Influenza outbreak detection and control measures in nursing homes in the United States

OBJECTIVE: To evaluate the use of influenza vaccine, rapid influenza testin g, and influenza antiviral medication in nursing homes in the US to prevent and control outbreaks. METHODS: Survey questionnaires were sent to 1017 randomly selected nursing homes in nine states. Information was collected on influenza prevention, de tection and control practices, and on outbreaks during three influenza seas ons (1995-1998). RESULTS: The survey response rate was 78%. Influenza vaccine was offered to residents and staff by 99% and 86%, respectively, of nursing homes. Among nursing homes offering the influenza vaccine, the average vaccination rate was 83% for residents and 46% for staff. Sixty-seven percent of the nursing homes reported having access to laboratories with rapid antigen testing ca pabilities, and 19% reported having a written policy for the use of influen za antiviral medications for outbreak control. Nursing homes from New York, where organized education programs on influenza detection and control have been conducted for many years, were more likely to have reported a suspect ed or laboratory-confirmed influenza outbreak (51% vs 10%,P = .01), to have access to rapid antigen testing for influenza (92% vs 63%, P = .01), and t o use antivirals for prophylaxis and treatment of influenza A for their nur sing home residents (94% vs 55%, P = .01) compared with nursing homes from the other eight states. CONCLUSIONS: Influenza outbreaks among nursing home residents can lead to s ubstantial morbidity and mortality when prevention measures are not rapidly instituted. However, many nursing homes in this survey were neither prepar ed to detect nor to control influenza A outbreaks. Targeted, sustained educ ational efforts can improve the detection and control of outbreaks in nursi ng homes.