How to protect workers and patients in a pandemic
How to protect workers and patients in a pandemic
If a pandemic strikes, you can count on being flooded with patients — and having health care workers out sick. Few people, if any, will have natural immunity to the new strain of the virus. The draft pandemic guidelines under development by the Centers for Disease Control and Prevention in Atlanta offer recommendations for preventing spread of the infection. They include both the ideal action and recommendations that take into account the trying circumstances of a pandemic. Here is an excerpt from those recommendations:
Staff Education: Educate staff about the epidemiology and prevention of influenza. This should be an annual event and should be repeated and geared toward a wider audience when a pandemic is expected. Extra effort should be made to ensure that all staff participate in this program, including nurses who work on a part-time basis, other staff who may not routinely care for patients but might be required to do so in the event of a pandemic, and non-patient care staff (e.g., administrative, medical records, and food service personnel).
Hand washing: Decreasing the risk of transmission of microorganisms in health care settings, accomplished primarily by hand washing, is a major component of infection control. Hands should be washed after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Hand washing with plain soap or detergent for at least 10 to 15 seconds under running water is an effective method of removing soil and transient microorganisms. If sinks for hand washing are not readily available, alcohol-based agents can be used. However, hand washing with soap and water should be done after every 10 to 15 uses.
Gloving: Clean, non-sterile, disposable gloves should be worn when touching blood, body fluids, secretions, excretions, and contaminated items. Gloves should be removed after use and before touching any non-contaminated items or touching another patient, and hands should be washed immediately with soap and water or an antiseptic handrub. Due to the significant number of health care workers with latex hypersensitivity, other strategies should be available, such as non-latex products alone or in combination with latex gloves, powder-free latex gloves, powdered latex gloves washed to remove powder, "low protein" latex gloves, and vinyl gloves.
Masks: Ideally, to be consistent with droplet precautions, health care workers and visitors should wear masks when they are within three feet of the patient, and the patient should wear a mask when being transported. However, this may not be practical during a pandemic, and health care institutions may want to consider limiting the use of masks for containment of other pathogens. Use of masks to prevent transmission of influenza in the community is also not likely to be effective.
Vaccination: During a pandemic, immunization of the entire population with a pandemic strain vaccine before the virus reaches the United States would be ideal. However, it is likely that the virus will be identified in the United States before enough vaccine for the entire population has been produced. If this is the case, it will be necessary to prioritize distribution of vaccine in such a way as to reduce morbidity, mortality, and social disruption. Guidelines for determining priority groups for vaccination in the situation of an initial vaccine shortage are being established and will likely include health care workers essential to patient care and the running of a health care institution as well as other essential community workers and those at high risk for medical complications (see priority group guidelines). Health care institutions should consider in advance who are the most essential staff and develop plans to immunize them in accordance with state and local pandemic plans.
Health Care Workers with Influenza-Like Illness: As part of the health care organization’s responsibility to implement measures that reduce transmission of infection, it may be necessary to exclude personnel from patient contact if they have symptoms of febrile upper respiratory tract infection suggestive of influenza. This is especially critical if the health care worker cares for severely immunocompromised patients including neonates, young infants, and patients in the intensive care unit. To reduce the likelihood of excluding personnel from duty, all health care workers should be strongly encouraged to receive annual influenza vaccine and receive pandemic strain vaccine once it is available.
During a pandemic, when health care systems are likely to be overwhelmed, it may be necessary to amend personnel restriction policies. For example, health care workers with symptoms of influenza-like illness, who are well enough to be at work, might be allowed to care for patients with known influenza, therefore freeing other personnel to care for non-influenza patients. Personnel with influenza-like illness should never be allowed to care for patients at high risk of complications from influenza infection.
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