title: Delays in the application of outbreak control prophylaxis for influenza A in a nursing home.
abstract: OBJECTIVE
  To identify delayed prophylaxis from a pre-existing database and strategies to improve performance.
  
  
  METHODS
  A skilled nursing facility with 14 floors (4 buildings). The "outbreak unit" was a 50- to 60-bed floor.
  
  
  METHODS
  We performed surveillance during six seasons using one protocol. Prophylaxis was started when influenza was cultured in the building and 10% of residents on the floor had a new respiratory illness within 7 days. We defined delayed prophylaxis as four or more residents on a floor with positive cultures whose specimens had been collected within 5 days before the application of prophylaxis.
  
  
  RESULTS
  We identified 14 examples of delayed prophylaxis. In three, delayed prophylaxis was related to the 3.9-day delay between culture collection and culture report There was a high degree of commonality among building attack rates within a season. During six seasons, the first case in the last building occurred 27 to 64 days after the first case in the facility. The two seasons with the greatest activity (68 and 154 cases, respectively) began with explosive, multi-floor outbreaks in a single building. The match between the circulating strain and the vaccine was good, except in 1997-1998 when there were seven examples of delayed prophylaxis.
  
  
  CONCLUSIONS
  Influenza may involve buildings sequentially with a commonality of building attack rates. Explosive, multi-floor outbreaks early in the season could lead to a lower threshold for prophylaxis within a larger area when initial cases are encountered later in the season. This strategy could have prevented five examples of delayed prophylaxis. Rapid testing of multiple specimens while waiting for culture confirmation could have prevented three examples of delayed prophylaxis.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Drinka
authors.forename: Peggy
authors.initials: P
authors.lastname: Krause
authors.forename: Lori
authors.initials: L
authors.lastname: Nest
authors.forename: Stefan
authors.initials: S
authors.lastname: Gravenstein
authors.forename: Brian
authors.initials: B
authors.lastname: Goodman
authors.forename: Peter
authors.initials: P
authors.lastname: Shult
mesh_terms: D000368:Aged; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000592:standards*; D009980:Influenza A virus / Q000302:isolation & purification; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D008297:Male; D011292:Premedication / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000592:standards*; D013996:Time and Motion Studies; D014922:Wisconsin / Q000453:epidemiology
chemical_list: D007252:Influenza Vaccines