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Is it catching?

The phrase is "new normal," and it's being widely used to describe reinforced protective measures against the spread of infectious diseases in Ontario's long-term care facilities.

The aggressive steps taken to keep the 2003 outbreak of severe acute respiratory syndrome (SARS) from spreading to nursing homes and other institutions came from extensive planning, says Dr. Bonnie Henry, associate medical officer of health for Toronto. The SARS experience also reinforced the need for older residents to be vaccinated against influenza.

"The principles we used to protect residents from influenza were really used to protect them as well from SARS," Henry says. "It was important to us because we know how devastating SARS can be in elderly populations."

Public health authorities have worked for years with the more than 535 long-term care homes in Ontario to prepare for such an outbreak, she says. SARS reinforced the need for additional efforts to protect the elderly, who are the most vulnerable.
During the SARS crisis, visitors were restricted and residents with symptoms were quickly isolated, Henry says.

As part of Ontario's new long-term practices, visitors and staff must continue washing their hands on entering and leaving nursing homes and hospitals.

"It's a basic measure that works," Henry says of hand-washing. Directives have been issued to Community Care Access Centres and home-care services, which caution employees to stay away from homes if they or their client show signs of a (potentially infectious) respiratory illness.

"The influenza vaccination is something we're going to emphasize more than ever this year," Henry says. "It is absolutely essential for protecting people from severe influenza, but also from febrile respiratory illnesses, so we don't have a cluster of fevers and respiratory symptoms and don't know what they are."

Tanya Cholakov of Ontario's Ministry of Health and Long-Term Care agrees that SARS taught the health-care community some lessons about how to contain infectious diseases.

"One of the positives is that we do have this high awareness, and we have been able to put in place a number of precautions that would help in the event of anything else," she says.

Surveillance programs to protect against respiratory or intestinal tract infections have long been in effect at the 65 homes in Ontario owned or operated by Central Park Lodges, says Mary Nestor, the company's director of communications and policy development.

"We have infection-control committees and someone, usually a nurse, responsible for infection controls in each home," Nestor says. Post-SARS measures include strict controls on visitors and on residents who leave the facility for an outing.

"If you're not feeling well, you do not visit," she says. "These are the kinds of stepped-up precautions that will be in place forever now."

Relatives who want to take residents out of the home will be provided with directives to ensure they avoid exposure to illness that could be transmitted back to the facility, she says.

Long-term care residents were protected far better from the SARS outbreak than patients in many hospitals, says Jane Cooper of the Ontario Long Term Care Association.

"I think the key is that long-term care facilities have always worked closely with public health and through SARS they've actually strengthened that partnership," she says.

"These are environments where people need to be comfortable that their loved ones are going to be well taken care of, and SARS just took that relationship one step closer."

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