Table 1 Description of the 3 to 5-steps multimodal strategy for nosocomial influenza prevention
Measure | Details and evolution | Units | Evaluation |
|---|---|---|---|
Promotion of vaccination among HCWs | - Communication and information (emails, posters etc.) on vaccination | All units | Vaccination rate among HCWs determined with data from the occupational health unit |
| Â | - Vaccination in the occupational health unit during all epidemic seasons | Â | Â |
|  | - Delocalized vaccination in units by a referent nurse was implemented from 2017–2018 onwards |  |  |
|  | - A survey on vaccine hesitation was carried out during the 2017–2018 epidemic season |  |  |
|  | - Delocalized vaccination at the hospital lunchroom was implemented from 2018–2019 onwards |  |  |
|  | - Interventional studies with implementation intention or impact of threat were carried out during the 2018–2019 and 2019–2020 epidemic seasons [31] |  |  |
Implementation of an epidemiologic surveillance | - Daily surveillance of the number of cases within the hospital | All units | Conformity rate for adherence to droplet precautions |
| Â | - Collection of information for all patients with a positive influenza test | Â | Â |
|  | - Check of droplet precautions’ application and oseltamivir treatment and reminder if necessary |  |  |
| Â | - Determination of nosocomial status by an infection control practitioner | Â | Â |
|  | - Outbreak control measures if > 2 cases with nosocomial transmission within one unit |  |  |
Communication | - Local recommendation available about management of influenza cases (precautions, treatment, outbreak management, etc.…) | All units | NA |
| Â | - Communication on influenza and vaccination to HCWs, patients and visitors with posters dispatched within the hospital | Â | Â |
| Â | - Weekly emails on vaccination for HCWs | Â | Â |
| Â | - Feed-back: weekly feedback to staff on outbreak evolution through the intranet portal during the epidemic period, reports in institutional commissions and in risk units at the end of the epidemic | Â | Â |
Implementation of systematic surgical masks use | - Systematic surgical masks use | Risk units* | Conformity rate for HCWs and visitors determined with biweekly audits in risk units during the epidemic period |
| Â | - Implementation for all HCWs and visitors regardless of their vaccination status for the duration of the epidemic period | Â | Â |
| Â | - Benchmarking (weekly feedback for each unit with comparison to the global results) | Â | Â |
Improvement of diagnosis capacities | - Serial tests with RT-PCR R-DiaFlu® (≈ 5 h, performed in the virology laboratory on weekdays and Saturday mornings): used during the 5 epidemic seasons | Risk units* | Number of tests performed during the epidemic period |
|  | - Rapid tests with RT-PCR GeneXpert® (≈ 35 min, performed in the virology laboratory): |  |  |
|  |     - for emergencies only in 2014–2015 |  |  |
|  |     - in routine practice for risk units in 2015–2016 (weekdays and Saturday mornings) |  |  |
|  |     - in routine practice for risk units and ICUs, and on specific demand for non-risk units with justification by clinician from 2016–2017 onwards (weekdays and Saturday mornings only in 2016–2017 and 2017–2018, extended to nights and weekends in 2018–2019) |  |  |
|  | - Rapid point-of-care tests with Cobas® Liat System (≈ 20–25 min, performed in the ED): assessment over a 2-weeks period during the 2017–2018 season [32]; then fully available during the 2018–2019 epidemic season |  |  |
|  | - Respifinder® 2Smart (≈ 4–5 days, performed in the virology laboratory on weekdays): used during the 5 epidemic seasons used during all epidemic seasons for patients hospitalized in intensive care units (ICUs) or on specific demand |  |  |