What nurses need to know about seasonal influenza to protectthemselves and their patients

All About Influenza

Objectives Describe seasonal influenza Discuss the value of flu vaccinations State NYSNA’s position regarding

mandatory vaccination Identify components of a

comprehensive flu prevention program Identify the elements of emergency

preparedness plan

What nurses need to know . . .

What is influenza? Is flu vaccine safe?What are the contraindications to the vaccine?What if I have a reaction?

What questions do you have?

General Information: Influenza

What is influenza? Influenza (flu) is a contagious

respiratory illness caused by the influenza virus.

It can cause mild to severe illness, and at times can lead to death.

Common flu symptomsFlu usually starts suddenly Fever (not always) Cough Sore throat Runny or stuffy nose Muscle or body aches Headaches Fatigue (may be extreme)

How flu spreads

Droplet (coughing, sneezing, talking) Aerosolization of the virus is also a

known mode of transmission Touching a surface or object that has

the virus on it then touching your own mouth, eyes or nose

Period of contagiousness

From 1 day before symptoms appear and up to 5-7 days after becoming sick

You can pass the flu on to someone before you know you are sick

How serious is the flu? Flu is unpredictable and how severe it

is varies from season to season Certain people are at greater risk for

serious complications if they get the flu

In the US, seasonal influenza causes on average more than 200,000 hospitalizations and 36,000 deaths annually

What if I get the flu? Stay home until at least 24 hours

without fever If symptoms worsen, seek care

through your healthcare provider Antiviral medications are not routinely

recommended for the average patient

Basic preventive measures Get vaccinated annually Wash hands frequently Avoid touching mucosal areas Block coughs and sneezes Practice social distancing Use appropriate respiratory protection Practice a healthy lifestyle

Influenza Vaccines

Influenza Vaccines Getting vaccinated annually is

the best protection Flu strains may vary from year

to year Occasionally a new strain

emerges for which there is little immunity

Who should get vaccinated? Beginning with the 2010–2011

influenza season, CDC recommended that everyone 6 months and older should get a flu vaccine each year.

Vaccination is especially important for health care workers because they care for those at high risk for complications of the flu.

Why YOU should get vaccinated Many of the patients you care for will

come into the hospital with the flu. Your vaccination is one component of a

total infection prevention program designed to protect YOU!

Keeping yourself healthy helps keep your family healthy

You don’t waste sick time on a preventable illness!

Two types of flu vaccine The “flu shot” – inactivated (killed

virus) given with a needle The nasal-spray flu vaccine – made

with live, weakened flu viruses (approved for healthy people 2-49 years of age who are not pregnant)

Both types of vaccine will not cause influenza!

How does the vaccine work?

Antibodies develop about 2 weeks after vaccination

Protects against the three specific strains included in the vaccine

Does not protect against flu-like illnesses caused by non-influenza viruses (this is why a comprehensive infection prevention program is necessary!)

When should I get vaccinated? Annual vaccination begins in

September and continue throughout the flu season which can last as late as May

Seasonal flu activity usually starts in October and peaks in January or later

How are vaccines prepared? Surveillance for circulating strains Selection of virus strain(s) Seed selection and passaging Manufacturing/clinical trials Packaging and shipping

Vaccine R&DNational Institute of Allergy and Infectious Diseases (NIAID) Technology to improve production, safety and efficacyVaccine and Treatment Evaluation Units Consortium that conducts clinical trials to evaluate treatments and vaccines

What about side effects? Serious side effects are very rare Observe contraindications Reporting adverse events improves

vaccine safety Vaccine Adverse Event Reporting

System (VAERS)

Vaccine injury compensation Vaccine Injury Compensation Program

accepts claims Compensation may include medical

expenses, lost income, death benefits to survivors

Should RNs get the flu vaccine?Both ANA and NYSNA urge registered nurses to get the seasonal influenza vaccine. Nurses have an ethical obligation not only to protect ourselves, but also to protect our patients and our families from influenza illness. Vaccination is a simple step that everyone should take. – nursingworld.org

NYSNA position: flu prevention Vaccination is an important component,

but can not be relied on as a solitary method to prevent and control influenza, as some agencies suggest

Voluntary vaccination should be part of a comprehensive program that includes infection prevention and control and emergency preparedness planning

NYSNA’s position

NYSNA encourages voluntary vaccination of all health care workers

NYSNA does not support mandating influenza vaccination as a condition of employment, as suggested by some health care facility policies and recently proposed state legislation

Future mandatory vaccination? NYSNA closely monitors state

regulatory and legislative activity for movement towards a change in state law or regulations that would mandate influenza vaccination of nurses and other health care workers as a condition of employment.

NYSNA will continue to . . . Monitor Health Department committees. Keep members informed on a timely basis Work with unions and other groups to

promote voluntary vaccination. Urge a positive rather than punitive

infection control approach. Encourage feedback from members Negotiate protective language into NYSNA

contracts.

Infection Prevention and Control

Components of prevention and control plan Hazard assessment for exposure risk Listing of workers at risk Mitigation steps Engineering & administrative controls Prophylaxis, vaccination, treatment Initial and ongoing training

Engineering controls Partitions in public areas Closed suctioning for intubated patients Negative pressure rooms Managing patient flow (move to

administrative controls section) Following NIOSH guidelines for cleaning

and HVAC systems (Move to work practices section)

Administrative controls Non-punitive sick time policy Emergency staffing procedures Ongoing cross training of staff Staff dedicated to flu patients Reducing visitation

Personal protective equipment Fit-tested N95 disposable respirator

or better recommended when: Within 6 feet of flu patient In small, enclosed space Performing high-risk procedures

Employer must have respiratory protection program in place

Contract language Relevant sections of contract

agreement: Essential personnel Sick time/call in policy Family leave/personal leave Workers compensation Disciplinary policy

Emergency Preparedness

Is your facility prepared?

Location of policy and procedures Facility plan for allocation of

additional staffing Nurses’ roles and responsibilities Role in triage and transfer of patients Plan for alternative care sites

Nurses need to know:

Is your facility prepared? Plans for cohorting patients Availability of PPE Plans for training and exercises Plans for adequate surge:

Capacity and Capability Staffing Supplies Beds Equipment

Initial and ongoing training Patient care protocols for triage in

Emergency Department Nurses’ roles and responsibilities

Triage Communication Documentation Debriefing

Surge planning capacity & capability

Capacity: How many patients can you put in beds, how many can you put on vents, how many can you put in ICU

Capability: Can you take care of the number of vents with qualified nurses, can you take care of a 110% occupancy, can you staff for all the hospital needs

Alternative Care Sites

Patient care protocols Available equipment and staff Security Patient transportation Standing orders Points of Dispensing (PODs)

Mandatory overtime Allowed during unanticipated staffing

emergencies Facilities should plan for increased

sick time during flu season Facilities should prepare for surges

during flu season Discuss in labor-management

meetings before flu season begins

Working in an emergency

“Adapting Standards of Care Under Extreme Conditions”

Legal and ethical issues facing nurses practicing in emergencies or disasters

Policies and strategies to guide nurses and institutions

State and federal law may not provide sufficient legal protection

Caring for workers in emergency

Have a family emergency plan Facilities should provide basic needs Emergency staffing plan Emotional needs must be met Workers compensation should cover

injuries resulting from emergency

ServNY emergency registryServNY is a registry for health professionals who wish to volunteer during an emergency or major disaster. Registering does not guarantee that you will be called upon, nor does it mean that you must participate if called. Volunteers will help ensure that people affected by a disaster will receive the health care they need.

References and contact info A reference page is provided in the

Influenza Tool Kit. For further information, contact:

Education Practice & Research Program, 800-724-NYRN(6976) ext. 282

EGW Occupational Health and Safety Representative, 888-551-3112