Can Instituting Enhanced Measures (EM) during Influenza Season Reduce Healthcare Associated Influenza Infections (HAIIs)
Background: Influenza is a respiratory illness caused by influenza virus and is spread from person to person. Influenza can be a life threatening infection and often leads to prolonged illness and hospitalization. UPMC Presbyterian (PUH) is a tertiary care hospital comprised of 158 ICU, 584 Med/Surg and 20 Rehab beds for a total of 762 licensed beds with a notably large immune compromised patient population (transplant). During flu season, ~20 influenza patients are cared for daily which includes care for those who require extracorporeal membrane oxygenation (ECMO). Since 2008 ≤3 HAII were identified annually except in 2010/11. That year there were 13 HAIIs, all H1N1. By 1/2014, 7 HAIIs (H1N1) were identified. All but 2 had no evidence of patient to patient transmission (PTPT). Because of a concern for healthcare personnel (HCP) to patient transmission (HTPT) enhanced measures (EM) were implemented. The objective of this study was to evaluate the effect of the EM on HAII secondary to HTPT.
Methods: On 1/31/14, prescribed interventions were developed based on local and national epidemiologic indicators. Influenza Critical Time Period was defined as national Flu positivity ≥ 25% and Pneumonia and Influenza Mortality ≥15% above predicted. EMs included:
· Empiric HCP masking for high-risk (transplant) patients and/or high risk units until discharge
· Encourage HCP flu immunization
HAIIs defined by CDC criteria and categorized as PTPT or presumed HTPT. Flu isolation density (FIDe) was measured monthly and defined as flu isolation days (FIDs)/patient days (PDs). FIDs were determined using Theradoc software and PDs were extracted from our electronic medical record. % HCP flu immunized was calculated.
Despite continued high FIDe in 2/14 they were no HTPT and only 1 PTPT HAII. Overall vaccination rates did not change over the time period (78%→78.4%) and so was not likely a contributor to decreased HAIIs. HCP empiric masking for high-risk populations was associated with eliminated HTPT HAIIs.
· FIDe can be high during Influenza critical time period.
· Both HCP and patients can be exposed/infected with flu and may transmit disease to others.
· EM such as HCP empiric masking can prevent HAIIs regardless of the influenza isolation density.
A. Querry, None