Real Time Detection of Influenza and Response in a Long-Term Care Facility

BACKGROUND:   Outbreaks of influenza in long-term care facilities (LTCF) can be devastating and are typically only identified after three critical steps: (1) one or more residents are ill enough to be sent to an emergency department for assessment or hospitalization, (2) specific testing for influenza is performed, and (3) resulting information is shared with the facility.  Delays in these steps impair timely implementation of control measures.  We describe an innovative approach for early influenza detection and reporting in a LTCF during the 2014-2015 seasonal influenza outbreak, characterized by a high proportion of drifted influenza A[H3] viruses.

METHODS: The primary outcome was the feasibility of real-time influenza detection within a LTCF, and included facility engagement, training of nursing staff in patient identification and nasal specimen collection, and overall reaction to this intervention.  We also assessed any infection control activities resulting from influenza detection.  When specimens were collected, a member of our team was contacted, retrieved the specimen, and assessed for influenza using an off-site Sofia immunofluoresence analyzer with wireless connectivity and Quidel’s Sofia Influenza A+B FIA.  Results were sent immediately to the LTCF and conveyed to public health. 

RESULTS:   Staff training occurred on 12/08/2014 and supplies were delivered on 12/12.  The first specimens were collected on 12/12 and influenza-positive specimens were initially noted on 12/15 and 12/16.  To date, 16 tests have been done in residents aged 69 to 102 years; five specimens tested positive for influenza.  Due to wireless connectivity, epidemiologists at the Wisconsin Division of Public Health were notified in near real-time.  Based on results, influenza antiviral prophylaxis was initiated for all eligible residents on the affected LTCF wing.   

CONCLUSIONS:   Early detection of an influenza outbreak in a LTCF occurred through the use of RIDT coupled with immediate wireless transmission of results.  Availability of this information in symptomatic residents, well in advance of any transfer to an emergency department or hospital, allowed for rapid implementation of prevention and control measures.  This approach is feasible and could be enhanced by on-site testing.  Coupling technology with wireless transmission of results to public health allows early intervention in a highly vulnerable population.