3 ways to protect yourself from H1N1
3 ways to protect yourself from H1N1
Recently, more than 16,000 nurses threatened to strike at 37 California hospitals due to concerns about what they said were lax safety standards putting them at risk of catching H1N1. This threat of strike occurred after a nurse who was a triathlete and marathon runner died of severe respiratory infection, pneumonia, and H1N1 flu, possibly contracted at her workplace.
This situation underscores the increased vigilance of ED nurses in protecting themselves during the 2009-2010 H1N1 flu pandemic. At The Hospital of Central Connecticut in New Britain, ED nurses are being "more diligent with [hand sanitizer], they have no problem with wearing N-95s, and they are receiving their flu shots," says Nancy Giardina, RN, MSN, ED educator. "No one wants to get sick! We're prepared for the worst, and meanwhile we just see one patient after another."
As a result of the H1N1 pandemic being declared a national emergency, hospitals can apply for waivers allowing them to establish alternate patient screening locations for H1N1 patients. Giardina says her ED has developed plans to care for H1N1 patients at an off-site clinic away from other ED patients, "but we aren't acting on anything, until and if we get inundated with patients."
The key: Be consistent
At Saint Louis University Hospital, ED nurses have been practicing respiratory etiquette year-round on any patient with respiratory symptoms. "Being consistent in practice is the only way to decrease the spread of respiratory illnesses," says Helen Sandkuhl, RN, MSN, CEN, FAEN, director of nursing for emergency services at Saint Louis University Hospital. "This practice should be followed consistently and not just during flu season." Here are three ways ED nurses are protecting themselves from H1N1:
• Patients with respiratory symptoms are masked before entering the ED.
However, patients might not always be cooperative. Giardina says, We give them a surgical mask as they walk in the door having symptoms or when they tell the triage nurse they're having symptoms. Then they go to the waiting room and take the masks off! Many patients don't want to wear them."
Saint Louis' ED has a "greeter nurse" stationed just inside the ED entrance, before the entrance to triage and the waiting room. "She screens all patients for any life-threatening processes that may be occurring," says Sandkuhl. "With ED overcrowding, this is the only sure way to make sure that patients do not fall through the cracks before triage or before being placed in a room for evaluation." If the patient's chief complaint falls into any of the areas of upper respiratory illness — fever, cold, runny nose, cough, or body aches — the patient is placed in a mask.
• ED nurses wear N-95 respirators when appropriate.
The Centers for Disease Control and Prevention reaffirmed its recommendation for health care workers to wear N-95 respirators when caring for suspected H1N1 patients, but these might be in short supply in your ED. Sandkuhl's ED nurses have followed this practice since the beginning of the 2009 flu season.
"Since our nurses follow this practice year round, it has not been a compliance issue," she says. "N-95 masks will become a premium item as the season goes on. At this time, we change masks between patients. If supply does not meet demand in the future, the practice may have to change."
ED nurses have done annual fit testing for N-95 respirators for many years. "St. Louis has a high concentration of TB patients, so this has come naturally to them," says Sandkuhl. "We say if you cannot take care of yourself, you cannot take care of others."
• The basics are done consistently.
"Hand washing is one of the most important ways to stop the spread of respiratory illnesses," says Sandkuhl. "There has been some difficulty obtaining hand sanitizer in some areas, but that should not be a reason not to have clean hands. Before hand sanitizer, we had soap and water, which did the job well."
Ten "spot checks" are done every month by the nurse manager or director, who checks to ensure that ED nurses are putting on masks and washing hands. "If someone is not compliant, we stop them and have an educational moment with them," says Sandkuhl. "This is all educational, never punitive." (See H1N1 update.)
Don't contaminate your N-95 respirator Avoid repositioning or touching your N-95 respirator before completing tasks that require its use, says Helen Sandkuhl, RN, MSN, CEN, FAEN, director of nursing for emergency services at Saint Louis University Hospital. "If repositioning of the respirator is unavoidable, this should be done in a way that avoids touching unprotected portions of the face or margins of the respirator," she says. "Gloves should be removed and hand hygiene should be performed before and after touching the respirator. If removal must be performed, the respirator should be considered to be contaminated." |
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