Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-20T05:22:01.575Z Has data issue: false hasContentIssue false
  • English
  • Français

Delays in the Application of Outbreak Control Prophylaxis for Influenza a in a Nursing Home

Published online by Cambridge University Press:  02 January 2015

Paul J. Drinka ,
Peggy Krause ,
Lori Nest ,
Stefan Gravenstein ,
Brian Goodman  and
Peter Shult
Paul J. Drinka*
Affiliation:
Wisconsin Veterans Home, King; Internal Medicine/Geriatrics, University of Wisconsin, Madison and theMedical College of Wisconsin, Milwaukee, Wisconsin
Peggy Krause
Affiliation:
Wisconsin Veterans Home, King, Wisconsin
Lori Nest
Affiliation:
Wisconsin Veterans Home, King, Wisconsin
Stefan Gravenstein
Affiliation:
Internal Medicine/Geriatrics, Eastern Virginia Medical School, Norfolk, Virginia
Brian Goodman
Affiliation:
Veterans Administration Medical Center, Madison, Wisconsin
Peter Shult
Affiliation:
Communicable Diseases Division, State Laboratory of Hygiene, Madison, Wisconsin
*
Wisconsin Veterans Home, N2665 County Road QQ, King, WI54946-0620
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To identify delayed prophylaxis from a preexisting database and strategies to improve performance.

Setting:

A skilled nursing facility with 14 floors (4 buildings). The “outbreak unit” was a 50- to 60-bed floor.

Methods:

We performed surveillance during six seasons using one protocol. Prophylaxis was started when influenza was cultured in the building and 10% of residents on the floor had a new respiratory illness within 7 days. We defined delayed prophylaxis as four or more residents on a floor with positive cultures whose specimens had been collected within 5 days before the application of prophylaxis.

Results:

We identified 14 examples of delayed prophylaxis. In three, delayed prophylaxis was related to the 3.9-day delay between culture collection and culture report. There was a high degree of commonality among building attack rates within a season. During six seasons, the first case in the last building occurred 27 to 64 days after the first case in the facility. The two seasons with the greatest activity (68 and 154 cases, respectively) began with explosive, multi-floor outbreaks in a single building. The match between the circulating strain and the vaccine was good, except in 1997-1998 when there were seven examples of delayed prophylaxis.

Conclusions:

Influenza may involve buildings sequentially with a commonality of building attack rates. Explosive, multi-floor outbreaks early in the season could lead to a lower threshold for prophylaxis within a larger area when initial cases are encountered later in the season. This strategy could have prevented five examples of delayed prophylaxis. Rapid testing of multiple specimens while waiting for culture confirmation could have prevented three examples of delayed prophylaxis. (Infect Control Hosp Epidemiol 2002;23:600-603).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 10 , October 2002 , pp. 600 - 603
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Advisory Committee on Immunization Practices (ACIP). Prevention and control of influenza: recommendations of the ACIP. MMWR 2001; 50(RR04):146.Google Scholar
2.Bradley, SE, LTC Committee of the Society for Healthcare Epidemiology of America. Prevention of influenza in long-term care facilities. Infect Control Hosp Epidemiol 1999;20:629–637.Google Scholar
3.Drinka, PJ, Gravenstein, S, Langer, E, Krause, P, Shult, P. Mortality following isolation of various respiratory viruses in nursing home residents. Infect Control Hosp Epidemiol 1999;20:812–815.Google Scholar
4.Drinka, PJ, Gravenstein, S, Schilling, M, Krause, P, Miller, BA, Shult, P. Duration of antiviral prophylaxis during nursing home outbreaks of influenza A. Arch Intern Med 1998;156:3155–3159.Google Scholar
5.Gravenstein, S, Drinka, P, Osterweil, D, et alA multicenter prospective double-blind randomized controlled trial comparing the relative safety and efficacy of zanamivir to rimantadine for nursing home influenza outbreak control. Presented at the 40th Interscienee Conference on Antimicrobial Agents and Chemotherapy; September 17-20, 2000; Toronto, Ontario, Canada. Abstract 1155.Google Scholar
6.Patriarca, PA, Weber, JA, Parker, RAet alEfficacy of influenza vaccine in nursing homes. JAMA 1985;253:1136–1139.CrossRefGoogle ScholarPubMed
7.Centers for Disease Control and Prevention. Update: influenza activity, US and worldwide, 1997-98 season, and composition of the 1998-99 influenza vaccine. MMWR 1998;47:280–284.Google Scholar
8.Hayden, FG, Atmar, RL, Schilling, M, et alUse of the selective oral neuraminidase inhibitor oseltamivir to prevent influenza. N Engl J Med 1999;341:1336–1343.CrossRefGoogle ScholarPubMed
9.Peters, P, Gravenstein, S, Norwood, P, et alLong-term use of oseltamivir for the prophylaxis of influenza in a vaccinated frail older population. J Am Geriatr Soc 2001;49:1025–1031.Google Scholar
10.Gomolin, IH, Leib, HB, Arden, NH, Sherman, FT. Control of influenza outbreaks in the nursing home: guidelines for diagnosis and management. J Am Geriatr Soc 1995;43:71–74.CrossRefGoogle ScholarPubMed
11.Welliver, R, Monto, AS, Carewicz, O, et alEffectiveness of oseltamivir in preventing influenza in household contacts: a randomized controlled trial. JAMA 2001;285:748–754.CrossRefGoogle ScholarPubMed
12.Hayden, FG, Gubareva, LV, Monto, AS, et alInhaled zanamivir for the prevention of influenza in families. N Engl J Med 2000;343:1282–1289.Google Scholar
13.Drinka, PJ, Krause, P, Nest, L, Miller, J, Gauerke, C. Experience with a rapid diagnostic test for influenza. Infect Control Hosp Epidemiol 2002;23:561.Google Scholar
14.Cohen, HE, ed. Red Book. Montvale, NJ: Medical Economics; 2002.Google Scholar