Since it was first identified in April, the 2009 H1N1 flu strain, also known as swine flu, has infected more than 1 million Americans and killed nearly 600, the Centers for Disease Control (CDC) estimates. So far H1N1 does not appear to be more dangerous than seasonal flu, which kills an estimated 36,000 Americans each year, but it appears to be more contagious and health officials are concerned that it could mutate and become deadlier. The populations at greatest risk appear to be children, pregnant women and those with compromised immune systems from pre-existing conditions.
New information and guidelines become available daily to address the H1N1 pandemic. The gold standard source of information is the CDC. Their website http://www.cdc.gov/h1n1flu/ posts regular situation updates and offers specific guidelines in a number of categories, such as:
• Vaccination.
• Clinical and public health guidance.
• How to stay healthy.
• Information for specific groups, such as travelers, pregnant women, schools and child care.
• Clinician information including patient education and management, vaccination guidelines, clinical and laboratory settings, testing, treatment, online training, and more.
The federal government also provides information through The U.S. Department of Health & Human Services Influenza website http://www.flu.gov/
Prevention. Vaccination and infection control measures, specifically handwashing and respiratory hygiene, have the potential to prevent pandemic worst-case scenarios. Worst case scenarios could evolve with healthcare personnel becoming ill at the same time as the number of patients needing care rapidly increased. Inadequate resources, such as hospital beds, ICU beds and ventilators could also develop. According to one prediction, the number of ventilators required could reach 198 percent of the current supply in the U.S.
Annual vaccination of healthcare personnel is key to patient safety programs. Although The Joint Commission requires accredited facilities to offer vaccinations to employees, the CDC estimates that only 40 percent of healthcare personnel receive flu vaccinations.
The CDC recently partnered with the American Nurses Association (ANA) to encourage nurses to be vaccinated and to educate the public about vaccination.
ANA encourages nurses to:
• Receive vaccination for both H1N1 and the seasonal flu.
• Learn their employers’ plans for responding to the pandemic.
• Learn the pandemic response plans of state and local governments and community-based organizations such as schools and businesses.
• Be prepared to assume the nurse’s role in executing facility, government, and community plans.
ANA devotes a section of its website to H1N1 http://nursingworld.org/h1n1
State Government Response. Visit your state’s website to learn your state’s plan. New York has required all healthcare personnel to receive vaccination in order to work. In Illinois, health officials prepared a state plan which includes a review of scopes of practice to mobilize inactive nurses and students to give vaccinations and care in the event that the governor declares a state of emergency.
Professional Organizations’ Response. Most professional organizations’ guidelines reference the CDC guidelines. Some specialty organizations that care for vulnerable populations have developed additional resources:
The National Association of School Nurses http://www.nasn.org/ has developed materials designed to educate school nurses and parents about influenza (available in English and Spanish), including a flyer, fact sheet, advisory letters and a template newsletter article.
The Pediatric Nursing Certification Board includes influenza-related content on its certification examinations http://www.pncb.org/ptistore/resource/content/news/H1N1.pdf
The American Academy of Pediatrics (AAP) http://www.aap.org/new/swineflu.htm offers clinical guidelines at its website.
The Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) has posted a Joint Statement for Pregnant Women about Influenza prepared by a coalition of professional organizations and the March of Dimes
http://www.awhonn.org/awhonn/content.do?name=07_PressRoom/7B6_Sep15_FluJointStmt.htm
The Emergency Nurses Association (ENA) has posted The National Strategic Plan for Emergency Department Management of Outbreaks of Novel H1N1 Influenza, prepared by an expert panel of emergency care experts. http://www.ena.org/media/news/alerts/Pages/NationalStrategicPlan.aspx
Your facility’s response. Know your facility’s workplace plan for:
• Offering and/or requiring vaccination
• Treating increased patients with decreased staff available
• Infection control, including using and supplying personal protective equipment
Your prudent actions can help to prevent pandemic worst-case scenarios.
References
American Nurses Association (2009). 2009 H1N1 – Information for nurses. Retrieved October 2009 from http://www.nursingworld.org/h1n1
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