Acute Respiratory Illness (ARI) in a RACF

Residential aged care facilities are encouraged to notify individual cases or suspected outbreaks of acute respiratory illness (ARI), specifically COVID-19, influenza and RSV, to their local public health unit. 

ARI outbreak definition 

An ARI outbreak is defined by 2 or more residents or staff with a new or worsening cough, runny nose, breathing difficulty or sore throat within a 72-hour period.  

Other symptoms may include:   

• Headache, muscle aches, fatigue, nausea, vomiting or diarrhoea 
• Fever (≥37.5°C) - but is less common in older adults 
• New onset or increase in confusion, change in baseline behaviour, falls, or worsening of underlying chronic illness.   

Residents with the above non-respiratory symptoms should be tested for respiratory pathogens, especially if there are already ARI cases in the facility.  

Actions to follow in a suspected ARI outbreak

• Isolate symptomatic residents and test for COVID-19, influenza and RSV. 
• Follow the guidelines on increasing infection control measures such as:  
• Personal protective equipment 
• Cohorting residents and staff to their wings or floors  
• Excluding symptomatic staff  
• Enhanced and increased cleaning and disinfection of commonly touched surfaces.  
• Inform the facility infection control practitioner & facility management. 
• Contact the Public Health Unit by phone (02) 9382 8333 or email. 
• If transferring a resident (with or without ARI symptoms) to hospital during an outbreak, notify the paramedics and hospital that the facility is experiencing a possible or confirmed ARI outbreak. 

Monitoring the ARI outbreak 

• The Public Health Unit will ask the facility to complete the online RACF Initial Risk assessment survey.  
• If the outbreak definition is met, the facility will be sent a link to submit a list of residents and staff with their vaccination status and COVID-19/influenza/RSV test results.  
• Symptomatic staff members (even if they do not have COVID-19, RSV or influenza) should be excluded from work until at least 5 days after onset of the acute illness, or until they are symptom free, whichever is longer.  
• An ARI outbreak is generally declared over when 7 days have passed since the last case tests positive or the date of isolation of the last case in a resident, whichever is longer. 

Managing visitors during an outbreak 

• Notify families and essential visitors of the outbreak and advise that strict infection control precautions will occur during the visit to prevent ongoing spread. Suggest limiting the number of visitors during the outbreak to reduce spread, especially to visitors at risk of serious illness themselves. We advise against the use of terms like “lockdown” which can be distressing to family members.  
• Ask visitors to wash their hands with soap and water, wear a mask, and conduct the visit outdoors if possible. 
• Put up signage about the outbreak so they are visible throughout the centre. Posters can be printed from the COVID-19 posters webpage of NSW Health. 
• For further information about managing visitors during an outbreak, refer to the guidelines.  

Guidance on use of antivirals in residential aged care facilities 

• The administration of antiviral treatment soon after symptom onset for people with COVID-19 or influenza can reduce disease severity and transmission to others.  
• Additionally, the administration of influenza antivirals to potentially exposed residents, reduces the risk of them developing influenza and assists in controlling the outbreak.  
• For information about the use of antivirals in residential aged care facilities, refer to the Guidance on use of antivirals in residential aged care facilities resources.  

To contact the Public Health Unit email or phone 02 9382 8333.  

For urgent after-hours advice, call Prince of Wales Hospital switchboard on 02 9382 2222