Rapid Assessment of and Prophylaxis for Influenza in Dwellers of Long-Term Care Facilities (RAPID-LTCF)

At a Glance

This project, Rapid Assessment of and Prophylaxis for Influenza in Dwellers of Long-Term Care Facilities (RAPID-LTCF), aimed to assess whether early detection of influenza results in earlier treatment of influenza and leads to fewer hospitalizations, reduced mortality and lower health care-associated costs for LTCF residents during influenza season. Over the course of the study, which spanned three flu seasons, nasal specimens were collected from 497 LTCF residents. Care facilities that completed rapid testing and treatment saw emergency room visits decline by 22 percent, hospitalizations decline by 21 percent and hospital length-of-stay decline by 36 percent.

The Challenge

Influenza is an infection that disproportionately affects residents of long-term care facilities (LTCFs), resulting in high infection rates, hospitalizations and related deaths. There are currently 396 LTCFs in Wisconsin, and their residents contribute disproportionately to the estimated $160 million in annual costs of influenza for the state’s elderly. Most LTCFs across Wisconsin and the nation have clear guidelines regarding detection and response to influenza, however, most facilities do not have the capacity to test for influenza when a case is suspected.

Project Goals

The primary goal of RAPID-LTCF was to assess whether early detection of influenza coupled with infection control guidance for a population of LTCF residents results in increased early antiviral treatment of influenza, increased use of antiviral prophylaxis for other at-risk residents and fewer hospitalizations, reduced mortality and lower health care associated costs during the influenza season. This was evaluated using a randomized controlled trial in which 20 Wisconsin LTCFs were randomized to an intervention or control arm. The intervention involved conducting rapid influenza tests on residents who had at least two minor flu symptoms such as runny nose, congestion, sore throat, cough or fever. The control sites followed standard infection control guidance.

Results

RAPID-LTCF made significant progress toward its primary goal. Over the course of the study, which spanned three flu seasons, nasal specimens were collected from 497 LTCF residents. The results of the on-site, rapid testing were available within 12 hours and often in as little as 15 minutes. Lowering the threshold for testing and decreasing the time to results led to increased use of the antiviral medication oseltamivir, known by its brand name, Tamiflu, for influenza prevention at intervention sites. The care facilities that completed rapid testing and treatment saw emergency room visits by residents decline by 22 percent, hospitalizations decline by 21 percent and hospital length-of-stay decline by 36 percent. LTCFs that leveraged rapid testing also grew adept at identifying and halting influenza outbreaks which resulted in a decline in cases from 22 percent in the first year to 3 percent by the final year of the study. Of the ten facilities that participated in rapid testing, nine opted to continue with rapid testing and treatment following the conclusion of the study.

Lasting Impact

The RAPID-LTCF study ended just before the COVID-19 pandemic, and the Centers for Disease Control and Prevention infections diseases section invited the researchers to present their study to inform response to COVID-19 infections in LCTFs.