Controlling Influenza Outbreaks

CDC Guidelines:

Interim Guidance for Influenza Outbreak Management in Long-Term Care

Recommended Dosage and Duration of Treatment or Chemoprophylaxis for Influenza Antiviral Medications.

Standard Precautions

Droplet Precautions

When the flu strikes

a facility, it is a potentially life threatening event for the elderly and immunocompromised residents that we care for.  The care team needs to move into a heightened sense of alertness and activity.

Ask the staff to immediately start cleaning all horizontal surfaces and door knobs every 8 hours with a CDC approved cleaning agent.  The least expensive and most effective is a

Dilute Clorox Solution:

Mix 1 cup (240 mL) of bleach in 1 gallon of water.
Wash surfaces with the bleach mixture.
If surfaces are rough, scrub them with a stiff brush.
Rinse surfaces with clean water.
Allow to air dry.


Once two confirmed cases have a occurred start chemo prophylaxis on all affected residents.  Tamiflu 75 mg daily x 10 days is commonly used.  Watch news and CDC reports for resistant strains that may need a different drug.

If the resident becomes symptomatic increase to full dose anti-viral (such as Tamiflu 75 mf BID x 5 days).

Check oxygen saturation levels on symptomnatic residents.  Residents with normal oxygen levels can be treated symptomatically. Residents with hypoxemia (88% or less) should be referred for evaluation at the local emergency department.


Implement Standard and Droplet Precautions for all residents with suspected or confirmed influenza.

CDC’s guidance titled Prevention Strategies for Seasonal Influenza in Healthcare Settings contains details on the prevention strategies for all health care settings. Specific recommendations are highlighted below.

Standard Precautions are intended to be applied to the care of all patients in all health care settings, regardless of the suspected or confirmed presence of an infectious agent. Implementation of Standard Precautions constitutes the primary strategy for the prevention of healthcare-associated transmission of infectious agents among patients and health care personnel.

Examples of standard precautions include:

  • Wearing gloves if hand contact with respiratory secretions or potentially contaminated surfaces is anticipated.
  • Wearing a gown if soiling of clothes with a resident’s respiratory secretions is anticipated.
  • Changing gloves and gowns after each resident encounter and performing hand hygiene
  • Perform hand hygiene before and after touching the resident, after touching the resident’s environment, or after touching the resident’s respiratory secretions, whether or not gloves are worn. Gloves do not replace the need for performing hand hygiene.

Droplet Precautions are intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions. Droplet Precautions should be implemented for residents with suspected or confirmed influenza for 7 days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer, while a resident is in a health care facility.

Examples of Droplet Precautions include:

  • Placing ill residents in a private room. 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 resident’s room. Remove the facemask when leaving the resident’s room and dispose of the facemask in a waste container.
  • If resident movement or transport is necessary, have the resident wear a facemask (e.g., surgical or procedure mask), if possible.
  • Communicate information about patients with suspected, probable, or confirmed influenza to appropriate personnel before transferring them to other departments.


See the CDC references information above for more specific information.

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