Zelia Souter
Zelia Souter, Nurse Manager of Cardiology Inpatient Unit 5B at TGH, says there were many learnings from a flu outbreak her unit experienced. “Now we know what happens when we get sick and what the potential impact is on patient care,” she says. (Photo: UHN)

In February 2016, Cardiology Inpatient Unit 5B in Toronto General Hospital experienced a flu outbreak that affected staff and patients, and eventually required half of the unit to shut down. The consequences were far-reaching: as 5B battled the flu, other units took any overflow patients that were admitted so no one else would be exposed.

Zelia Souter, Nurse Manager of 5B, sat down with UHN News to reflect on the outbreak, what the team learned, and why it's important to fight the flu this season in every way possible – including rolling up our sleeves for the flu vaccine.

What were the first signs of the flu outbreak and what happened from there?

We initially knew about two patients who had flu symptoms, who we isolated. It was Feb. 23 when we realized that we in fact had an increase in the number of patients who were testing positive, and we called an outbreak at that time.

By Feb. 25, we had six cases on our unit confirmed with influenza type B and we had two more patients that were pending swabs. We had a total of eight patients on isolation. It was that quick.

​​Concurrently, we had staff with flu symptoms. A total of 24 staff were listed as ill – across nursing and inter-professional teams. Out of those, four were confirmed Flu B cases. All these staff were followed up with and they took time off to recover.

When it was all said and done – the outbreak officially lifted on March 7 – there had been eight patient cases of flu and four confirmed staff cases, with an additional 20 who were sick with symptoms but not confirmed cases by testing. Of the eight patients, it was confirmed that seven had acquired the flu in the hospital – whether through direct transmission from another patient before the symptoms were apparent, through transmission from a healthcare provider, or from contaminated surfaces or hands.

How did you manage the outbreak?

We had Infection Prevention and Control Physicians, Drs. Camille Lemieux and Susy Hota, help to determine how to manage patients and staff during the outbreak. We gave Tamiflu, an antiviral medication used to treat flu symptoms, to patients with symptoms and then we gave a lower dose of Tamiflu to all the patients who were remaining in order to help protect against the flu.

Any staff who had hands-on and direct care with patients on the unit were required to take Tamiflu prophylactically as well. There was also daily huddling on the unit to communicate updates and answer questions about the outbreak.

What were some of the challenges you encountered?

In order to prevent the further spread of the flu, if you had worked in this environment in direct patient care, you were restricted in working somewhere else. There was an incubation period we were concerned about during which people may have been carrying the virus but not yet showing symptoms.

We also had to close down half of the unit at one point because there were not enough staff to care for existing patients, and we couldn't admit additional patients onto the unit. If we admitted new patients, they would have to be exposed to the flu virus – we didn't want to impose that on them.

Closing down part of our unit meant there were implications on a broader scale, as other areas of the hospital had to take on our overflow of patients that were coming into the Emergency Room.

How did the outbreak impact the patient experience?

Some patients had a hard time. They had to stay in their rooms and there were restrictions on families visiting. It was very difficult for them. We did provide ongoing support to both patients and families.

Infection Prevention and Control communicated regularly with patients and families. The unit management also kept open lines of communications with patients and families through formal letters.

What did you learn from this experience?

We now understand first-hand how important it is for staff to not come to work ill in order to break the chain of transmission.

We learned that we needed to have an increased awareness about flu symptoms; worsening cough, fever, runny nose. We also needed more awareness on how to protect ourselves immediately. We learned to not assume that a cough is the result of another condition other than the flu. Now we are more likely to put on a mask with each patient who exhibits a cough. 

We're now doing more staff education on the use of Personal Protective Equipment (PPE) and discussing any symptoms in our safety huddles immediately.

We also learned how to communicate broadly during an outbreak.

We're hoping we're not going to be back there, but if we do come back upon this again, we have some better strategies and some recommendations that will guide us through that process.

How did the outbreak impact how your team approaches the flu vaccine?

During the outbreak, we learned that some staff had taken the vaccine and some hadn't. This year we are discussing the benefits of taking the vaccine throughout the flu campaign.

We've been out there supporting everyone and encouraging them to take it because last year's example provided us with something to talk about. Now we know what happens when we get sick and what the potential impact is on patient care.

It is one key part of protecting ourselves from an outbreak. This example should guide us – I certainly got my flu shot!

What do you hope other teams will learn from your experience?

The biggest learnings are the heightened awareness of PPE, the signs and symptoms of the flu, and communicating updates to the right people so you can stop an outbreak before it occurs.

If you are caught in an outbreak, rely on the experts at hand – Infection Prevention and Control and Occupational Health.

The hospital does a very good job in supporting the team when outbreaks occur. You really need to rely on those who have already experienced it. A big highlight and thank you to the staff who stuck it out – that's nursing, the physicians, dietary, the social workers, housekeeping, respiratory technicians, dialysis staff, ECG technicians, and the blood technicians. It takes the whole team to step in when a unit is in an outbreak, and these teams were really there for us.

The Occupational Health Toolkit for the management of the outbreak was also instrumental.  The toolkit provided needed tools to guide me, as the manager, in addressing a complex set of circumstances such as dispensing Tamiflu and what to do if staff members report flu-like symptoms during an outbreak.

Our tagline for the Flu Campaign this year is #IFightTheFlu4. Who are you fighting the flu for by getting your flu shot?

I fight the flu for the patients. The patients who are here and who would become very sick and compromised as a result of any potential transmission.

We also want to keep the staff healthy – we want to keep ourselves healthy. Although some may feel that the flu may not be a problem for them, there are others who could be very compromised by it and we need to keep that in mind.

The UHN Flu Campaign ends Friday, Nov. 25, but you'll be able to get your flu shot past the end date in Occupational Health and Safety Clinics across UHN. Remember, the flu vaccine is just one part of the Flu Protection Bundle, which includes eating well, sleeping well, hand hygiene and respiratory etiquette. You can learn more about the bundle here.

If you get your flu shot on or before Nov. 25, be sure to participate in our social media contest for one of five $200 Cadillac Fairview gift cards. Take a photo with our #IFightTheFlu4 sign - located at every flu cart – and submit it through one of the following options:

  • Using Twitter: Tweet your photo with our sign, tell us who you are fighting the flu for, tag us at @UHN_News, and use our campaign hashtag, #IFightTheFlu4.
  • Using email: Email social@uhn.ca , attach your photo with our sign and tell us who you are fighting the flu for.​

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