The flu epidemic in the Korian nursing home in Lyon was well managed. But the consequences could have been avoided with a better vaccination policy.
No major fault, but a succession of small errors. These, in essence, are the conclusions of the General Inspectorate of Social Affairs (Igas) on the flu epidemic that occurred at the end of December in the Korian-Berthelot nursing home in Lyon (Rhône).
The results are impressive: 72 infections including 13 fatal.
Entered by the Ministry of Health, the institution recognizes that the overall management of the outbreak was in accordance with the recommendations. But Christmas day played a pivotal role, she explains in a report made public on February 6.
A responsive team
The flu epidemic started shortly before the holiday season on December 19. The Korian-Berthelot retirement home was then welcoming 102 retirees. Aged on average 85 years, these people “are old and are weakened by the pathologies from which they suffer”, underlines the Igas in its report. An advanced age which reduces the effectiveness of the vaccine and increases the risk of infection with a virus.
Faced with this vulnerability, specialized establishments apply so-called “barrier” measures: hand hygiene, surface maintenance, wearing masks in the event of illness, etc. In this regard, the Igas mission does not identify any major anomalies. Staff practices were compliant and were adapted from the first cases. The care was also quick and the monitoring precisely traced. The inspectors also salute the “competence” and “professionalism” of the Regional Health Agency (ARS), quickly alerted to the epidemic.
A “misguided” strategy
So why has the flu circulated so much, and so quickly? The report points to two major flaws in the protection of nursing home residents. The first concerns preventive vaccination, recommended for anyone over 65 years of age. The coverage rate is “much lower than the group’s objectives”.
Indeed, the Korian group asks its establishments to achieve 90% vaccination among its residents and 50% among staff. This year, the objectives are not quite reached and the Lyon structure is far from the mark: vaccination coverage is 40% … among caregivers as well as residents.
“This difference from single to double requires explanations,” slices the Inspection. Difficult to obtain, since the coordinating doctor was not met by the inspectors. Several reasons explain this delay. The vaccination campaign was almost at a standstill at the time of the epidemic: in three weeks, three residents received the vaccine.
Christmas slack
This poor coverage is also caused by the refusals of 13 families and the desire to wait for receipt of the care vouchers. A “misguided” strategy, in the very words of the mission. A sum of 650 euros for all vaccines is, in fact, largely bearable by the establishment. This set of errors “resulted in particular in differences in practice depending on the floor”.
But the series doesn’t end there. Despite the advice of the ARS, the nursing home relaxed its efforts shortly before Christmas. Transmission slows down, staff grows to a lull. The doors are open to families. 42 visitors are gathered for an event. The consequence is unfortunate. The epidemic is resuming. 14 new cases are declared on December 28, causing the total confinement of the residents.
Four recommendations
The Igas therefore makes four recommendations for the establishment. The Inspectorate points out the inaccuracies in the epidemiological and vaccination monitoring, which must clearly improve. But the policy of establishments vis-à-vis vaccination must change: it must become the priority of the coordinating doctor. Exchanges with the ARS would also have every interest to be strengthened, in order to further improve monitoring.
The authors of the report recommend being more insistent on a preventive injection. To do this, staff members must continue to inform families and improve targeted contact on vaccination. Written agreement must be obtained. On the other hand, it is not necessary to wait for the arrival of the care vouchers – synonymous with delay.
.
