Long-Term Care Survey Alert

Published on Thu Jul 23, 2009 PDF

4 ways to give your surveillance efforts a booster.

It's official: The World Health Organization has declared a swine flu pandemic.

And that means your facility needs to be ready to identify and report what could turn out to be the tip of an outbreak in your community.

"Experts do predict that the novel H1N1 will be a predominant flu this coming flu season," says James Marx, RN, MS, CIC, an infection control expert and principal of Broad Street Solutions in San Diego. And even if the swine flu doesn't end up being a major problem, your ramped-up surveillance will pay off by preventing the spread of other seasonal flu viruses and communicable illnesses, such as the norovirus. Here's what experts suggest you should do now.

"Identifying potential cases of swine flu (novel H1N1) can be tricky," says Deborah Burdsall, RN, MSN, CIC, infection preventionist at Lutheran Home in Arlington Heights,Ill., and a spokesperson for the Association for Professionals in Infection Control. That's because some of the symptoms for novel H1N1 -- sudden onset of fever with headache, sore throat, and the usual flu aches and pains -- may not stand out as something unusual. But the novel H1N1 virus also has "a component of diarrhea and nausea, which isn't always true of influenza. In addition, the Centers for Disease Control & Prevention has noted that some people with H1N1 were complaining of sudden dizziness," Burdsall notes.

Good idea: Evaluate staff members' symptoms, too -- and weed out false alarms. For example, if a staff person reports that she had 24 to 48 hours of nausea and vomiting without a respiratory component or fever -- that's most likely a GI virus, says Burdsall. "That is not influenza."

The facility needs systematic ways to detect the first signs of potentially communicable illness. For one, look at the 24-hour nursing report, and talk to front-line staff to find out what they noted in shift report. Doing walking rounds, the nurse can pick up valuable information from the CNAs who might mention that a resident "doesn't look right" or "doesn't seem himself," Burdsall says.

Tip: "The supervisors and schedulers can quickly tell you if staff members are sick," adds Burdsall. "That approach works well for any communicable disease."

Be preemptive: Screen all patients for signs and symptoms of febrile respiratory illness "at any point of entry to the facility," advises the CDC in its interim guidance for infection control or care of patients with confirmed or suspected novel H1N1 in any healthcare setting.

In a potential pandemic situation, the clock is ticking. So make sure you can quickly report a suspected case of novel H1N1 from the frontline staff to the facility administration to the public health authorities.

Best practice: If they haven't already, the facility infection control staff should introduce themselves to the county health department to which they will report, advises Burdsall. You need a name, phone number and e-mail address in case the facility has to report an illness with a "high index of suspicion for a highly contagious or potentially dangerous pathogen, such as H1N1 flu or norovirus, etc."

Also review the list of diseases the facility has to report. "Each [geographical] location is slightly different in that regard," Burdsall points out.

The CDC urges healthcare providers to monitor the H1N1 flu Web site at www.cdc.gov/H1n1flu/update.htm and local health department Web sites for information.

For example, "Healthcare facilities should be reviewing and making plans to implement their facility contingency response and/or pandemic response plans," urges the CDC. This includes planning to manage increasing patient volume and potential staffing shortages.

Editor's note: Check out the pandemic flu preparation checklist for long-term care facilities at www.pandemicflu.gov/plan/pdf/longtermcare.pdf. And read about the key infection prevention and control measures for novel H1N1 in the next Long-Term Care Survey Alert.