Winter wellness in aged care
Flu, influenza-like illness (ILI), and viral gastroenteritis (‘gastro’) infections occur across the ACT community, especially during the winter months. The elderly, particularly those living in aged care facilities, can be more vulnerable to these infections due to underlying medical conditions or medications that suppress their immune systems. A flu, ILI or gastro infection in an elderly resident may lead to functional decline, hospitalisation, and in some cases death.
Aged care facilities can be challenging environments for infection control, due to staff, residents and visitors moving throughout the facility and interacting with each other, residents sharing communal meals and other group activities, as well as shared spaces and people within close proximity.
It is important to be proactive to minimise transmission of flu, ILI and gastro in aged care settings. The risk of spreading flu can be reduced by residents, staff and visitors receiving the flu vaccine each year - see the Immunisation section below for more information. For other ways to protect elderly residents, see the preventing spread of infections in aged care section below.
Occasionally, outbreaks of flu, ILI and gastro occur in aged care facilities. When outbreaks occur, the facility is required to report these to the Communicable Disease Control (CDC) Section of ACT Health and implement outbreak precautions.
Immunisation of all residents and staff (including nurses, aged care assistants, reception, laundry, cleaning, kitchen, volunteers etc.) can prevent illness from flu and reduce transmission in aged care settings. All staff in aged care facilities should get a flu vaccine each year before the flu season.
ACT Health have developed some resources to increase flu immunisation uptake among staff:
- Brochure “Flu – it can stop with you”
- Poster “You have a higher risk of catching the flu than adults in non-healthcare settings
- Poster “Flu can be serious, even in healthy people
- Poster “Flu vaccination is your best protection
- Poster “You can spread flu to your patients and the people you care for
- Poster “Tracking flu vaccination in our staff
- Influenza Vaccination – FAQs for Staff of Aged Care Facilities
- Declination form
- Checklist for managers
- Annual Seasonal Influenza Vaccine fact sheet
Posters and brochures are available for order from the Immunisation Unit on (02) 6205 2300.
In 2018, there are two new age-specific trivalent influenza vaccines (TIVs) available free to those aged 65 years and older. These vaccines are formulated to provide increased protection against influenza for older people, compared to the quadrivalent influenza vaccines (QIVs). While the QIVs are still available for people 65 years and over, vaccine experts recommend the specially-formulated TIVs over the QIVs for this age group. The TIVs are only available through GPs.
More information about flu immunisation can be found here.
Family and friends should be reminded that they should not visit an aged care facility when they are unwell with any respiratory or gastro symptoms. Residents with symptoms will need to be isolated to prevent spreading the infection to other residents in the facility, and unwell staff should be excluded from work (see the Infection Control section for further details).
Cough and sneeze etiquette, as well as hand hygiene, should be promoted to residents, staff and visitors all year and especially during the cooler months. The following posters can be displayed around aged care facilities:
Over the winter months, when flu, ILI and gastro are more common in the community, outbreaks can occur in aged care facilities. Staff should be alert to any change in symptoms or behaviour among residents and remember that not all elderly residents will have a fever when they have flu, ILI or gastro. Any change in a resident's usual behaviour or any unusual symptoms should be reported to the care manager/nurse in charge (or equivalent) of the facility.
Under the Public Health Act 1997, aged care facilities are required to notify CDC if they have:
- three or more cases of ILI** among residents and/or staff in a 72 hour period
- two or more cases of gastroenteritis (diarrhoea and/or vomiting) among residents and/or staff in a 24 hour period
More information about notifiable disease reporting and surveillance is available here.
To report an outbreak or seek advice please call the Communicable Disease Control (CDC) Section on 6205 2155.
Other resources to assist you during an outbreak of ILI or gastro in an aged care setting:
- ILI aged care line list
- Gastro aged care line list
- Influenza fact sheet
- Viral gastroenteritis fact sheet
- ILI specimen collection guide
Ensuring appropriate infection control practices are adhered to year round will limit the spread of infectious diseases in an aged care facility. The most important infection control practices are effective hand hygiene, isolation of ill residents, and exclusion of sick staff. Other infection control measures include appropriate cough and sneeze etiquette and use of personal protective equipment, visitor restrictions and effective environmental cleaning.
Infection control is vital to minimising transmission and controlling outbreaks of flu, ILI and gastro in aged care facilities. To effectively manage an outbreak, you may need to implement additional infection control practices, increase the frequency and efficiency of environmental cleaning using appropriate products, and restrict the movement of patients, staff and visitors.
For advice about infection control, you can call the Communicable Disease Control (CDC) Information Line on 02 6205 2155 and ask for a member of the Infection Control team.
Unwell residents must be isolated to prevent spread to other residents. Residents with influenza must be isolated for 5 days from onset of symptoms. The isolation period for other viral respiratory infections may be longer than influenza – please call the CDC for advice on 6205 2155. Residents with gastro symptoms require isolation for the duration of their symptoms as well for 48 hours after their last symptom. Staff with symptoms of gastro or ILI/flu should be excluded from work for the same isolation periods.
Resources to assist with outbreak management in an aged care setting:
- STOP – outbreak sign for front entrance (flu)
- STOP – outbreak sign for front entrance (gastro)
- STOP – PPE sign for ill resident’s door
- Order to fit and remove PPE
Additional resources for outbreak management and infection control
For further information about outbreak management and infection control, please visit:
- Guidelines for the Prevention, Control and Public Health Management of Influenza Outbreaks in Residential Care Facilities in Australia (Australian Government Department of Health - 2017)
- Influ-Info Kit for Aged Care (Australian Government Department of Health - 2014)
- Gastro-Info Gastroenteritis Kit for Aged Care (Australian Government Department of Health - 2014)
- Prevention and control of infection in residential and community aged care (Australian Government Department of Social Services – 2013)
In May 2018, CDC hosted an Aged Care Forum. The presentations from the forum are available here:
- Influenza in the ACT during 2017
- Influenza vaccination in aged care
- Outbreak management in aged care
- Infection control during an outbreak