NYS Nurses Association

H1N1 Influenza

Practice advice for registered professional nurses and other providers from Thomas J. Lowe, RN, MPH, COHN-S, NYSNA Occupational Safety and Health Representative. Updated Sept 28, 2009.

• The NYS Department of Health (DOH) call center: 800.808.1987 is available for questions concerning seasonal and H1N1 influenza vaccinations; callers should use option #1.
• CDC Website
• US Food and Drug Administration: Personal Protection Equipment for the 2009 H1N1 Flu Virus
• Additional World Health Organization information
• American Nurses Association (ANA) efforts and information
• OSHA Quick Cards™ and Fact Sheets: Pandemic Protection and Preparation
  • How to Protect Yourself in the Workplace
  • What Employers can do to Protect Workers
  • Healthcare Workers Classified as Very High or High Exposure Risk for Pandemic Influenza
  • Protect Yourself: Pandemic Flu Respiratory Protection
• Updated: How should nurses respond to this threat?
• Related: Influenza: Impact, Prevention, and Control - Online course from e-leaRN™
  

What is H1N1?

The swine influenza (H1N1) virus causes a febrile respiratory illness with symptoms similar to the seasonal flu. However, the Center for Disease Control and Prevention (CDC) has anticipated that the flu vaccination received for this year will not be effective against this virus.

CDC CLASSIFYING CASES WITH NEW CASE DEFINITION

As of August 30, 2009, the CDC began classifying all influenza like illnesses (ILI) and pneumonias associated with ILI in the total count. Using this new counting format, the total hospitalizations as of this update are 4,569 and 364 deaths. There were 1,035 confirmed H1N1 hospitalized cases and 33 H1N1 deaths. Confirmation of H1N1 is done on select cases, in designated hospitals for purposes of tracking the predominate circulating virus.

Public officials continue to issue reminders about how to prevent infection, such as frequent hand-washing, avoiding people who are ill, staying home if you are sick, keeping your hands away from your face, cleaning shared surfaces, and not sharing personal items.

What is being done to control the disease?

The State Emergency Preparedness Plan had been activated and New York State has been put on high alert. This activation allows the state to effectively monitor the situation and respond quickly to newly reported cases. For information about New York City cases, see the New York City Department of Health online.

The Institute of Medicine (IOM) has issued an objective paper on the use of respiratory protection for healthcare workers. The report establishes the N-95 respirator as the minimal acceptable level of respiratory protection. The CDC is now in the process of updating their guidance for healthcare personnel on the use of respiratory protection and will issue a companion document with the guidance which will address the judicious use of respiratory protection and possible strategies to avoid a shortage of personal protective equipment.

How should nurses respond to this threat?

• Advisory from the City of New York Department of Health and Mental Hygiene - updated infection control recommendations for H1N1 influenza.
• Updated: Advisory from the New York State Department of Health for further details on detecting and reporting suspected cases of H1N1 influenza outside of New York City.

The CDC is providing guidance for clinicians and public health professionals regarding the care of individuals who may infected by the virus and Emergency Use Authorization for medications and devices related to the outbreak.

Unless further instructions are released by the CDC, infection control actions remain similar to the seasonal flu:

• Wash your hands. Since most viral illnesses are transmitted by contact, washing your hands will decrease the spread of illness among your family, colleagues and patients. Encourage children to wash their hands often. Sneeze or cough into a tissue or into your elbow, and instruct others in this method. Never rely totally on antiseptic hand cleansers; they need to be washed off with soap and water periodically to remain effective;
• Stay home when you are ill and keep children home from school to avoid spreading viruses to others in the community.
• Caring for individuals in the home or hospital settings requires diligent use of standard precautions. Be certain to follow your facility or agency policies for precautions.
• Those patients who present with febrile illness should be considered for H1N1, especially if they have traveled into Mexico recently or were in contact with persons who had febrile respiratory illness during the seven days preceding their own illness onset.
• Clinicians who suspect H1N1 should obtain a nasopharyngeal swab, place the swab in a viral transport medium, refrigerate the specimen and contact their state or local health department to facilitate transportation and timely diagnosis.

What is the best advice for nurses to give?

As professionals, nurses will be asked by family and friends what they should be doing. The message is: good personal hygiene, good nutrition, sleep, and stay well. If you start to feel ill, isolate yourself from others to avoid spreading whatever you have. Watch for flu-like symptoms – cough, fever, sore throat, muscle ache and general malaise. With this flu, some report gastrointestinal symptoms as well. Call your healthcare practitioner before going to the office or the hospital and follow their advice. If you have been in close contact with someone with the flu, you should also keep your distance (house quarantine) for five to seven days. If you are still well after that time, it is probably okay to go out again.

Families should have a pantry stocked to sustain a quarantine of at least seven days, should it become necessary. Nurses also should remind folks that the strain we are seeing in the U.S. so far is mild and recovery takes the course expected with an ordinary flu. Immunocompromised people need to take extra care to avoid exposures. For everyone, emphasize respiratory etiquette and social distancing (avoid crowds, keep at least six feet between people, smile and nod rather than shake hands).

We need to help calm the fear! Emphasize good hygiene, respiratory etiquette, and common sense. This air of calm is part of the Risk Messaging that needs to happen. Risk Messaging is the process of dispelling myths and fears with facts and direction. Review this information from the Emergency Nurses Association about when to go to the emergency department.

What if I’m caring for an infected patient?

Family emergency plan

Nurses may be called upon to provide care to those who fall ill. This is a good time to review and update your family emergency preparedness plan for the family. If public health measures close the schools or stagger work schedules for your spouse, how will you handle child or elder care duties? What if your facility is quarantined for seven days and you cannot leave? Are you prepared?

Respiratory protection and prophylaxis

As you may be required to wear a respirator, are you medically cleared and fit-tested to wear one? If not, there should be a plan in place to comply with this OSHA standard (29 CFR 1910. 134). A written respiratory protection plan should be in place that describes where the respirators are stored, under what conditions they are to be used, and how to obtain new ones as needed. Every healthcare facility should have a policy and plan for prophylaxis for nurses with potential exposures and treatment for nurses who contract the flu.

Emergency preparedness plan should be in place

Nurses can assist in the implementation of the hospital's emergency preparedness plan. It is prudent to use an N95 respirator when caring for a patient with cough and fever of unknown origin. Ensure that the HVAC system for triage and the emergency department can be isolated if necessary. Check the negative pressure in the respiratory isolation area. Breaking out the HAZ-MAT suits is simply nonsense! Reviewing the surge capacity and capability trigger points for the next level of action should be done and a review of resources which will be used at each level should be done.

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