You can review and change the way we collect information below. If resident movement or transport is necessary, have the resident wear a facemask (e.g., surgical or procedure mask), if possible. Older adults and other long-term care residents, including those who are medically fragile and those with neurological or neurocognitive conditions, may manifest atypical signs and symptoms of influenza virus infection (e.g., behavior change), and may not have fever (https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy866/5251935). Quality Improvement Organizationsexternal icon. There are no FDA-cleared influenza diagnostic assays that utilize saliva specimens. *Note that older adults and other long-term care residents, including those who are medically fragile and those with neurological or neurocognitive conditions, may manifest atypical signs and symptoms of influenza virus infection (e.g., behavior change), and may not have fever (https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy866/5251935). These cookies may also be used for advertising purposes by these third parties. Test any resident with symptoms of COVID-19 or influenza for both viruses. If single room isolation or cohorting of residents with SARS-CoV-2 and influenza virus co-infection is not possible, consult with public health authorities for guidance on other management options (e.g., transferring the resident; placing physical barriers between beds in shared rooms and initiating antiviral chemoprophylaxis for roommates to reduce their risk of acquiring influenza). CDC Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities . The updated guidance, which applies regardless of a nursing home's level of vaccination status, includes the following recommendations: Source control - Everyone in a health care facility. J Am Geriatr Soc 2002; 50:60816. Perform hand hygiene before and after touching the resident, after touching the residents environment, or after touching the residents respiratory secretions, whether or not gloves are worn. You can review and change the way we collect information below. Visit. When at least 2 patients are ill within 72 hours of each other and at least one resident has laboratory-confirmed influenza, the facility should promptly initiate antiviral chemoprophylaxis with oral oseltamivir to all non-ill residents living on the same unit as the resident with laboratory-confirmed influenza (outbreak affected units), regardless of whether they received influenza vaccination during the current season. The following influenza tests are recommended: molecular assays, including rapid molecular assays, other molecular tests, or reverse transcription polymerase chain reaction (RT-PCR). Antiviral treatment works best when started within the first 2 days of symptoms. Ask a family member or friend to help you schedule a vaccination appointment if you cant get vaccinated on site. New federal data shows adults who received the updated shots cut their risk of being hospitalized with . If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Some patients, such as older adults, children with neuromuscular disorders, and young infants, may have atypical clinical presentations. See the CDC guidance Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination for information on communal dining and activities. Most COVID-19 deaths occur in people older than 65. Influenza Other Respir Viruses 2014; 8:7482. The local public health and state health departments should be notified of every suspected or confirmed influenza outbreak in a long-term care facility, especially if a resident develops influenza while on or after receiving antiviral chemoprophylaxis. Intern Med 2002; 41:36670. CMS and CDC continue to provide guidance for nursing homes and other long-term care . Additionally, CDC has developed guidance to implement facility-wide testing in nursing homes and updated the interim testing guidance to integrate testing with other core prevention strategies. The burden of respiratory infections among older adults in long-term care: a systematic review. While CDC recommends judicious use of antiviral medications for chemoprophylaxis to reduce the possibility of development and spread of antiviral resistant influenza viruses, chemoprophylaxis may be considered for healthcare personnel, regardless of their influenza vaccination status, if the outbreak is caused by a strain of influenza virus that is not well matched by the vaccine, or based upon other factors (e.g., to reduce the risk of short staffing in facilities and units where clinical staff are limited and to reduce staff reluctance to provide care to residents with suspected or laboratory-confirmed influenza). Interim Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities. CDC. CDC Long-Term Care Facility Vaccine Toolkit; CMS now posts this information on the CMS COVID-19 Nursing Home Data website along with other COVID-19 data, such as the weekly number of COVID-19 cases and deaths. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Many LTC providers have identified strategies and partnerships to obtain and administer COVID-19 vaccines for residents and staff. https://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm Last Reviewed: November 22, 2022 Source: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD) Rainwater-Lovett K, Chun K, Lessler J. More information is available, Recommendations for Fully Vaccinated People, CDCs Infection Prevention and Control Recommendations, more likely to get very sick from COVID-19, characteristics that might accelerate spread, National Center for Immunization and Respiratory Diseases (NCIRD), CDC COVID-19 Response Health Equity Strategy, Upper-Room Ultraviolet Germicidal Irradiation (UVGI), Guidance for Schools & Child Care Programs, Ventilation in Schools and Child Care Programs, Homeless Service Sites & Correctional Facilities, COVID-19 Childrens Eagle Book Coloring Storybook, U.S. Department of Health & Human Services, Facilities that serve unrelated people who live in close proximity and share at least one common room (e.g., group or personal care homes and assisted living facilities) should apply prevention strategies based on, Healthcare services delivered in these settings should be informed by. Residents who receive a COVID-19 vaccine (or their medical proxy) also receive a fact sheet before vaccination. (For more information seeRecommended Dosage and Duration of Treatment or Chemoprophylaxis for Influenza Antiviral Medicationsand (https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy866/5251935). The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Cookies used to make website functionality more relevant to you. Zanamivir should be used when persons require chemoprophylaxis as a result of exposure to influenza virus strains that are suspected or known to be oseltamivir-resistant. Peters PH Jr, Gravenstein S, Norwood P, et al. More information is available, Recommendations for Fully Vaccinated People, Children and teens ages 6 months-17 years, different recommendations for COVID-19 vaccines, Older adults and people with certain health conditions, stay up to date with all recommended COVID-19 vaccines, What to Expect after Your COVID-19 Vaccine, Frequently Asked Questions about COVID-19 Vaccination, Information about Medicare and COVID-19 Vaccine, Talking with Patients about COVID-19 Vaccination, National Center for Immunization and Respiratory Diseases (NCIRD), Possibility of COVID-19 Illness after Vaccination, Investigating Long-Term Effects of Myocarditis, How and Why CDC Measures Vaccine Effectiveness, Monitoring COVID-19 Cases, Hospitalizations, and Deaths by Vaccination Status, Monitoring COVID-19 Vaccine Effectiveness, U.S. Department of Health & Human Services. The following practices should be considered when SARS-CoV-2 and Influenza viruses are found to be co-circulating based upon local public health surveillance data and testing at local healthcare facilities. Bush KA, McAnulty J, McPhie K, et al; Southern New South Wales Public Health Unit. Influenza Surveillance Report (FluView), Previous Forecasts for the 2021-2022 Season, Tools to Prepare Your Practice for Flu Season, Multiplex Assays Authorized for Simultaneous Detection of Influenza Viruses and SARS-CoV-2, Information on Collection of Respiratory Specimens for Influenza Virus Testing, Information for Clinicians on Rapid Diagnostic Testing for Influenza, Algorithm: Interpreting Influenza Testing Results When Influenza is Circulating, Algorithm: Interpreting Influenza Testing Results When Influenza is NOT Circulating, Guide: Influenza Diagnostic Testing in Closed Setting Outbreaks, Guidance: Standard-Based Electronic Laboratory Reporting, Guidance: Antiviral and Obstetric Health Care, Guidance: Outbreak Management in Long-Term Care Facilities, Guidance: Use of Mask to Control Influenza Transmission, Guidance: Prevention & Control in Peri- and Postpartum Settings, U.S. Department of Health & Human Services, Infection Prevention and Control Measures, Influenza-related illness and death, especially among people at increased risk for severe influenza complications. Oseltamivir prophylaxis in controlling influenza outbreak in nursing homes: a comparison between three different approaches. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Influenza can be introduced into a long-term care facility by newly admitted residents, healthcare personnel and by visitors. This guidance applies at all large facilities - nursing, assisted living and residential care. The fact sheet explains the risks and. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Visitors should call ahead to arrange or schedule a visit. These cookies may also be used for advertising purposes by these third parties. Conduct daily active surveillance until at least 1 week after the last laboratory-confirmed influenza case was identified. They help us to know which pages are the most and least popular and see how visitors move around the site. Older adults and other long-term care residents, including those who are medically fragile and those with neurological or neurocognitive conditions, may manifest atypical signs and symptoms of influenza virus infection (e.g., behavior change), and may not have fever. DHS 132, DHS 134, and DHS 145. DHHS Guidance on Masking for Assisted-Living Facilities NEW 7/14/2021 Guidance on Communal Dining/Group Activities for NF and AL Nursing Home Visitation - COVID-19 from CMS Essential Caregiver Guidance for Long-Term Care Facilities Licensure Unit, Office of Outpatient and In-Home Care Services Guidance Making nursing homes better places to live, work, and visit. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Place symptomatic residents in Transmission-Based Precautions using all recommended PPE for care of a resident with suspected SARS-CoV-2 infection1. 03, 2023: The CDC has listed three Connecticut CountiesLitchfield, Middlesex and New Haven Countiesin the Medium/Yellow category as part of its weekly COVID-19 Community Levels update. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Consent or assent for a COVID-19 vaccine is given by LTC residents (or people appointed to make medical decisions on their behalf called a medical proxy) and documented in their charts per the providers standard practice. To report a case of COVID-19 in a long-term care facility: Call the Infectious Disease Epidemiology team at 802-863-7240 (option 7 after business hours or on weekends; option 8 during business hours), or. Information on. Some COVID-19 vaccination providers may require written, email, or verbal consent from recipients before getting vaccinated. Cookies used to make website functionality more relevant to you. Specific recommendations are highlighted below. The facility should encourage all individuals to be up to date with all recommended COVID-19 vaccine doses, based upon the latest recommendations. While highly effective, antiviral chemoprophylaxis is not 100% effective in preventing influenza illness. Less common symptoms can include new or worsening malaise, headache, or new dizziness, nausea, vomiting, diarrhea, and loss of taste or smell. The agency defers to states that may have local guidance restricting the size of gatherings. You can review and change the way we collect information below. Administer each injection in a different injection site. Western Pac Surveill Response J 2016; 7:1420. These cookies may also be used for advertising purposes by these third parties. Use of antiviral drugs for chemoprophylaxis of influenza is a key component of influenza outbreak control in institutions that house residents at higher risk of influenza complications. E) Influenza antiviral chemoprophylaxis considerations.9-14. New Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating. The Centers for Medicare & Medicaid Services (CMS) and CDC continue to . COVID-19 Vaccines for Long-term Care Residents, Safe, Easy, Free, and Nearby COVID-19 Vaccination, Centers for Disease Control and Prevention. Oseltamivir is the recommended antiviral drug for chemoprophylaxis of influenza in long-term care settings. CDC recommends everyone stay up to date with COVID-19 vaccines for their age group: People who are moderately or severely immunocompromised have. Having preapproved orders from physicians or plans to obtain orders for antiviral medications on short notice can substantially expedite administration of antiviral medications. Administer the current seasons influenza vaccine to unvaccinated residents and healthcare personnel as per current vaccination recommendations. Test for influenza with a molecular assay in the following: Ill persons who are in the affected unit(s) as well as previously unaffected units in the facility, Persons who develop acute respiratory illness symptoms after beginning antiviral chemoprophylaxis. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. ACIP recommends that HCP be prioritized in the earliest phase of COVID-19 vaccination. B) Residents confirmed with influenza only should be placed in a single room, if available, or housed with other residents with only influenza. Residents and their families can ask a LTC provider about the current COVID-19 vaccination rate among their staff and residents. On April 27, 2021, CDC released updated healthcare infection prevention and control recommendations in response to COVID-19 vaccination, and CMS issued a revised QSO 20-39-NH (PDF) with updated guidance for visitation, group activities and communal dining in nursing homes accounting for the impact of COVID-19 vaccination. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Facilities can also assess the unique risks of their setting and the populations they serve and use enhanced COVID-19 prevention strategies, described below, to help reduce the impact of COVID-19. Chang YM, Li WC, Huang CT, et al. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. How to Acquire PPE All long-term care facilities are instructed to purchase necessary personal protective equipment. All information these cookies collect is aggregated and therefore anonymous. All information these cookies collect is aggregated and therefore anonymous. Residents with only influenza should be placed in Droplet Precautions, in addition to Standard Precautions. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. The previous CMS guidelines, issued in September 2020 and largely adopted by the states, recommended allowing indoor visits if a facility has been case-free for 14 days and is located in a county with a positivity rate on coronavirus tests of less than 10 percent. CDC's guidance titled Prevention Strategies for Seasonal Influenza in Healthcare Settings contains details on the prevention strategies for all healthcare settings. Immunization of Health-Care Personnel. Implementation of Standard Precautions constitutes the primary strategy for the prevention of healthcare-associated transmission of infectious agents among patients and healthcare personnel. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Talk with the LTC staff about getting vaccinated on site. In addition to monitoring their COVID-19 Community Levels, facilities can consider factors that would indicate heightened risk, including the following: In addition to implementing the recommended prevention steps at each COVID-19 Community Level, congregate settings can consider adopting any of the following enhanced prevention strategies: To receive email updates about COVID-19, enter your email address: We take your privacy seriously. Residential Care Facilities must allow outdoor visits for all residents, regardless of vaccination status, under written policies and implementation plans that include all of the following restrictions and minimum requirements. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. A)Obtain respiratory specimens for influenza and SARS-CoV-2 testing2. No, there is currently no national requirement that residents of assisted living communities wear face masks. Currently, there are no data on the safety and efficacy of COVID-19 vaccines in these populations to inform vaccine recommendations. While these considerations are specific to care of residents residing in nursing homes, some practices could be adapted for use in other long-term care settings (e.g. If a private room is not available, place (cohort) residents suspected of having influenza residents with one another; Wear a facemask (e.g., surgical or procedure mask) upon entering the residents room. Interim Guidance for Influenza Outbreak Management in Long-term Care Facilities [153 KB, 7 pages]. Ensure that the laboratory performing influenza testing notifies the facility of tests results promptly. Saving Lives, Protecting People, Given new evidence on the B.1.617.2 (Delta) variant, CDC has updated the, The White House announced that vaccines will be required for international travelers coming into the United States, with an effective date of November 8, 2021. All Residential Care Facilities, Assisted Living Facilities, Intermediate Care Facilities, Skilled Nursing Facilities should follow current Centers for Disease Control and Prevention (CDC) Guidelines related to managing healthcare personnel who have tested positive or an exposure to COVID-19. Deaths, which bottomed at about 60 in June . Mask-Wearing and Social Distance Guidance. DHS 132, DHS 134, and DHS 145. Ill residents should be placed on droplet precautions with room restriction and exclusion from participating in group activities as described below. Clinicians should consult the manufacturers package insert for approved ages, recommended drug dosing adjustments and contraindications. These cookies may also be used for advertising purposes by these third parties. Information about influenza testing is available at: https://www.cdc.gov/flu/professionals/diagnosis/index.htm. Informed consent is required to implement a standing order for vaccination, but this does not necessarily mean a signed consent must be present. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Thank you for taking the time to confirm your preferences. (https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm). Information for Long-term Care Administrators and Managers, Information for Jurisdictions (State and Local Immunization Programs). In the setting of an influenza outbreak, empiric antiviral treatment should be given as soon as possible to residents with suspected influenza without waiting for influenza testing results, especially if results will not be available on the day of specimen collection. CDC has developed many resources specific to help support long-term facilities during the COVID-19 pandemic. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. When there is influenza activity in the local community, active daily surveillance (defined below) for influenza illness should be conducted among all new and current residents, healthcare personnel, and visitors of long-term care facilities, and continued until the end of influenza season. Residents in the facility who develop symptoms of acute illness consistent with influenza or COVID-19 should be moved to a single room, if available, or remain in current room, pending results of viral testing. Persons receiving antiviral chemoprophylaxis who develop signs or symptoms should be tested (see above) and switched to antiviral treatment doses pending results. COVID-19 Guidance and Resources Nursing Homes and Long-term Care Facilities Vaccine Access in Long-term Care Clinical Staff Information Fact sheets, guidelines, reports, and resources Be a Safe Resident More information is available, Travel requirements to enter the United States are changing, starting November 8, 2021. This guidance is for assisted living residences and group homes for people with intellectual and developmental disabilities that are not regulated by the Centers for Medicare and Medicaid Services (CMS). While unusual, an influenza outbreak can occur outside of the normal influenza season; therefore, testing for influenza viruses and other respiratory pathogens should also be performed during non-influenza season periods. COVID-19 Community Levels Update, Mar. Given the predominance of women of child-bearing potential among the healthcare workforce, a substantial number of HCP are estimated to be pregnant or breastfeeding at any given time. Long-term care facilities are expected to adhere to the infection prevention and control standards, quarantine requirements, and testing . AHCA has provided a high-level summary of the changes and linked to each guidance for additional information. If a fully vaccinated person decides to attend an event or large gathering, the CDC says, they should. CDC twenty four seven. Published: September 23, 2022. covid19@ahca.org. ONeil CA, Kim L, Prill MM et al. Merritt T, Hope K, Butler M, et al. Clin Infect Dis 2004; 39:45964. Peramivir is approved for early treatment of influenza in persons aged 6 months and older. Although vaccination by the end of October is recommended, influenza vaccine administered in December or later, even if influenza activity has already begun, is likely to be beneficial in the majority of influenza seasons because the duration of the season is variable, and influenza activity might not occur in certain communities until February or March. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. You will be subject to the destination website's privacy policy when you follow the link. Thus, coordination between state and local health officials and healthcare administrators is needed to ensure vaccine access to HCP not affiliated with hospitals. C. Indoor Visitation Implementation of outbreak control measures can also be considered as soon as possible when one or more residents have acute respiratory illness with suspected influenza and the results of influenza molecular tests are not available the same day of specimen collection. Long-Term Care Facilities & Assisted Living Guidance for long-term care facilities including visitation guidance, infection prevention and control measures, and outbreak management. Further considerations around use of COVID-19 vaccines in pregnant or breastfeeding HCP will be provided once data from phase III clinical trials and conditions of FDA Emergency Use Authorization are reviewed. Please see Antiviral Drugs: Information for Healthcare Professionals for the current summary of recommendations for clinical practice regarding the use of influenza antiviral medications. Regardless, visitors should physically distance from other residents and staff in the facility. CDCs guidance titled Prevention Strategies for Seasonal Influenza in Healthcare Settings contains details on the prevention strategies for all healthcare settings. Booy R, Lindley RI, Dwyer DE, et al. Follow CDC Guidelines After COVID Vaccines: Burlington Officials . Drinka PJ, Gravenstein S, Schilling M, Krause P, Miller BA, Shult P. Duration of antiviral prophylaxis during nursing home outbreaks of influenza A: a comparison of 2 protocols. When 2 cases of laboratory-confirmed influenza are identified within 72 hours of each other in residents on the same unit, outbreak control measures should be implemented as soon as possible. Placing ill residents in a private room. For the latest information on influenza vaccination, see. Considerations for Preventing Spread of COVID-19 in Assisted Living Facilities; NHSN COVID 19 Reporting Module; LTCF Overview; C.difficile Infection (CDI) & Multidrug Resistant Organisms (MDRO) . C) Residents with symptoms of acute respiratory illness who are determined to have neither SARS-CoV-2 infection nor influenza should be cared for using Standard Precautions and any additional Transmission-Based Precautions based on their suspected or confirmed diagnosis.8, A) Prescribe antiviral treatment as soon as possible if influenza testing is positive OR prescribe empiric antiviral treatment based upon a clinical suspicion of influenza while test results are pending for symptomatic residents.9-12. CDC Resources for Nursing Homes CDC Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spre COVID-19 Community Transmission Level COVID-19 Vaccines for People who are Moderately or Severely Immunocompromised Stay Up to Date with Your COVID-19 Vaccines CMS Resources for Nursing Homes Resident and staff vaccination data from assisted living and other LTC settings may be monitored by your state. Containing influenza outbreaks with antiviral use in long-term care facilities in Taiwan, 20082014. COVID-19 vaccines do not guarantee complete immunity to the virus. Four influenza antiviral drugs approved by the U.S. Food and Drug Administration are recommended for treatment of uncomplicated influenza in the United States: neuraminidase inhibitors: oral oseltamivir (available as a generic version or under the trade name Tamiflu), as a pill or suspension; zanamivir (trade name Relenza), available as an inhaled powder using a disk inhaler device; and intravenous peramivir (trade name Rapivab); and a cap-dependent endonuclease inhibitor: baloxavir marboxil (trade name Xofluza) available as a tablet. See thelatest recommendations on treatment of nonhospitalized persons with mild-to-moderate COVID-19, andTherapeutic Management of Nonhospitalized Adults With COVID-19. For persons aged 65 years, the following quadrivalent influenza vaccines are recommended: high-dose IIV, adjuvanted IIV, or recombinant influenza vaccine. Assisted living facilities: facility providing help with activities of daily living. Vaccinating long-term care facility residents, staff, and visitors against COVID-19 is a crucial step in preventing the spread of COVID-19 and protecting others. Long-term care facilities may be defined as institutions, such as nursing homes and skilled nursing facilities that provide healthcare to people (including children) who are unable to manage independently in the community. In some cases, facilities may choose to apply Standard Precautions and Droplet Precautions for longer periods based on clinical judgment, such as in the case of young children or severely immunocompromised residents, who may shed influenza virus for longer periods of time. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. All information these cookies collect is aggregated and therefore anonymous. Check where your state stands on nursing home and long-term care visitors. Treating and preventing influenza in aged care facilities: a cluster randomised controlled trial. Consent/assent for vaccination should be obtained from the resident or their medical proxy and documented in the residents chart per standard practice. Ohio is on the ROAD BACK and now is the time to evolve our practices as the COVID-19 pandemic enters the next phase. Considerations for sub-prioritization, of equal importance, include: Furthermore, given the storage requirements of mRNA vaccines, initial vaccine distribution may be limited to large healthcare systems with ultracold freezer capacity.