COMMENT
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n March 2013, 12 patients on a single ward in a tertiary respiratory transplant centre contracted influenza. There was no corresponding community outbreak. This was a novel situation for the respiratory department and hospital trust. While policies outlining respiratory infection, isolation and immunisation existed, there were no guidelines specific to this. Cases have been reported worldwide as per Malavaud et al (2001) and Wong et al (2010), but this is probably the first outbreak of influenza A (H3 N2) in the UK in this setting. We want to share our experience. Within a 72-hour period, all 12 affected patients on the 30-bedded unit quickly developed pyrexias, cough, dyspnoea and in some cases vomiting and respiratory failure. All had throat swabs and blood cultures taken. Influenza A, H3N2 variant, was identified. Of the 21 symptomatic staff members, 15 had swabs taken, two of which were positive for H3N2. The outbreak management group comprised virologists, microbiologists, respiratory physicians, infection control personnel, nurses and managers. They met regularly throughout the outbreak period. Implemented infection control measures were: ■■ Closure of the ward and cohorting of the bays ■■ No crossover of staff to transplant patients off the ward ■■ Advising non-essential personnel and anyone with symptoms not to attend the ward ■■ Cancellation of non-essential procedures ■■ Strict usage of personal protective equipment and Filtering Facepiece (FFP3) fitted masks, particularly for aerosol-generating procedures ■■ Enhanced hand hygiene with alchohol gel and soap ■■ Stockage of oseltamivir on the ward ■■ Oseltamivir treatment for all affected high-risk staff and patients ■■ Oseltamivir prophylaxis offered to all ward patients and exposed high-risk members of staff (chronic condition or immunocompromised) ■■ Contact tracing to advise on oseltamivir prophylaxis of all immunocompromised patients and all highrisk patients on the ward 48 hours before the index case. Their GPs were contacted. ■■ Producing an information sheet for staff and GPs ■■ Increased and terminal ward cleaning. There were 151 bed days lost on the respiratory ward and 53 on two other wards owing to influenza. Fourteen patients (including two on another ward) had positive swabs for H3N2. All patients and two staff members were given treatment oseltamivir. Fourteen patients and two staff members were given prophylactic oseltamivir. There was 45% influenza vaccine uptake in the cardiothoracic department
staff and all affected patients had been vaccinated. There were no significant influenza complications or deaths. All the patients clinically improved and were discharged home. Although community outbreaks are common, the Trust had no such experience. A multidisciplinary approach was adopted. Containment, identification of the pathogen, prompt treatment and contact tracing were effective in controlling further transmission. Once the nature of the outbreak became clear, the importance of preventing any crossover to transplant patients off the ward was recognised. McMenamin et al (2013) showed that with the trivalent influenza vaccine, adjusted vaccine effectiveness against all laboratory-confirmed influenza in primary care was 51% for the 2012/2013 season and this explains why some immunised individuals were affected. The vaccine consists of three viral strains (Influenza A H1, AH3 and influenza B), based on the strains prevalent the year before. The importance of staff vaccination is emphasised by the Department of Health (2013). Prompt identification of the pathogen, effective infection control measures and a multidisciplinary approach were pivotal in management of this outbreak. Our infection control methods should be applicable to other similar hospital influenza BJN outbreaks. Malavaud S, Malavaud B, Sandres K et al (2001) Nosocomial outbreak of influenza virus A (H3N2) infection in a solid organ transplant department. Transplantation 72(3): 535-7 Wong BC, Lee N, Li Y, Chan PK et al (2010) Possible role of aerosol transmission in a hospital outbreak of influenza. Clin Infect Dis 51(10): 1176-83 J McMenamin, N Andrews, C Robertson et al (2013) Effectiveness of seasonal 2012/2013 vaccine in preventing laboratory-confirmed influenza infection in primary care in the United Kingdom: Mid-Season analysis. Euro Surveill 18(5): pii: 20393
Aujayeb A, Specialist Respiratory Registrar, Russell A, Respiratory Ward Sister, Walton K, Consultant Microbiologist, Samuel J, Consultant Microbiologist,Waugh S, Consultant Virologist, Valappil M, Consultant Virologist, Fagg R, Occupational Health, Gray S, Infection Control Sister, West S, Consultant Respiratory Physician, Meachery G, Consultant Respiratory and Transplant Physician, Cardiothoracic and Transplant Unit, Freeman Hospital, Newcastle upon Tyne
© 2013 MA Healthcare Ltd
Editorial Board Palo Almond, Academic and Research Consultant, Anglia Ruskin University Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Ruhi Behi, Head of School, School of Healthcare Sciences, University of Wales, Bangor Dr Lizzy Bernthal, Research Fellow and lead nursing lecturer, Medical Directorate, Birmingham, Honorary Research Fellow University of Southampton. Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland Willie Doherty, CNS Continence Care, Park Drive Health Centre, Baldock, Hertfordshire Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser (U.K) Joy Notter, Professor, Birmingham City University, UK & Saxion University of Applied Science, NL Lynn Parker, Independent Educational Adviser, Infection Control, Sheffield Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Head of School, Nursing, Midwifery and Healthcare, Thames Valley University Bernadette Porter, Nurse Consultant, Multiple Sclerosis, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Jo Sharman, Operational Commissioning Manager, University Hospitals Birmingham NHS Foundation Trust John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
Influenza: an outbreak in a UK respiratory centre
British Journal of Nursing, 2013, Vol 22, No 21
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 18, 2015. For personal use only. No other uses without permission. . All rights reserved.
1206
I
n March 2013, 12 patients on a single ward in a tertiary respiratory transplant centre contracted influenza. There was no corresponding community outbreak. This was a novel situation for the respiratory department and hospital trust. While policies outlining respiratory infection, isolation and immunisation existed, there were no guidelines specific to this. Cases have been reported worldwide as per Malavaud et al (2001) and Wong et al (2010), but this is probably the first outbreak of influenza A (H3 N2) in the UK in this setting. We want to share our experience. Within a 72-hour period, all 12 affected patients on the 30-bedded unit quickly developed pyrexias, cough, dyspnoea and in some cases vomiting and respiratory failure. All had throat swabs and blood cultures taken. Influenza A, H3N2 variant, was identified. Of the 21 symptomatic staff members, 15 had swabs taken, two of which were positive for H3N2. The outbreak management group comprised virologists, microbiologists, respiratory physicians, infection control personnel, nurses and managers. They met regularly throughout the outbreak period. Implemented infection control measures were: ■■ Closure of the ward and cohorting of the bays ■■ No crossover of staff to transplant patients off the ward ■■ Advising non-essential personnel and anyone with symptoms not to attend the ward ■■ Cancellation of non-essential procedures ■■ Strict usage of personal protective equipment and Filtering Facepiece (FFP3) fitted masks, particularly for aerosol-generating procedures ■■ Enhanced hand hygiene with alchohol gel and soap ■■ Stockage of oseltamivir on the ward ■■ Oseltamivir treatment for all affected high-risk staff and patients ■■ Oseltamivir prophylaxis offered to all ward patients and exposed high-risk members of staff (chronic condition or immunocompromised) ■■ Contact tracing to advise on oseltamivir prophylaxis of all immunocompromised patients and all highrisk patients on the ward 48 hours before the index case. Their GPs were contacted. ■■ Producing an information sheet for staff and GPs ■■ Increased and terminal ward cleaning. There were 151 bed days lost on the respiratory ward and 53 on two other wards owing to influenza. Fourteen patients (including two on another ward) had positive swabs for H3N2. All patients and two staff members were given treatment oseltamivir. Fourteen patients and two staff members were given prophylactic oseltamivir. There was 45% influenza vaccine uptake in the cardiothoracic department
staff and all affected patients had been vaccinated. There were no significant influenza complications or deaths. All the patients clinically improved and were discharged home. Although community outbreaks are common, the Trust had no such experience. A multidisciplinary approach was adopted. Containment, identification of the pathogen, prompt treatment and contact tracing were effective in controlling further transmission. Once the nature of the outbreak became clear, the importance of preventing any crossover to transplant patients off the ward was recognised. McMenamin et al (2013) showed that with the trivalent influenza vaccine, adjusted vaccine effectiveness against all laboratory-confirmed influenza in primary care was 51% for the 2012/2013 season and this explains why some immunised individuals were affected. The vaccine consists of three viral strains (Influenza A H1, AH3 and influenza B), based on the strains prevalent the year before. The importance of staff vaccination is emphasised by the Department of Health (2013). Prompt identification of the pathogen, effective infection control measures and a multidisciplinary approach were pivotal in management of this outbreak. Our infection control methods should be applicable to other similar hospital influenza BJN outbreaks. Malavaud S, Malavaud B, Sandres K et al (2001) Nosocomial outbreak of influenza virus A (H3N2) infection in a solid organ transplant department. Transplantation 72(3): 535-7 Wong BC, Lee N, Li Y, Chan PK et al (2010) Possible role of aerosol transmission in a hospital outbreak of influenza. Clin Infect Dis 51(10): 1176-83 J McMenamin, N Andrews, C Robertson et al (2013) Effectiveness of seasonal 2012/2013 vaccine in preventing laboratory-confirmed influenza infection in primary care in the United Kingdom: Mid-Season analysis. Euro Surveill 18(5): pii: 20393
Aujayeb A, Specialist Respiratory Registrar, Russell A, Respiratory Ward Sister, Walton K, Consultant Microbiologist, Samuel J, Consultant Microbiologist,Waugh S, Consultant Virologist, Valappil M, Consultant Virologist, Fagg R, Occupational Health, Gray S, Infection Control Sister, West S, Consultant Respiratory Physician, Meachery G, Consultant Respiratory and Transplant Physician, Cardiothoracic and Transplant Unit, Freeman Hospital, Newcastle upon Tyne
© 2013 MA Healthcare Ltd
Editorial Board Palo Almond, Academic and Research Consultant, Anglia Ruskin University Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Ruhi Behi, Head of School, School of Healthcare Sciences, University of Wales, Bangor Dr Lizzy Bernthal, Research Fellow and lead nursing lecturer, Medical Directorate, Birmingham, Honorary Research Fellow University of Southampton. Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland Willie Doherty, CNS Continence Care, Park Drive Health Centre, Baldock, Hertfordshire Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser (U.K) Joy Notter, Professor, Birmingham City University, UK & Saxion University of Applied Science, NL Lynn Parker, Independent Educational Adviser, Infection Control, Sheffield Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Head of School, Nursing, Midwifery and Healthcare, Thames Valley University Bernadette Porter, Nurse Consultant, Multiple Sclerosis, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Jo Sharman, Operational Commissioning Manager, University Hospitals Birmingham NHS Foundation Trust John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
Influenza: an outbreak in a UK respiratory centre
British Journal of Nursing, 2013, Vol 22, No 21
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 18, 2015. For personal use only. No other uses without permission. . All rights reserved.
