Caring for patients, protecting patients and protecting staff are always top priorities for Adult Family Homes. Strong infection-control practices can help achieve these goals by preventing the spread of respiratory viral infections. When we understand where germs live and how they spread, we can recognize infection risks and make the right decisions to prevent illnesses.

Germs

Germs are everywhere​. Germs live and thrive in places called reservoirs. Common reservoirs include human skin, guts, blood, respiratory systems,​ environmental surfaces, dirt/dust, and medical devices. Germs spread by touch​, splashes and sprays to the eyes, nose, or mouth​, inhalation​ and by needlestick or cuts.

Standard precautions

Standard precautions for preventing infections include hand hygiene, cleaning and disinfecting surfaces​, giving medications and injections safely​, wearing personal protective equipment (PPE) that is appropriate for the situation and cleaning and disinfecting medical equipment between patients.

Other precautions

Droplet precautions prevent the spread of pathogens (e.g., influenza, pertussis, meningitis) transmitted through close-range respiratory droplets.

Contact precautions prevent the spread of pathogens via direct (person-to-person) or indirect (environmental surface) contact.

Airborne precautions are infection control measures used to prevent the spread of pathogens that remain suspended in the air, from coughing or sneezing.

Common respiratory viral infections

COVID-19, influenza and Respiratory Syncytial Virus (RSV) are common respiratory viral infections found in Adult Family Homes.

COVID-19 most often causes respiratory symptoms that can feel much like a cold, the flu, or pneumonia. COVID-19 may attack more than your lungs and respiratory system. Other parts of your body may also be affected by the disease. Most people with COVID-19 have mild symptoms, but some people become severely ill.

Influenza is a contagious respiratory illness caused by influenza viruses that infect tissues in the nose, throat, and sometimes the lungs. It can cause mild to severe illness, and at times can lead to death. Getting a flu vaccine has been shown to prevent flu and its severe complications. Flu vaccines are updated yearly.

Respiratory syncytial virus, or RSV, is a common respiratory virus that infects the nose, throat, respiratory tract, and lungs. RSV symptoms are not specific, which makes it difficult to distinguish RSV from the common cold or other respiratory viruses (like the flu or COVID-19). RSV spreads in the fall and winter along with other respiratory viruses. It usually peaks in December and January.

Thousands of hospitalizations and deaths occur every year from these respiratory viral infections. Vaccines are available for each of these respiratory viral infections and are recommended for individuals who are age 65 and older.

Transmission of common respiratory viral infections

COVID-19 spreads when an infected person breathes out droplets and very small particles that contain the virus. Other people can breathe in these droplets and particles, or these droplets and particles can land on others’ eyes, nose, or mouth. In some circumstances, these droplets may contaminate the surfaces they touch.

Per the CDC, experts think that influenza viruses spread mainly by droplets made when people with flu cough, sneeze, or talk. Less often, a person might get influenza by touching a surface or object that has influenza virus on it and then touching their own mouth, nose, or possibly their eyes.

Respiratory syncytial virus (RSV) can spread when an infected person coughs or sneezes, by direct contact with someone who has RSV, or by touching a contaminated surface. RSV contamination on surfaces can last up to 6 hours.

Preventing respiratory infections in Adult Family Homes

The best way to prevent respiratory infections in Adult Family Homes is to follow these best practices:

• Stay up to date with immunizations​
• Practice good hygiene (practices that improve cleanliness)​
• Take steps for cleaner air​
• Use precautions to prevent spread​ when a worker or resident has a respiratory virus
• Seek health care promptly for testing and/or treatment if a worker or resident has risk factors for severe illness
  • Treatment may help lower the risk of severe illness

Treating residents with respiratory infections

If a resident has or is suspected of having a respiratory infection, they should be isolated and tested. Anyone with even mild symptoms of COVID-19, regardless of vaccination status, should receive a viral test for SARS-CoV-2 as soon as possible.

For Covid-19, Influenza, and RSV infections, implement the following minimum precautions, additional precautions may be required depending on the virus present:

• Place infected residents in private rooms.
• Ensure good ventilation.
• Require staff members and other residents to keep a six ft distance from an infected person to minimize risk.
• Require all staff members to wear a surgical mask, gloves and gown when working within three to six feet of the resident. Adult Family Home workers should consider wearing a respirator or high filtration mask like an N95 mask when caring for a resident who has or is suspected of having a respiratory infection.
• Put surgical masks on patients if they need to be around uninfected people or if they need to be transported out of their room.
• Change mask and other PPE between patients.

Notes:

• Droplet precautions prevent the spread of pathogens (e.g., influenza, pertussis, meningitis) transmitted through close-range respiratory droplets
• Contact precautions prevent the spread of pathogens via direct (person-to-person) or indirect (environmental surface) contact
• Airborne precautions are infection control measures used to prevent the spread of pathogens that remain suspended in the air, from coughing or sneezing.

Additional Notes:

• COVID-19 spreads when an infected person breathes out droplets and very small particles that contain the virus. Other people can breathe in these droplets and particles, or these droplets and particles can land on others’ eyes, nose, or mouth. In some circumstances, these droplets may contaminate the surfaces they touch.
• Per the CDC, experts think that influenza viruses spread mainly by droplets made when people with flu cough, sneeze, or talk. Less often, a person might get influenza by touching a surface or object that has influenza virus on it and then touching their own mouth, nose, or possibly their eyes.
• Respiratory syncytial virus (RSV) can spread when an infected person coughs or sneezes, by direct contact with someone who has RSV, or by touching a contaminated surface. RSV contamination on surfaces can last up to 6 hours.

Staff with respiratory infections

If an Adult Family Home staff member has symptoms of a respiratory illness, they should avoid coming to work to minimize the risk of transmitting the illness to residents and other staff members. In general, asymptomatic staff who have been exposed to a respiratory virus but do not develop symptoms or test positive for a viral infection DO NOT NEED TO BE RESTRICTED FROM WORK.

If an Adult Family Home staff member tests positive for a respiratory infection, they need to stay at home and wait until their symptoms have subsided before returning to work.​ Employees diagnosed with the flu or presumed to have the flu can return to work when they have been without fever for 24 hours (without use of fever-reducing medication). Those with ongoing respiratory symptoms should be evaluated to determine if they should be in contact with residents and other staff members.

Follow this Washington State Department of Health guide Preventing Respiratory Disease in Adult Family Homes to keep residents and staff safe and healthy.

This blog is part of the Adult Family Home Industry Worker Safety Awareness Training Program created by the Adult Family Home Council, Long-Term Care Foundation of Washington State and PIM Savvy. Program funding and support for this project has been provided by the state of Washington, Department of Labor & Industries, Safety & Health Investment Projects.

Resources

Standard precautions for the prevention and control of infections | WHO
Immunizations for Respiratory Viruses Prevention | CDC
Hygiene and Respiratory Viruses Prevention | CDC
Taking Steps for Cleaner Air for Respiratory Virus Prevention | CDC
Preventing Spread of Respiratory Viruses When You’re Sick | CDC
People at Increased Risk for Severe Respiratory Illnesses | CDC
Treatment of Respiratory Viruses | CDC
Staying Up to Date with COVID-19 Vaccines | CDC
Who Needs a Flu Vaccine | CDC
People at Increased Risk for Severe Respiratory Illnesses | CDC
Preventing Respiratory Disease in Adult Family Homes | DOH
About COVID-19 | Covid | CDC
About Influenza | Influenza (Flu) | CDC
About RSV | RSV | CDC