title: Surveillance for respiratory illness in long-term care settings: detection of illness using a prospective research technique.
abstract: BACKGROUND
  The overall frequency and severity of viral respiratory infections affecting residents of long-term care facilities (LTCFs) is not well described. This is due primarily to the cumbersome and expensive techniques required for adequate surveillance of respiratory illnesses and the associated costs and availability of a laboratory capable of the relevant and timely report of diagnostic tests. Here we describe our technique for surveillance of respiratory illness in the LTCF. Elements of it may serve as strategies for routine care.
  
  
  METHODS
  Nurses were trained to record respiratory complaints and to track them using a histogram-based calendar charting system. For the research technique, all new illnesses during the winter months, no matter how minor, were sampled for viral culture.
  
  
  RESULTS
  Influenza A and B, parainfluenza types 1 through 4, herpes simplex virus types 1 and 2, rhinovirus, and respiratory syncytial virus (RSV) were detected in the nursing homes studied. Outbreaks of influenza were documented annually by prospective surveillance. Outbreaks of parainfluenza type 1 and RSV indistinguishable clinically from influenza were detected.
  
  
  CONCLUSIONS
  Intense surveillance for respiratory illness and viral pathogens using the described research technique identified viral activity reliably on an annual basis in several large LTCFs. Elements of the research protocol may be adapted for general use to create a cost-effective surveillance program for LTCFs that have limited resources. Such a technique is essential for implementing effective measures for outbreak prevention and control.
authors.affiliation: Eastern Virginia Medical School Norfolk, VA 23507-1912, USA.
authors.forename: S
authors.initials: S
authors.lastname: Gravenstein
authors.forename: A
authors.initials: A
authors.lastname: Ambrozaitis
authors.forename: M
authors.initials: M
authors.lastname: Schilling
authors.forename: D
authors.initials: D
authors.lastname: Radzisauskiene
authors.forename: P
authors.initials: P
authors.lastname: Krause
authors.forename: P
authors.initials: P
authors.lastname: Drinka
authors.forename: P
authors.initials: P
authors.lastname: Shult
authors.forename: B
authors.initials: B
authors.lastname: Freund