Acute respiratory infections (ARIs) in residential care facilities

IMMEDIATE ACTION FOR NEW ACUTE RESPIRATORY SYMPTOMS:
  • Isolate resident and test.
  • Activate infection prevention and control measures as per facility outbreak management plan, do not wait for pathology confirmation.

An ARI outbreak should be declared if:

  • 2 or more residents test positive for influenza or COVID-19 within a 72-hour period OR
  • 2 or more epidemiologically-linked acute respiratory infections in residents, where influenza and COVID-19 have been excluded, within a 72-hour period.

Facility exposure risk assessment is required following case/s of COVID-19 or influenza in staff or visitors.

Background

Residential care facilities (RCFs) and their residents are vulnerable to the spread of acute respiratory illness (ARI) due to the impact of communal living environments and other health conditions or comorbidities. Outbreaks of respiratory viruses in RCFs can lead to hospitalisation and significant morbidity and mortality among residents. The introduction of respiratory viruses into RCFs, such as residential aged care or other community based residential health facilities can lead to staff absenteeism and increased demand on facility operations.

While specific vaccination and anti-viral treatment recommendations exist for influenza and COVID-19, common strategies apply for the planning, preparation, detection and management of cases and outbreaks of ARI.

The onset of new or worsening acute respiratory symptoms may be caused by the following respiratory viruses:

  • Influenza (the flu)
  • COVID-19
  • Respiratory syncytial virus (RSV)
  • Human metapneumovirus (hMPV)
  • Parainfluenza virus
  • Rhinovirus
  • Adenovirus.

ARIs, particularly influenza, are most common in Queensland between June to September when people are more likely to congregate indoors without adequate ventilation, with a peak usually in August. In tropical areas, the pattern can be more variable and may include clusters outside this period. COVID-19 infections tend to occur in waves. COVID-19 trends are monitored, and the Queensland Government COVID-19 traffic system is adjusted accordingly.

The following information has been developed to guide RCFs with consideration to resident wellbeing; for detailed information please refer to the following national recommendations:

Outbreaks of Acute Respiratory Infection in Residential Care Facilities - Australian Government/Department of Health and Aged Care

Influenza infection (flu) – CDNA National Guidelines for Public Health Units - Australian Government/Department of Health and Aged Care

Queensland Health has extended the outbreak definition described in the CDNA Outbreaks of Acute Respiratory Infection in Residential Care Facilities guidelines, to protect residents from morbidity and mortality associated with other respiratory virus outbreaks.

Prepare

RCF service providers should:

  • Develop and implement an RCF Winter Plan, which details vaccination provision, pre-deployment of PPE and other consumables, outbreak management planning, anti-viral treatment, testing and workforce and visitation contingencies.
  • Provide annual infection prevention and control (IPC) training to all staff and ensure staff are familiar with clinical management pathways and outbreak management and regularly monitor hand hygiene and PPE practice.

Protect

Vaccination

Anyone entering a residential care facility should be free from respiratory symptoms and preferably vaccinated against influenza (flu) and COVID-19 to provide the best protection for the residents. In Queensland Health facilities, all staff, volunteers and students must be up-to-date with their COVID-19 vaccinations. Compliance with Aged Care Quality Standards requires a facility to provide a mandatory influenza vaccination program that promotes the benefits of vaccination, access to free vaccination and vaccine administration record keeping. It is important to provide residents (or their substitute decision makers) with information about the benefits and risks of influenza vaccine and COVID-19 vaccines to ensure informed decision making. Residents have the right to refuse vaccination.

Visitation

Decisions about vaccination entry requirements and visitation during outbreaks are the responsibility of the facility owner or operator and should comply with the Industry Code for Visiting in Aged Care Homes

Identify cases

1. Actively monitor staff and residents for symptoms of ARI, including:

  • cough
  • breathing difficulty
  • sore throat
  • runny nose/nasal congestion OR
  • change in baseline condition with or without other symptoms such as fever, headache, fatigue or vomiting and diarrhoea

2. Isolate symptomatic residents and refer to your Outbreak Management Plan when ARI symptoms are detected in a single resident.

3. Implement initial IPC measures, including transmission-based precautions and environmental cleaning and disinfection.

4. Perform respiratory virus testing and confirm local laboratory testing arrangements as soon as possible.

5. Notify the local public health unit (PHU) of an OUTBREAK when:

  • 2 or more residents test positive for influenza or COVID-19 within a 72-hour period OR
  • 2 or more epidemiologically-linked acute respiratory infections in residents, where influenza and COVID-19 have been excluded, within a 72-hour period.

Respond

Early activation of an Outbreak Management Plan allows for rapid outbreak response and likely reduction in the number of ill residents and staff.

During an outbreak, RCF service providers should communicate early and regularly with residents, family and staff about the outbreak. Communication should include appropriate signage and provide advice on hand and respiratory hygiene requirements, visitation guidelines and PPE use.

Contact your local PHU early for advice and resources on case and contact management.

Declaring an outbreak over

An ARI outbreak may be declared over by the facility outbreak management team in conjunction with local PHU advice if:

  • no new cases occur within 8 days following the onset of symptoms in the last resident influenza case
  • 7 days after the last COVID-19 case tests positive or the date of isolation of the last COVID-19 case in a resident, whichever is longer
  • a minimum 8 days from onset of symptoms in the last resident with non-influenza/COVID-19 ARI, local PHU advice may recommend continuation of outbreak management in circumstances of high transmission or morbidity

Residential care facilities

The RCF can be any public or private service where facility staff provide residents with

personal care or health care. This includes:

  • residential aged care facilities
  • community based residential health facilities (for example, drug and alcohol services)
  • long stay hospital wards and rehabilitation hospitals
  • other similar accommodation settings in Australia
  • disability service facilities (it is acknowledged that services are typically smaller with restricted options for isolation and infection prevention and control).

Source:

Outbreaks of Acute Respiratory Infection in Residential Care Facilities

Communiques from Queensland Health

2023 ARIs Communique for Private Residential Care Facilities (PDF 190 kB)

2023 ARIs Communique for QH Residential Care Facilities (PDF 195 kB)

Further resources

Last updated: 23 August 2023