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Excerpt from the Long Term Care Outbreak Procedure manual – Regina Qu'Appelle Health Region December 2015 Management of Staff
The management of staff, and other personnel who provide services in a long-term care facility, is an important component in the implementation of outbreak control measures and requires careful consideration and planning. Immunization or chemoprophylaxis may be a recommended measure to prevent and control the outbreak. The causative organism will determine if this measure is necessary. Staff can inadvertently bring organisms from one unit to another or from a facility in outbreak to another facility. Staff must disclose if they work in different healthcare facilities. Influenza is the only respiratory organism that staff can be immunized against to help protect residents by decreasing the risk of transmission. Immunization
It is the responsibility of the direct care staff to minimize the risk to residents and provide the
highest standard of care. Receiving the annual influenza immunization is considered part of this
responsibility.
Influenza immunization has been shown to reduce the mortality and morbidity of residents under the
care of immunized staff and reduce worker absenteeism during the influenza season. It has been
shown to be 50-60% effective in preventing hospitalization and 85% effective in preventing
death in elderly persons living in LTC facilities7.
Influenza Immunization – Staff
Influenza vaccine should be administered annually to all staff and physicians who work in the LTC
facility. Any new staff or residents that come to the facility during the influenza season (typically
November to April) should also have their immunization status assessed and be provided with the
vaccine as required.
Staff should be made aware that those who are not vaccinated and who do not receive Oseltamivir
(Tamiflu®) may be excluded from work for the duration of the outbreak.

Direct Care Staff

As soon as an outbreak is identified, health care workers (HCWs) providing direct care to residents
should:
Be cohorted to provide care for either infected or non-infected residents within the wing/facility as much as possible. It is strongly advised they should be cohorted to the wing/facility for the duration of the outbreak. Call PPHS to discuss situations that cannot meet this requirement.
During Influenza outbreaks it is important that exposed and unvaccinated staff not work in
areas or provide direct care to residents not affected by the outbreak.
Excerpt from the Long Term Care Outbreak Procedure manual – Regina Qu'Appelle Health Region December 2015
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7 Saskatchewan Ministry of Health – Outbreaks in Long Term Care and Integrated Facilities; Generic Respiratory Protocol –
Introduction; Reviewed: June, 2010
Symptomatic Staff: Exclusion of symptomatic staff is REQUIRED.
 All ill staff should report illness and stay home until they are well. If they become ill at work they should report to the supervisor immediately and follow the appropriate exclusionary period.  Exclusion can be as long as 5 to 7 days. If all symptoms have resolved, they may be able to return after 3 days depending on the organism causing the outbreak.  Excluded staff members are discussed with PPHS to determine duration of illness and return to work date. Each organism has a different incubation period and may require more or less days of exclusion.  Symptomatic staff should not work at any other long term care or other health facility while
excluded. Discuss with PPHS on a case by case basis for any additional concerns. Staff Who Work In More Than One Facility/Unit/Wing - Asymptomatic

 It is advised that staff should not work in unaffected units/facilities if they have been working on
a unit/facility in outbreak.  If an individual is required to work in another facility, it should only occur after 48 hours has
passed from the time of their last exposure in the facility AND they remain asymptomatic. This time frame may be extended at the discretion of Public Health.  If this cannot be met, facilities should discuss these situations with Public Health.
During an Influenza outbreak:
 Asymptomatic, vaccinated staff working on an affected unit should not work in any other long
term care/health facility. o If vaccinated staff must work in another facility, it should only occur after 48 hours has passed from the time of their last exposure in the facility AND they remain asymptomatic. o If they become symptomatic during that time they should not work at any
facility.
 Asymptomatic, unvaccinated staff – It is strongly advised they:
o Unvaccinated, exposed staff are not to work in any other units/facilities until the
outbreak is declared over
o Be vaccinated with the Influenza vaccine recommended for the current Influenza season. If not vaccinated they are required to wear a mask in all patient care areas as per the regional Immunize or Mask policy. Excerpt from the Long Term Care Outbreak Procedure manual – Regina Qu'Appelle Health Region December 2015 o Receive Oseltamivir (Tamiflu®) chemoprophylaxis in consultation with their family physician for 2 weeks after immunization, or until the outbreak has been declared over, whichever is shorter. (especially full-time staff who have significant direct contact [i.e. at least 2-3 hours per day] with residents). o The dose of Oseltamivir (Tamiflu®) recommended for healthy staff members is 75 o Drug cost is at the staff's expense but is often covered by employer drug plans.
o Refer to the "Letters" section for staff and the staff persons physician letters

Management of Volunteers and Students
In principle, non-essential volunteers and students should be excluded from the facility for the
duration of the outbreak except in the instances where facility management and IPC personnel/MHO
have mutually identified exceptions (see below).
Communication:  Students and their preceptors should be informed that there is an outbreak in the facility.  Volunteers and students should be excluded as much as possible from working in the outbreak wing/unit/ward. If they are made aware of the risks associated with the outbreak they should be cohorted to the affected wing/unit/ward and not work in any other units/facilities.  If an individual is required to work in another unit/facility, it should only occur after 48 hours has
passed from the time of their last exposure in the facility AND they remain asymptomatic. This time frame may be extended at the discretion of Public Health.  If the cause of the outbreak is Influenza, unvaccinated students are not permitted to work in any
other unit or facility for the duration of the outbreak or until the maximum incubation period for Influenza has passed (4 days) from the time of their last exposure in the facility AND they remain asymptomatic. Excerpt from the Long Term Care Outbreak Procedure manual – Regina Qu'Appelle Health Region December 2015

Source: http://urnss.ca/wp-content/uploads/2016/03/RQHR-Management-of-Staff-and-Students-During-Outbreaks-in-LTC.pdf