Tips to Help Reduce and Manage Influenza-Related Hospitalizations in Dialysis Patients

Along with the general population, hospital admissions among dialysis patients tend to fluctuate with the seasons. Winter months are historically associated with a spike in admissions, largely due to influenza, sepsis, cardiac and pulmonary issues, and other multi-organ failure etiologies. In addition, influenza data from recent years indicate flu cases are on the rise. In 2018, winter hospitalization rates were particularly high due to a record-setting number of influenza cases, causing unexpectedly high patient care volume. Thus far in 2019, the Centers for Disease Control data suggest a later-than-usual rise in influenza cases. This spike in admission rates places a strain on hospital care teams as they seek to provide around-the-clock care to dialysis patients. There are, however, tactics that care teams can proactively employ to help navigate these seasonal fluctuations.

The following three efforts may help to reduce influenza-related hospitalizations:

1. Encourage patients and caregivers to receive the influenza vaccine. Educate patients and caregivers about the risks and benefits of vaccination. Between 2005 and 2014, an estimated 40,000 lives were saved by influenza vaccines. While approximately 97 percent of U.S. dialysis patients receive the vaccine, that may not be enough. Herd immunity works best when nearly all individuals are vaccinated.  In this case, that means both dialysis patients and their caregivers.
2. Educate patients on when and where to go for health care. Develop and communicate to patients and their caregivers the value of early intervention when they begin to feel ill, and where to seek care: convenience clinics, primary care clinics, urgent care clinics or emergency rooms.
3. Consider antiviral prescription for vulnerable patients. Antiviral medications, when prescribed early in the course of confirmed influenza, may help protect vulnerable patients by shortening illness duration and preventing complications.

In addition, the following five efforts may help improve results for patients who are hospitalized with influenza:

1. Equip dialysis team members to provide care in multiple hospitals. Cross-credentialing team members at multiple local facilities can aid in the process of quickly responding to surges in patient volume.
   
2. Employ triage protocols consistently. Ensure the proper management of high patient loads through strict adherence to triage protocols. This safeguards the prioritization of the most critical patients.
   
3. Increase inter-facility communication. When appropriate, work with your hospital, outpatient facilities and community to share population-based health information (e.g., number of patients with influenza symptoms) in an effort to anticipate greater resource needs.
   
4. Prepare for surging treatment volumes. Reserve non-critical training sessions, meetings and events for months with traditionally lower inpatient volume.
   
5. Engage leadership to foster care team success. Involve leadership to better understand and respond to care team challenges during the higher workload associated with the flu season. Leadership support can help foster clinical success.

Efforts to prevent and mitigate influenza outbreaks remain our best tactics to improve population health. However, a universal vaccine (for the majority of known Type A flu viruses) may be on the horizon. Recently completing the mouse-model research stage, a promising vaccine is now being tested in other animal models whose respiratory systems bear important similarities to humans. The vaccine is unique in that it targets the interior stalk of the virus—common among most influenza viral strains—and not as susceptible to regular mutation. In the meantime, the health care community must continue to collaborate to address the increasing prevalence of influenza among dialysis patients and the general population worldwide.