What are the management recommendations for parainfluenza in long-term care settings?

Management of Parainfluenza in Long-Term Care Facilities

Long-term care facilities must implement standard and contact precautions for parainfluenza virus, combined with active surveillance systems to rapidly identify potential outbreaks and prevent transmission among vulnerable residents. 1

Infection Control Precautions

Hand Hygiene (Critical Foundation)

• Decontaminate hands after any contact with a patient or after touching respiratory secretions or potentially contaminated surfaces, regardless of glove use 1
• Use soap and water when hands are visibly soiled with blood, body fluids, or proteinaceous material 1
• Use alcohol-based hand rub when hands are not visibly soiled 1
• After removing gloves, decontaminate hands immediately and avoid touching environmental surfaces in the patient's room 1

Personal Protective Equipment

• Wear gloves when entering the room of any patient with confirmed or suspected parainfluenza infection, or before handling respiratory secretions or contaminated fomites 1
• Change gloves between patients and after handling respiratory secretions from one patient before contacting another 1
• Wear a gown when entering the room and when soiling with respiratory secretions is anticipated 1
• Change the gown after contact with the infected patient and before providing care to another resident 1
• Ensure clothing does not contact potentially contaminated environmental surfaces after gown removal 1

Surveillance and Outbreak Detection

Active Surveillance Requirements

• Establish mechanisms for continuing surveillance to allow rapid identification of potential outbreaks in the facility 1
• Create alert systems to promptly notify appropriate healthcare personnel of any increase in parainfluenza or other respiratory virus activity in the local community 1
• Establish reporting mechanisms to promptly inform local and state health departments of increased viral respiratory illness activity in the facility 1

Diagnostic Testing During Outbreaks

• During periods of increased respiratory illness prevalence in the community or facility, attempt prompt diagnosis using rapid diagnostic techniques 1
• Prioritize testing for residents at high risk for serious complications: those with compromised cardiac, pulmonary, or immune function 1
• Test residents presenting with atypical presentations (diarrhea, falls, delirium) in addition to classic respiratory symptoms, as these may precede respiratory manifestations 2

Staff Education and Compliance Monitoring

Educational Requirements

• Educate all personnel according to their level of responsibility about the epidemiology, modes of transmission, and prevention strategies for parainfluenza virus 1
• Training should emphasize that parainfluenza spreads primarily through large respiratory droplets and contaminated hands 3

Compliance Oversight

• Establish mechanisms for infection-control staff to monitor personnel compliance with facility infection-control policies regarding parainfluenza 1

Common Pitfalls to Avoid

• Do not rely solely on routine surveillance cultures for respiratory viruses in asymptomatic residents, as this approach lacks validation 1
• Avoid touching environmental surfaces or items in the patient's room after glove removal and hand decontamination 1
• Do not underestimate the vulnerability of long-term care residents—their advanced age and comorbidities create a setting conducive to rapid viral spread 4, 5
• Recognize that infections may be introduced by staff, visitors, or transferred residents, requiring vigilance across all entry points 4

Additional Protective Measures

• Practice respiratory hygiene and cough etiquette throughout the facility 3
• Clean frequently touched surfaces routinely to reduce fomite transmission 3
• Consider spatial separation in common areas where infected residents may be present 3
• Avoid aerosol-generating procedures (such as nebulization) unless performed with appropriate precautions and PPE for all personnel in the room 3