Monday, October 26, 2009

H1N1 Precautions: Get Ready for the Upcoming Flu Season and Get Vaccinated!

It is clear that the 2009-2010 flu season is shaping up to be potentially severe and the CDC and World Health Organization has classified the new H1N1 flu as a pandemic. Hospitals are preparing now for potentially large influxes of patients infected with the seasonal and/or H1N1 flu virus. Additionally, there is significant concern that a large percentage of the healthcare workforce will also be infected thereby jeopardizing hospitals capability to meet the needs of the patient population. The CDC has identified healthcare workers as top priority to receive the H1N1 vaccine in order to prevent drastic workforce shortages when the demand for healthcare will be at its highest. The seasonal flu vaccine and the H1N1 (Swine) flu vaccine are separate vaccinations. It is recommended that healthcare workers get vaccinated for both the seasonal flu and H1N1. More information on the 2009 H1N1 (Swine) flu vaccine can be found on the FDA's website.

The absolute necessity to become vaccinated cannot be further demonstrated than by the recent reports from RN Magazine and The Sacramento Bee (a local newpaper) about a 51 year old California Nurse whose contracted case of H1N1 influenza resulted in her death. This otherwise healthy nurse had a prior MRSA infection when she contracted the H1N1 flu. Although not confirmed, it is suspected that both infections were contracted at the hospital where she was employed. As healthcare workers, our responsibility is not only for our own health but also for the health of the patients to whom we provide care. Younger nurses in particular may be more susceptible to H1N1 in comparison to older healthcare workers who may still have some residual immunity from past exposure (possibly from the swine flu outbreak in 1976).

According to the CDC, the groups recommended to receive the 2009 H1N1 influenza vaccine include:

Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated.

Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants younger than 6 months old might help protect infants by "cocooning" them from the virus.

Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity.

All people from 6 months through 24 years of age:

Children from 6 months through 18 years of age because cases of 2009 H1N1 influenza have been seen in children who are in close contact with each other in school and day care settings, which increases the likelihood of disease spread.

Young adults 19 through 24 years of age because many cases of 2009 H1N1 influenza have been seen in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population.

Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.

Many states are mandating that healthcare employers offer both the seasonal flu vaccine and the H1N1 flu vaccine to their employees, as well as, information about the vaccinations. New York is the first state to MANDATE healthcare workers in outpatient ambulatory clinics, nursing homes, and hospitals to obtain the flu vaccinations. The only exception to that new regulation is for those healthcare workers that have a medical contraindication to the flu vaccine. The dominant flu virus this year is the H1N1 virus. The first shipments of the new H1N1 vaccine were being sent to hospitals on October 7th. To find more resources on the seasonal or H1N1 flu in your state, visit the Government's Flu website. Local flu vaccination provider's can be found by visiting the American Lung Association's website.

The H1N1 flu presents itself with similar symptoms as the regular seasonal flu. Symptoms include fever, chills, headache, upper respiratory tract symptoms (cough, sore throat, rhinorrhea, shortness of breath), myalgias, arthralgias, fatigue, vomiting, or diarrhea. Clinicians should expect complications to be similar to seasonal influenza: exacerbation of underlying chronic medical conditions, upper respiratory tract disease (sinusitis, otitis media, croup) lower respiratory tract disease (pneumonia, bronchiolitis, status asthmaticus), cardiac (myocarditis, pericarditis), musculoskeletal (myositis, rhabdomyolysis), neurologic (acute and post-infectious encephalopathy, encephalitis, febrile seizures, status epilepticus), toxic shock syndrome, and secondary bacterial pneumonia with or without sepsis. More information about clinical management is available on the CDC Website.

As is frequently said, the best offense is a good defense and our defense in this situation is paying strict attention to proper infection control procedures. Like other influenza viruses, H1N1 is spread by coughing and sneezing (airborne droplet). Focusing on the basics of proper hand hygiene and respiratory protection standards is essential in preventing the spread of the flu. In addition, aggressive education about hand washing and proper sneezing and coughing etiquette for patients and families is also a mandatory piece of the infection control plan. It is being recommended to wear an N95 or similar respirator when caring for a patient with suspected flu. Additionally, patients suspected of being infected should be in private respiratory isolation rooms. Be sure to be aware of the facility guidelines/policies with regards to the use of personal protective equipment and respiratory isolation procedures. If you have not already done so, please be sure you have been properly fitted for an N95 respirator. Clinical One can help to make arrangements for respirator fit testing if needed but many times this can be done through the facility's employee health department.

As hospitals are preparing for the upcoming flu season, they are requesting that all temporary contract workers become vaccinated or at the very least acknowledge the risk associated with a potential flu infection and sign a declination form. Due to the overwhelming requests from our clients to ensure our travelers are prepared for the flu season, we are asking everyone to complete a Flu Assessment Form.

Clinical One Volunteers at Local Flu Clinics

It's important that we all do our part during this flu season to keep ourselves and others safe. Flu clinics offer an excellent opportunity for nurses to volunteer their services and give back to the local community. Contact your state's health department to see how you can participate in a flu clinic in your area.

For more information, visit our website at


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