mismatch with this year’s flu vaccine, increasing the likelihood that it may spread through our more medically fragile patient populations.

Planning Now Can Make a Real Difference

Regardless of whether flu has arrived in your facility or not, taking steps now to prepare your facility and staff can make a huge difference in the outcomes for your patients.

I learned early in my career that preparation and planning can go a long way toward minimizing impact from these respiratory illnesses. In the mid-90s, I served as medical director for a facility in the Seattle area that had been decimated by an especially severe influenza outbreak the year before my arrival. Determined to prevent a repeat, I developed an intensive influenza prevention and containment program for my facilities, and led the staff in implementing systematic detection and containment practices to minimize transmission for the following year. The results were astonishing—nearly zero fatalities from influenza among our patients by taking a few proactive steps.

Ideas for Developing Your Containment & Prevention Plan

We now employ an established checklist in our facilities for detecting, treating, and isolating respiratory illness outbreaks in our facilities based on what I learned from those early experiences, and we continue to update our process as new guidance emerges. I encourage you and your teams to stand ready and employ some of the tools we currently have available, including:

  • Have flu testing supplies available in advance of outbreaks and be proactive in confirming flu cases promptly. Research has demonstrated that utilizing rapid testing improves influenza containment in our facilities, although they are less sensitive. Start out with POC of Influenza and COVID If you receive a negative result from a rapid test when symptoms are present, follow up with PCR testing that also includes COVID and RSV to further evaluate and narrow down your diagnosis.
  • Carefully track cases and contain the infection by keeping infected/exposed patients in their rooms or wards, cancelling common activities, and having patients receive meals and therapy sessions in their rooms. Minimize patient and staff transfers from exposed areas of your facility while infected patients are still in their most contagious stages of illness. Increase environmental cleaning and disinfecting measures as well. Our experiences with COVID taught us a great deal about how to effectively manage disease outbreaks in our facilities, so employ those measures with other illnesses too.
  • Ensure your pharmacy has adequate antiviral and chemoprophylactic supplies on hand to respond quickly to new cases. Olsetamivir remains an effective agent to treat and use in a prophylactic manner to both reduce infection and minimize serious complications. Consider keeping a few doses in your e-kit to respond promptly to suspected cases. Work closely with your pharmacist and your medical director to have patients’ renal function test results at hand so you can dose appropriately.
  • Use chemoprophylaxis for those in close contact with an infected patient, and isolate to prevent further spread during the window where patients are most contagious. Encourage your staff to obtain chemoprophylaxis from their primary care providers and initiate treatment promptly if they are exposed or show symptoms as well. If cases are confined to one ward, administer to entire ward. If cases extend to more than one ward, administer to your entire facility.
  • Monitor staff absenteeism for emerging cases and use similar protocols to prevent spread to those providing care to your patients.

Remember, these treatment, testing, and prophylactic tools are available to us—employ them fully. Develop a plan for your facility, work with your pharmacist, and obtain needed supplies to test your patients and identify confirmed cases. Although the flu vaccine is less effective for preventing transmission this year, evidence shows that vaccinated patients who do contract influenza experience fewer serious complications than those who are not vaccinated—that goes both for our patients, and our teams as well.

Don’t Stop at Flu Diagnosis

And lastly, if your patient with respiratory illness symptoms doesn’t test positive for the flu or COVID, keep digging. For the first time I am also seeing more RSV in our facilities, and we can approach these infections with the same urgency as the other more common respiratory viruses. Triple-testing methods for COVID, Influenza and RSV are now available to identify specific illnesses and assist in containment and prevention. Standing ready to intervene preemptively for emerging strains of disease is key to keeping our facilities healthy during the respiratory virus season.