Gearing Up for the Heart of Flu Season

While most people who become infected with influenza viruses recover without any after effects, the flu can lead to serious illness and death. During 31 flu seasons from 1976-77 through 2006-07, flu-associated deaths ranged from approximately 3,300 to 49,000 annually, according to a report from the Centers for Disease Control and Prevention. This season, the CDC noted a steady increase in flu activity during November and early December. For the week ending Dec. 24, 2016, the proportion of people seeing a healthcare provider for influenza-like illness increased to 2.9 percent, above the national baseline of 2.2 percent.

Healthcare professionals throughout Cleveland Clinic prepare for flu season, which typically lasts from October through April, and offer top-notch care to those who become infected.

Vaccinations are key to prevention

Even though flu season is well underway, it’s not too late for people to get vaccinated, says James Bryant, DNP, RN, CEN, CPEN, CCRN, NEA-BC, Associate Chief Nursing Officer of Emergency Services at Cleveland Clinic. “Nobody wants to be this sick, with aches, pains, fever and chills that can take a week or so to get over,” he says.

The CDC recommends that everyone six months or older receive a flu vaccine each year. In addition to the standard flu shot – the inactivated influenza vaccine or IIV – there are three other versions this season:

• The recombinant influenza vaccine (RIV) is the only 100 percent egg-free vaccine on the U.S. market. It’s made from recombinant DNA, so it clones the flu virus.
• The Fluzone® High-Dose influenza vaccine is designed specifically for people 65 years or older.
• The intradermal flu vaccine, approved for adults from 18 to 64 years old, is injected into the skin rather than the muscle and uses a much smaller needle. It requires 40 percent less antigen than the regular flu shot.

In addition, the CDC indicates that the nasal spray flu vaccine – the live attenuated influenza vaccine or LIAV – should not be used during 2016-17 because it may not offer the same level of protection as other vaccines.

A quicker diagnosis method

In the past, Cleveland Clinic and other healthcare organizations would swab the noses of patients to test for flu and perform a quick screening. However, this type of testing also required additional lab testing for any negative samples, taking 24 to 48 hours for a final result. This season, nurses in Cleveland Clinic’s Emergency Department and other facilities rely on an automated, multiplex, real-time system for rapid in vitro qualitative detection and discrimination of Influenza A and B virus RNA in nasopharyngeal swab specimens. The test delivers a positive or negative result in 20 minutes with no need for additional testing.

Dr. Bryant says there are several advantages to using this real-time diagnosis system. “When we get a lot of patients, it’s sometimes hard to find enough private rooms or spaces for them,” he says. “If we know without a doubt that someone has the flu, we can send the patient home with proper instructions and antiviral medicine to minimize their symptoms.”

In addition, if patients need to be admitted, the hospital can cohort flu patients, placing them together in rooms or on units. Finally, a firm diagnosis helps clinicians rule out other flu-like illnesses. “It’s important that we know what patients have so we can treat them appropriately,” says Dr. Bryant.

Advice for healthcare providers

Dr. Bryant offers several tips for clinical nurses and nurse leaders to help prevent the spread of influenza and reduce its effects:

• Set a good example. “The biggest thing nurses can do is be proactive ourselves,” he says. “Be as healthy as you can and get your flu shot. Also encourage family members to get flu shots so you are not a carrier of the virus.”
• Encourage patients and their families to get vaccinated. “It takes two to three weeks to develop immunity, but it’s never too late to get the shot,” says Dr. Bryant. “Even if the vaccine is not a perfect match, it can reduce the severity of the flu,”
• Keep abreast of flu severity in your area. Read the weekly FluView influenza surveillance report prepared by the CDC.
• Wash your hands frequently. Meticulous handwashing is critical, as is cleaning stethoscopes and other equipment between patients and using gloves.
• Set up handwashing stations. Place hand sanitizer, masks and tissues in strategic spots on your unit or in your medical office. “Encourage people to cover their coughs and sneezes, wash their hands and wear masks if they’re in crowded places like the ED waiting room or a pediatrician’s office,” says Dr. Bryant.
• Recognize flu symptoms. “When you see people who have fever, aches and chills and believe it’s the flu, test them and then ask physicians if they qualify for Tamiflu® or other antiviral medicine to reduce the severity of the illness,” Dr. Bryant says.
• Stay home if you’re sick. “That’s hard for people in the healthcare profession,” admits Dr. Bryant. “We don’t want to let our colleagues down. But if you’re sick, you really need to stay home to decrease the risk to your patients and each other.”
• Prepare for a reduction in staff. Nurse leaders should have contingency plans in place in case nurses – or their families – catch the flu and can’t come to work. How will you operate with a 10 or 25 percent reduction in staff?

This is the time of year that flu cases often rise: The weather in many places gets colder, and people who have gathered together for the holidays begin to hunker down at home. “It takes about 10 days or so for the flu to replicate, and then people really start getting sick,” says Dr. Bryant. “It’s best to be prepared!”