GPs sound alarm over aged-care flu standards

However, despite the potentially fatal consequences for residential aged care facility (RACF) residents, there are no uniform, evidence-based standards for vaccination or containment.
 
Concern about the ad hoc approach has been so great that it prompted a group of GPs in South Australia, which has had the highest number of lab-confirmed notifications per capita, to arrange a meeting with SA Health to detail specific issues related to influenza containment within RACFs.
 
One of the meeting’s organisers, GP and Immunisation Coalition (IC) member Dr Rod Pearce, told newsGP there have been several issues related to managing the outbreaks but that he is hopeful of collaborating with government and RACFs to formulate a standardised approach for next winter.
 
‘At the moment there’s no predictable response from RACFs that satisfies GPs that their patients are being looked after properly,’ he said.
 
‘Lots of GPs [are] saying there’s a problem … we think outbreak control should be managed with some sort of evidence base.
 
‘We are considering putting together a trial in South Australia next year where we actually look at outbreak control, and manage RACFs in a way where we can document the response and get some evidence about the best way to do it.’
 
Dr Pearce said antivirals are currently being underutilised during outbreaks, and that more collaboration between RACFs and GPs could improve patient safety by helping to increase immunisation rates of both patients and staff. He also called for a more uniform approach to managing the flow of patients and visitors that could potentially introduce infection into the facilities.
 
‘They’re being done, but they’re being done ad hoc. Each place has got its own way of doing it. So if there was better communication with GPs, then the GPs could support what’s being done,’ he said.
 
‘Guidelines, the evidence base and the protocols that RACFs use for vaccinations and outbreaks is not standardised in a predictable way, so that creates the opportunity for ad hoc methods to put the whole process at risk.
 
‘There are about 250 RACFs in SA, and about one-fifth are run by the state. We’re hoping we can work with them next year to look at something that is more consistent and robust, so at least we will have a handle on what’s going on and GPs can be more confident that there is a more uniform response.’
 
Aged and Community Services Australia (ACSA) CEO Patricia Sparrow told newsGP the peak body would consider any new proposal for universal standards, but would need to see the detail and understand how implementation would work in practice. 
 
‘There are already various requirements and standards in operation that relate to outbreaks and those would need to be considered as well,’ she said.
 
‘The Commonwealth has responsibility for aged care and as part of this responsibility prescribes a mandatory influenza management program.  However, this is separate to the responsibility that the states and territories have in relation to the management of health-related outbreaks that occur in their respective jurisdictions.’
 
Aside from concerns over the ad hoc approach to containing outbreaks and vaccine coverage, Dr Ken McCroary, Vice Chair of the RACGP Expert Committee – Standards for General Practices, told newsGP a standardised approach to administering vaccines is also required to ensure maximum efficacy.
 
‘The stringency of the cold chain varies through all these different places – I’ve personally walked into nursing homes and seen their fridges at –2⁰ with ice all over the vaccines,’ he said.
 
‘I’ve also seen [staff] at nursing home wards get them out of the fridge at 9am and then leave them on the trolley for the entire shift until three or four o’clock in the afternoon as they give all the residents their vaccine, which by then is just a complete waste and ineffective.’

influenza residential aged care facilities standards vaccination