With the arrival of the season winter virusesthe Ministry of Health already works in the prevention protocols to reduce risks among the most vulnerable population, in this case the elderly who are in residences. To this end, it has just published the update of the Guide for the Prevention and Control of Outbreaks of Acute Respiratory Infections for Nursing Homesfocusing this time on more exhaustive surveillance of outbreaks that may pose greater risks.
The Epidemiology service points out that outbreaks due to Acute Respiratory Infections (ARIs) “They constitute a public health problem”and its appearance and severity may be favored by factors related to the residents themselves (their dependency, fragility or comorbidities) and the environment (services, use of common areas or air quality and ventilation).
Among the most common respiratory infections caused by viruses are COVID-19, influenza, respiratory syncytial virus (RSV) and human matapneumovirus, while among those of bacterial origin the most relevant are pneumococcal pneumonia and polymicrobial pneumonia. aspiration.
With this new guide, the Ministry of Health of the Region of Murcia gives the guidelines to act when one or more cases of infections are detected acute respiratory infections in nursing homes with a view to avoiding outbreaks. Furthermore, the team led by counselor Juan José Pedreño insists that “the measures included in this protocol They must be applied in all residential centers of vulnerable people in the Region of Murcia, regardless of their ownership, whether public, private or concerted.
The data managed by Social Policy amounts to 84 nursing homes and 40 disability homes of the Region.
The updated guide is a regional adaptation of the national protocol and, as established, all outbreaks of ARIs that occur in said centers must be reported to the Epidemiology service of the General Directorate of Public Health.
Among the preventive measures proposed by the document, for example, the promotion of vaccination of residents and professionalshence the flu and COVID-19 immunization campaigns begin in residences. To this would be added precautions such as correct hand hygiene and the use of Personal Protective Equipment (PPE) such as gloves, masks and single-use gowns in the case of caring for a resident with symptoms.
No strict isolation
One of the most criticized measures during the COVID-19 pandemic was the total isolation to which older people who were in nursing homes were subjected, driven by fear of an unknown virus, a measure that was subsequently highly criticized. For this reason, the new guide for the Region of Murcia insists that “strict isolation of symptomatic people is not recommended” and it is only proposed that, while they present symptoms, avoid the use of closed common spaces.
The general director of Public Health of the Region of Murcia, José Jesús Guillén, states that “the implementation of the guide is an example of effective collaboration between health authorities, those responsible for Social Policy and residential centers”, at the same time which highlights that «“Its application allows us to continue improving the response capacity to these respiratory diseases.”.
In this way, “it has been possible to establish a integrated surveillance system “which allows the early detection of cases of both influenza and COVID-19, two respiratory diseases that can have serious consequences in the elderly population,” explains Guillén.
According to figures provided by the Ministry of Health, during the 2023-2024 season, when these outbreaks began to be declared after the publication of the first guide, 1,325 cases of respiratory viruses have been recorded in residences. 75.4% were caused by SARS-CoV-2, 5.8% by the influenza virus and 1.1% by RSV (respiratory syncytial virus), while the rest of the ARI outbreaks were mixed.
The person responsible for Public Health insists that “this joint approach with residences “It allows resources to be optimized and provides a more complete vision of the epidemiological situation.”
Professionals miss more coordination and ventilation measures
One of the system inefficiencies detected during the coronavirus pandemic was the lack of connection and coordination between residential centers and the health system, a problem that remains unresolved for those responsible who were in charge of coordination at that time and that is not addressed in depth in the Ministry’s document.
The doctor Abel Novoawho coordinated the group for Advanced Chronicity and Social Health Care (Corecaas) of the Murcian Health Service (SMS) during the health crisis, qualifies the Public Health guide as “very generic” and there is a lack of actions so that residents do not have to go to the emergency room door of a hospital in the event of a respiratory infection, “since moving them exposes them to other viruses “which can cause complications.”
The specialist points out that flu outbreaks are highly frequent in nursing homes, which leads to high mortality, and remembers that during Covid they worked with protocols for early diagnosis, «recommending antiretroviral treatments in the first 48 hours, the use of which is not now mentioned in the guide.
Dr. Novoa also misses that the document preventive measures refer to ventilation“when it is proven that this is essential for the prevention that is intended, both ventilation of the facilities and the air renewal systems.”
Precisely, from Corecaas a report was made on How healthcare in nursing homes should change to avoid another crisisin which it was stated that, for decades, the residences have been disconnected from the health system and that, in the pandemic, “residents had suffered not only from COVID-19 but also from the measures taken in the outbreaks and that “They affected infected and unaffected.”
The study produced results that showed the health needs of a very aged population in which 47.3% were advanced frail; 45.4% suffered from severe dementia; Up to 43.7% were totally dependent and 72.9% used diapers.
Liaison nurses
To try to partially alleviate the disconnection between residential and health centers, the figure of liaison nurses was launched, with a professional in each of the nine health areas to distribute and manage carealthough professionals report that these positions have been disappearing in 2024.
However, the Ministry of Health states that “the health care group in residences continued to function, always adapting resources to the epidemiological situation”, although they currently have specific liaison nurses only in four health areas, “while this figure is readjusted and redesigned.” In the rest, he says, there is the collaboration of a team of nurses who respond to requests and resolve incidents, in coordination with the management of each hospital and health centers.
