Preparing for a Flu Pandemic

According to a July 26, 2006, report from the World Health Organization, there have been 232 cases worldwide of avian influenza and 134 deaths. As of this writing, there is no known case of human-to-human transmission of this virus, although there have been reports that there is an Indonesian family with multiple cases of the disease, which marks the first time that a family cluster has contracted the disease.

Although the initial symptoms are similar to regular influenza, pandemic flu is likely to be far more serious and deadly because there are no known vaccines for humans. Pandemic flu can spread outside the normal flu season (November to March) and cause much greater social disruption than regular flu.

Because nursing homes serve very high-risk and susceptible populations, healthcare professionals cannot assume that a flu pandemic simply won’t happen, no matter how minimal the chances of occurring. The stakes are simply too high. These professionals must be vigilant in preparing for this crisis to safeguard the elderly and disabled individuals who are most at risk.

Because of the dangers pandemic flu presents, the Illinois Council on Long Term Care, a professional association representing nearly 200 nursing homes that serve more than 37,000 residents, has been educating its members on how to prepare for this potential crisis. Council representatives have attended flu pandemic conferences sponsored by the Illinois Department of Public Health and have participated in flu exercises involving coordinated public safety responses. In addition, the Illinois Council has written several clinical newsletters on the avian flu pandemic and has drafted a model facility policy for its membership.

The Illinois Council offers the following recommendations to nursing home professionals on preparing for a flu pandemic. We encourage readers to look over this material to make sure they have considered several of the most important avenues of preparation.

The Importance of Infection Control
If a flu pandemic strikes, nursing home residents will generally not be going out of their buildings to become infected with the disease. Instead, the risk will come from others bringing the virus in with them. Nursing home professionals will need to employ the strictest of infection-control procedures that include the following:

• Stop visitors at the door and check for flu-like symptoms. No one with flu-like symptoms should be allowed in the building because it will put residents at extreme risk. Facilities should post signs outside the front doors indicating that anyone with flu-like symptoms should not come in.
• Have items, such as facial masks, boxes of tissue, hand gel sanitizers, and pamphlets describing appropriate coughing techniques available throughout the building at “respiratory” kiosks.
• Have staff members providing care to residents with flu-like symptoms follow strict isolation procedures, wearing gloves, facial masks, and gowns as needed.
• Educate everyone involved. Nurses should review infection-control guidelines with the staff and teach families about proper respiratory hygiene. Families should be asked not to visit the facility if they are feeling ill.
• Keep all residents with flu-like symptoms in one section of the building, away from healthier residents. Designate one team of staff members to work in this section only.

Unlike seasonal flu, even healthy people will be at increased risk for serious complications because no one has developed immunity to this virus. The symptoms can progress to complications and death in as quickly as two days. Because of the rapid progression of this illness, professionals must be ready to act quickly to isolate and protect residents from harm.

Develop a Pandemic Flu Policy
Pandemic flu preparation should be treated as one of the nursing home’s most crucial forms of emergency planning. Facilities should develop a multidisciplinary planning committee to gear up for a flu pandemic. The committee should assign one person to monitor public health advisories and update committee members when pandemic influenza is nearing the facility’s geographic area. This committee should also develop a pandemic flu policy that includes considerations such as the following:

• Evaluate and diagnose residents and staff with flu-like symptoms. Procedures should be in place to isolate residents when necessary to prevent the spread of influenza.
• Communicate with staff, residents, and responsible parties regarding the status of pandemic flu in the facility. Plan how this communication will take place, such as through e-mail, letters, or phone calls.
• Plan for staff absences. Facility leaders will need to decide how to handle staff who get sick at work; who are symptomatic, but well enough to work; and those who need to take care of sick family at home. How will the facility get extra employees if staffing is running short?
• Plan on how the facility will get the vaccine and antivirals when they become available. Facility representatives should know the agencies that will be in charge of distribution and their locations.
• Be prepared to provide acute care in the nursing facility in case the local hospitals become overloaded.
• Plan to stockpile at least a week’s supply of consumable resources, including medical supplies, when there is evidence that pandemic influenza has reached the United States.

The most important piece of advice is to remain informed about the key issues. For the latest advisories about the pandemic flu, committee members can visit the official federal government Web site at www.pandemicflu.gov. Another source of information is the Centers for Disease Control and Prevention (CDC), which has a hot line, (800) CDC-INFO, and Web site, www.cdc.gov/flu/avian.

The Department of Health and Human Services and the CDC have also released a pandemic influenza planning checklist for long-term care facilities. This document is available at www.pandemicflu.gov/plan/LongTermCareChecklist.html.

Nursing home professionals are dedicated to protecting the health, safety, and well-being of the vulnerable populations they serve. They cannot simply assume that a flu pandemic won’t happen, no matter how minimal its chances of occurrence. By planning ahead, and staying informed, these professionals can create a strong safety net of care for the thousands of elderly and disabled citizens who are the most in danger of falling prey to this epidemic.