All eyes and resources in the long term care profession currently are focused on the COVID-19 pandemic, and rightfully so. This virus has spread through facilities like nothing seen before.

Unlike COVID-19, the flu season arrives like clockwork on a yearly basis. Unfortunately, in addition to the ongoing pandemic, flu season is looming just around the corner. Now more than ever, facilities need to be proactive in protecting their residents.

This article will spotlight four areas for facilities to focus on for influenza prevention and control this fall, while also remaining in substantial compliance with the Focused Infection Control Survey from the Centers for Medicare & Medicaid Services.

Personal Protective Equipment

PPE is crucial in preventing the spread of viruses such as influenza and the coronavirus. According to the Centers for Disease Control and Prevention (CDC), health care personnel (HCP) need to implement standard precautions when caring for residents with influenza. These include:
  • Hand hygiene;
  • Glove use for any contact with potentially infectious material; and
  • Gown use for any patient-care activity when contact with blood, body fluids, secretions (including respiratory), or excretions is anticipated.
Moreover, HCP and facilities also must implement droplet precautions. Because these entail the addition of facemasks and eye protection, facility leadership needs to ensure the building has enough PPE on hand for staff to wear when caring for residents with influenza.

Due to COVID-19, some facilities may struggle to maintain PPE stocks. CDC offers on its website guidance for optimizing PPE, along with a burn rate calculator for facilities facing shortages. Not only does the facility need adequate PPE to prevent and reduce the spread of influenza, but surveyors will also be reviewing PPE stock to determine if it is adequate.

If PPE is in short supply, surveyors will also review steps the facility took to address the shortage. If a facility does not already have a procedure in place for monitoring PPE par levels (the amount of PPE on hand), it should immediately initiate one to ensure staff have the PPE needed.

Facilities also need to ensure HCP are competent in the performance of PPE utilization. PPE utilization is a large focus of the new Focused Infection Control Survey and is one of the top two citations facilities are receiving. The Occupational Safety and Health Administration requires that each HCP knows the following regarding PPE:
  • When it is necessary;
  • What kind is necessary;
  • How to properly put it on, adjust, wear, and take it off;
  • The limitations of the equipment; and
  • Proper care, maintenance, useful life, and disposal of the equipment.
Facility leadership should conduct competency observations of staff prior to influenza season and provide ongoing, just-in-time education when a caregiver is observed in noncompliance.


The influenza vaccine is an essential part of protecting residents. CDC recommends an annual influenza vaccine for all eligible persons aged six months and older. 

Appendix PP of the State Operations Manual, under F-tag 883, provides the guidance that surveyors will apply. The facility must develop policies and procedures to ensure that:
  • Each resident is offered an influenza immunization from Oct. 1 through March 31 annually, unless the immunization is medically contraindicated, or the resident has already been immunized during this time period. The facility should secure the supply from its pharmacy by the end of September or as soon thereafter as possible.
  • Each resident, or his or her representative, receives education on potential side effects of the vaccine. This should be completed when obtaining consent at least one week prior to administration of the vaccine. Facilities should have a plan in place for this, especially if there are restrictions on visitation.
  • The resident or the resident’s representative has the opportunity to refuse immunization. Vaccine administrations and refusals alike should be documented in the medical record.
  • Prior to administering the influenza vaccine, the facility should:
  • Consider whether the facility has been in touch with its pharmacy to pre-order enough of the current influenza vaccine for residents and employees. If not, managers need to do so immediately.
  • Review current influenza education tools to ensure they are current.
  • Review current influenza screening tools to ensure they are current.
  • Review current influenza consent forms to ensure they are current.
  • Review staffing to ensure enough staff are on hand to administer the vaccines and monitor the residents according to facility policy.


CDC says influenza testing should occur in the facility when residents show signs and symptoms of influenza-like illness. Although COVID-19 and influenza share many similarities, CDC guidance emphasizes key differences that may assist the facility and physician in determining if an influenza test is warranted.


The facility should ensure there are enough influenza test kits in-house prior to the influenza season in case they are needed.


  • Education of staff is a very important piece of the infection control puzzle. Facilities should begin influenza education now, and include, at a minimum, the following:
  • Facility policy and procedures on isolation precautions and cohorting;
  • Hand hygiene—education should be combined with verification of competency;
  • PPE utilization and donning/doffing—education should be combined with verification of competency;
  • Facility policy and procedure on influenza vaccination of residents, including but not limited to:

    • Consents;

    • Education and screening of residents/resident representatives;

    • Administration of vaccine;

    • Monitoring of residents post-vaccination;

  • Signs and symptoms of influenza; and
  • Facility policy and procedure for influenza testing.
Regardless of a facility’s current situation, flu season is coming. Focusing on these key areas will help prepare the facility for the 2020-2021 influenza season—and may also help with ongoing coronavirus preparedness and response. With targeted efforts, started now, facilities can avoid being overwhelmed by the rapidly approaching influenza season.
Denise Winzeler, RN-BSN, LNHA, DNS-CT, QCP, is curriculum development specialist for the American Association of Directors of Nursing Services (AADNS). She can be reached at