Flu Resource Pack for Care Homes 2019/20 Cheshire and Merseyside

1. Flu Resource Pack for Care Homes 2019/20 Cheshire and Merseyside PHE North West Health Protection Team (Cheshire and Merseyside, Greater Manchester and Cumbria and Lancashire)

2. Overview • Key messages and impact of flu • Preparing for flu • Actions for a single case of flu • Actions for an outbreak of flu or flu-like illness • Key Contacts • Flu Resources NW SLT event

3. Key Messages • Flu is not just a bad cold, it can be a serious illness in certain groups of people:

4. Key Messages • Care home residents are more at risk because they: • Are older • Have underlying medical conditions • Live closely, and spend a lot of time with, other residents and staff • Therefore have multiple risk factors: being over age 65 years, have a long term condition and reside in a long-stay home

5. Impact of Flu Outbreaks • Elderly care home residents are more likely to suffer severe symptoms, require hospitalisation or die from flu. • Greater resources required for infection control in care home. • Potential closure of care home to new admissions. • Potential impact on reputation of care home from severe cases or deaths.

6. Key Messages • Each winter different types of the flu virus circulate, so people need to be vaccinated every year. • Frontline staff have a duty of care to protect their residents from flu, particularly those who may have a poor response to their own vaccination. • The flu vaccine is the best way to protect people against flu: eligible residents and ALL STAFF should be vaccinated each year. • Good infection control practice is essential to limit the spread of flu, particularly once a case occurs in a care home. NW SLT event

7. Preparing for Flu Action Card

8. Preparing for Flu 1 • Nominated Lead • Nominate a staff member to act as the influenza coordinator for your home and share flu pack with ALL staff. • Flu Vaccination • Ensure care home GP/Pharmacist administers the seasonal flu vaccine to ALL residents aged over 65 and those with a chronic health condition in September to early November BEFORE outbreaks. • Ensure ALL staff involved in patient care (including pregnant women) have received their FREE seasonal flu vaccine in September to early November via their registered GP or local pharmacy. • Staff can show their identification badge or pay slip to prove their eligibility.

9. Preparing for Flu 2 • Keep Records • Maintain a record of flu vaccination status and latest kidney function tests of ALL residents and share with care home GP practices – template provided in pack. • Infection Control • Ensure ALL staff read and follow care home infection control policies. • Reinforce Catch it, Bin it, Kill it hygiene messages with staff, residents and visitors. • Provide liquid soap/disposable paper towels/alcohol-based hand rub in every room, communal areas, entrances and exits. • Provide Personal Protective Equipment (PPE): disposable gloves, aprons, surgical masks. • Ensure linen management and clinical waste disposal systems are in place. • Maintain adequate stock of cleaning materials (disposal cloths, detergent). • Inform local Community Infection Prevention Control Team (CIPCT) if a resident is transferred back from a hospital/home with a flu outbreak.

10. When to Suspect Flu • Symptoms of flu or influenza like illness include:

11. Resident displaying signs and symptoms of flu like illness Suspected Single Case of Flu Protect Case Isolate Case • Single room until recovered or 5 days after onset of symptoms • Tissues • Covered sputum pots • Hygienic disposal Protect Other Residents GP Assessment of Case • May require investigations: • Sputum • Nose and throat swab Isolate Immunocompromised Residents Infection Control Measures • Hand hygiene • Respiratory hygiene • PPE for staff • Environmental cleaning Supportive Management • Rest • Keep warm • Plenty of fluids Treatment Prescribed by GP following medical review

12. When to suspect a flu outbreak? • Two or more cases which meet the clinical case definition above, arising within the same 48-hour period in people who live or work in the care home NW SLT event

13. Suspected Flu in Staff Member • Symptomatic staff should be excluded from care home until fully recovered • Symptomatic bank staff should also be excluded from other care homes they work in.

14. Flu Outbreak Action Card

15. Enhanced Infection Control • Hand and respiratory hygiene for residents, staff and visitors • Isolate symptomatic cases – single rooms or cohort together • Cohort staff to symptomatic and well residents • Bank staff should not work in other homes/hospitals until 2 days after last contact with the home, or if exposure is continuous, when the home re-opens • Exclude symptomatic staff and visitors until recovered • Discourage visits from elderly, very young or pregnant women • Provide tissues, and alcohol-based hand runs in communal areas, entrances and exits • Provide PPE for staff • Enhanced environmental cleaning • Avoid transfers in and out of home • Limit hospital attendances to urgent cases ;forewarn hospital • Discuss discharges from hospital to care home with CIPCT/ HPT • Discuss partial or whole closure to new admissions with CIPCT/HPT Suspected Flu Outbreak Report Outbreak • CIPCT in hours • PHE Health Protection Team (HPT) out of hours Contact GP • Assess symptomatic residents • Advise on immediate treatment • Liaise with CIPCT Implement • Ensure advice from GP/CIPCT/ HPT in completed • Support collection of swabs from symptomatic residents • Ensure prescribed medications (antivirals) given in a timely manner Document • Influenza outbreak coordinator to: • Monitor residents daily to identify new, symptomatic residents • Complete daily list of residents with suspected/confirmed flu • Share information with CIPCT/HPT/HC provider as required • gggggg

16. Reporting a Suspected Flu Outbreak NW SLT event

17. Contact Details

18. PHE Role in Flu Outbreak • PHE will work with care home, GP and CIPCT to assess if the outbreak is likely to be flu. • Advise on initial infection control measures (out of hours). • Advise if, and how, swabs should be taken. • May set up an Outbreak Control Team to coordinate actions. • Trigger the use of antivirals, if appropriate. • Assist with outbreak communication to NHS, the media and public if required. • An outbreak of flu is usually declared over once no new cases have occurred in the 5 days since the appearance of symptoms in the last case.

19. Resources • To order leaflets and posters: • https://www.orderline.dh.gov.uk/ecom_dh/public/home.jsf (free to order and deliver) • To download leaflets and resources: • Guidance on outbreaks of influenza (flu) in care homes poster: https://www.gov.uk/government/publications/guidance-on-outbreaks-of-influenza-in-care-homes-poster • The flu vaccination leaflet: https://campaignresources.phe.gov.uk/resources/campaigns/34/resources/2347 • All about flu and how to stop getting it: https://campaignresources.phe.gov.uk/resources/campaigns/34/resources/2345 (EasyRead leaflet for people with learning disabilities)