Transcript Urinary Tract Infections in Long Term Care

Influenza 2013 - 2014
Gregory Gahm, MD
Epidemiology
How significant is influenza - really?
Influenza Epidemiology
The Influenza Virus
Getting Infected…
Viral Replication
Viral Replication
Viral Replication
Viral Replication
Multiplication & Migration of the Virus
Preventive Medicine
How do I stay healthy?
The best way to prevent flu is to
GET VACCINATED!!! - unless:


You’ve had a documented serious reaction to a previous dose
You’ve had Guillain-Barre associated with the vaccine
Few Side Effects



Most common → redness, soreness or swelling
at injection site (Bravo! for your immune system!)
Less common → fever and body aches
Egg allergy is not a contraindication – esp
with a new recombinant vaccine made
without any eggs used in the process
Recipe for Making a Flu Vaccine
AKA: Why you
can’t get the flu
from the vaccine
Making a Vaccine – Step 1
Inoculate eggs with the virus
Making a Vaccine – Step 2
Incubate until egg is full of live virus
Making a Vaccine – Step 3
Separate virus from egg, discard egg

Making a Vaccine – Step 4
Thoroughly KILL virus
(chemically, multiple times)
Making a Vaccine – Step 5
Chop KILLED virus into small pieces
Making a Vaccine – Step 6
Discard the killed RNA
Making a Vaccine – Step 7
Put remaining viral shell pieces with
Hs & Ns into vaccine
Benefits of being vaccinated
The ACIP recommends
Universal Vaccination
(everyone >6 months old)
For NH residents the vaccine reduces the risk of:



Hospitalization by 50%
Pneumonia by 60%
Death and complications related to flu by 75-80%
In kids / young adults, it is 70-90% effective in preventing flu
(also keeps them from spreading it to sibs, parents and our patients)
Flu Vaccines for 2013-14
Viral Strains




A/California/7/2009 (H1N1)
A/Victoria/361/2011 (H3N2)
B/Massachusetts/2/2012
+/- B/Brisbane/60/2008
Vaccines Available





LAIV (FluMist; 2 – 49 yo) – Quadrivalent
Tri - & Quadri - valent inactivated vaccine (IM)
High Dose Fluzone (over 65)
Intradermal Fluzone (ages 18-64)
RIV3 = Recombinant, egg-free vaccine for persons 18 – 49 yo
High Dose Fluzone

For ages >65 only

Contains 4X the antigen for each of the 3 viral strains

Only 20-25% of frail elderly (NH pts) develop protective
antibodies with the normal seasonal vaccine

Non-serious adverse events were more frequent




Pain at injection site
Muscle aches
Redness / swelling at injection site



Headache
Low-grade fever
Malaise
Serious adverse event rates were equivalent
How do I stay healthy?






Avoid close contact with people who are sick
Stay home when you are sick
Cover mouth & nose when coughing / sneezing
Cover mouth & nose when someone else
coughs or sneezes!
Wash your hands and practice other good,
common sense health habits
VENTILATE! Open doors & windows on nice days!
Clinical Medicine
Influenza Recognition and Treatment
Influenza

A Respiratory Virus


NOT the ‘stomach’ flu
Spread by coughing and sneezing
Symptoms… AKA…
How do you know if a patient has the flu?

2 Major Symptoms:
 Sudden onset of HIGH Fever
and/or a Nonproductive Cough

LTCFs: watch for multiple cases in a short period of time
Other common symptoms:
Muscle aches – often profound
Sore throat or nasal congestion
Headache
Confusion or Delirium
Rapid Testing

Problems with collecting / sending swabs

Misses H1N1
Antiviral Treatment

If you think someone has the flu:

Involve the provider as soon as there are symptoms!
Meds only work if started <48 hours from start of symptoms

When in doubt, start treatment – STAT – based on clinical judgment






STAY HOME or cohort sick patients in LTCFs!
Plenty of rest, fluids, nutrition
Treat muscle aches / fever with NSAIDs, ASA, Tylenol
Cough / lethargy can last 2 – 3 weeks depending on frailty
Infectious from 1-2 days before symptoms start until 1-2 days after coughing stops
CDPHE Mandatory Vaccination in LTC
General Provisions
Healthcare entities and workers have a shared
responsibility to prevent spread of infection and
avoid causing harm to their patients or residents by
taking reasonable precautions to prevent the
transmission of vaccine-preventable diseases.
Vaccine programs are, therefore, an essential part of
infection prevention and control for slowing or
stopping the transmission of seasonal influenza
viruses from adversely affecting those individuals
who are most susceptible.
Definitions

Employee: any person who performs a service for
wages or remuneration, including students, trainees,
persons who have individual contracts with the
healthcare entity, physicians with staff privileges
and allied health professionals with privileges.

Does not include volunteers or persons who provide
services through a contractual arrangement between
the licensee and a separate organization, association
or other healthcare entity.
Definitions

Healthcare Worker: any person, working in a facility who has
the potential for exposure to patients, residents or consumers of
the entity and/or to infectious materials, including body
substances, contaminated medical supplies and equipment,
contaminated environmental surfaces or air.

Includes, but is not limited to physicians, nurses, CNAs,
therapists, techs, EMTs, dental personnel, pharmacists, lab
personnel, students, trainees, contractual personnel, and persons
not directly involved in patient care (eg, clerical, dietary,
housekeeping, laundry, security, maintenance, billing and
chaplains)
Definitions

Influenza Season: November 1 through March 31

Proof of Immunization: A written statement from a
licensed healthcare provider who has administered a
flu vaccine to a healthcare worker
Vaccination Targets to be Exempt from Masks
% of Employees
Vaccinated by Dec 31
2012
60%
2013
75%
2014
90%
Other Requirements to be Exempt from Masks
1
2
3
4
5
6
7
Have defined procedures to prevent spread of flu from unvaccinated
workers
Maintain documentation for 3 years
Report vaccination to CDPHE by March 31
Provide vaccine for each healthcare worker
Have a written policy regarding vaccination of your healthcare workers
that addresses:

Proof of immunization, or

A signed medical exemption
Maintain proof of annual immunization for employees
Inform other healthcare workers who provide services on the premises
that you have these policies, require them to be immunized or wear a
mask, and you can provide the mask.
Masks
Each healthcare worker without proof of
immunization must wear a surgical or procedure
mask during flu season when in direct contact with
patients and in common areas.