Nursing

Practice Alerts & Guidelines

Swine Flu - April 2009

On April 27, 2009, twenty-eight students at a private school in Queens, New York tested positively for swine flu. Because the number of diagnosed cases is increasing, Governor Paterson has activated New York State's health emergency preparedness plan and put the State on high alert to quickly identify and respond to any cases of this flu. For information about New York City cases, please see www.nyc.gov/html/doh/html/pr2009/pr016-09.shtml

At the same time, the U.S. Food and Drug Administration, in response to requests from the U.S. Centers for Disease Control and Prevention, has issued Emergency Use Authorizations (EUAs) to make available to New York State public health and medical personnel important diagnostic and therapeutic tools to identify and respond to the swine flu virus under certain circumstances. The related news release can be found at www.hhs.gov along with timely information and specific questions and answers on swine flu.

The swine influenza (H1N1) virus causes an illness primarily characterized by fever and upper respiratory symptoms similar to the seasonal flu. However, the CDC has anticipated that the flu vaccination received for this year will not be effective against this virus.

The Office of the Professions, whose role is to protect the health, welfare, and safety of the public through its many functions in licensure, professional discipline and the oversight of practice, becomes involved immediately when there are local, regional and statewide emergencies. The licensed professionals of this State are the ones who commonly identify or recognize situations that can become public health and safety emergencies. Qualified nurses are among the first to recognize the telltale symptoms that signal the presence of new or unusual health problems and provide guidance to halt the progression of the emergency. In fact it was a School Nurse, a Registered Professional Nurse, who correctly identified the children in Queens, isolated them, and made calls alerting appropriate authorities so that rapid testing and a coordinated response could be made. Many other licensed professionals are called into the process of recognition, identification of organisms and treatment including: physicians; clinical laboratory technologists, whose education includes identifying biohazards and pathogens; pharmacists, who can not only dispense, but also immunize; veterinarians, who have expertise in animal health and its relationship to human health; engineers, who assure safe disposal of hazardous waste; and many of the rest of the 48 licensed professions. OP is here to assist you with guidance and support.

Protecting yourself, your families and your patients from possible infection is the best prevention. Unless further instructions are released from 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.
• Never rely totally on antiseptic hand cleansers; they need to be washed off with soap and water periodically to remain effective.
• Teach children to wash their hands often. Washing with soap and hot water for at least 20 seconds is ideal (that's about as long as it takes to sing the "Happy Birthday" song twice).
• Sneeze or cough into a tissue or into your elbow, and instruct others in this method, especially children. Do not use cloth handkerchiefs. In addition, teach children to keep their hands away from their face and avoid touching their mouth, nose or eyes.
• Stay home when you are ill. Keep children home from school to avoid spreading viruses to others in the community.
• Caring for individuals in the home or in hospital settings requires unrelenting adherence to universal precautions. Be certain to follow your facility or agency policy for precautions.

Those patients who present with flu-like symptoms should be evaluated for swine influenza, especially if they have traveled into Mexico recently or were in contact with persons who had febrile respiratory illness during the 7 days prior to the onset of their own illness.

Clinicians who suspect swine influenza should obtain a nasopharyngeal swab from the patient, place the swab in a viral transport medium, refrigerate the specimen and contact the State or local health department to facilitate transportation and timely diagnosis.

Further clinical guidance for laboratory safety, case definition infection control and information for the public can be found at www.cdc.gov/swineflu/investigation.htm.

The CDC has issued guidance for travelers to remain healthy and reduce their risk of infection. Updated information can be obtained at: wwwn.cdc.gov/travel/contentSwineFluUS.aspx.

Please stay informed by attending to media reports. Additional information can be obtained at the following web sites: www.hhs.gov; www.cdc.gov; www.nyhealth.gov; www.schoolhealthservicesny.com; or the 24 hour toll-free hotline that New Yorkers across the State can use to get answers to their questions. The hotline number is 1-800-808-1987; NYC residents should call 311.