Preparing for a Two-Pronged Flu Season: Novel H1N1 Influenza and Seasonal Flu
This year’s flu season promises to be more challenging than most as healthcare professionals nationwide prepare to handle an onslaught of two types of flu: Novel H1N1 Influenza, commonly called swine flu, and seasonal flu. Crozer-Keystone’s Pandemic Planning Taskforce is mounting a coordinated system-wide campaign to manage this challenge through preventive measures and education.
With ongoing guidance from the Pennsylvania Department of Health and the Centers for Disease Control and Prevention (CDC), the CKHS taskforce has been developing a plan of action for nursing staff, physicians and others providing care in inpatient, outpatient, emergency and home care settings.
“Guidelines from the state and the CDC for managing H1N1 flu continue to evolve, so our staff should expect that some guidance may change over the course of the flu season,” notes Kevin Fosnocht, M.D., CKHS assistant vice president of Quality and Patient Safety, and a member of the taskforce.
Crozer-Keystone’s plan for managing Novel H1N1 is based, in part, on the CDC’s “3 Action Steps” to protect against the flu, as well as other guidance.
CKHS has organized a vaccination program for all nursing staff, physicians and volunteers against seasonal flu as well as Novel H1N1 influenza. All healthcare workers (HCWs) should receive the seasonal influenza vaccination, currently available to all staff, and the H1N1 vaccination when it is available. To start, CKHS will offer the H1N1 vaccine on a priority basis to HCWs with direct patient contact, and to HCWs who are pregnant or have chronic illnesses. Individuals can receive both seasonal flu and H1N1 vaccinations at the same time, one in each arm.
As of Oct. 5, the U.S. Food and Drug Administration (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for persons 10 years of age and older. This is slightly different from CDC’s recommendations for seasonal influenza vaccination which states that children younger than 9 who are being vaccinated against influenza for the first time need to receive two doses. Infants younger than 6 months of age are too young to get the 2009 H1N1 and seasonal flu vaccines.
The CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that certain high risk groups of the population receive the Novel H1N1 vaccine as soon as it becomes available. These priority groups include:
- Pregnant women.
- People who live with or care for children younger than 6 months of age.
- Healthcare and emergency medical services personnel.
- All people between the ages of 6 months and 24 years.
- People age 25 through 64 years who have chronic health conditions associated with higher risk of medical complications from influenza.
Once the demand for vaccine for these target groups has been met, everyone from ages 25 through 64 years should be vaccinated.
“Hand washing is one of the best ways to prevent the spread of flu,” says Eileen Young, MSN, RN, CKHS assistant vice president of Clinical Utilization and Outcomes. “Its importance can not be overemphasized.” Before every patient contact, healthcare providers should clean their hands with soap and water or alcohol-based hand sanitizer. If the patient has flu-like symptoms, a surgical mask should also be used.
For a complete list of patient care precautions, nursing staff should see the “Patient Care Checklist for H1N1” issued by the World Health Organization (WHO), which has been distributed in poster format to every unit throughout CKHS facilities.
Nursing staff should also take the following everyday precautions to prevent the spread of flu, and teach patients to do the same:
- Cover your nose and mouth with a tissue when you cough or sneeze, and immediately throw the tissue in the trash after use. In the absence of a tissue, cough or sneeze into the crook of your elbow to avoid the spread of droplets.
- Avoid touching your eyes, nose or mouth.
- Stay home if you get sick. Limit contact with others as much as possible. The CKHS taskforce is currently working with Human Resources to develop specific “stay at home” guidelines for staff to ensure that they and their patients are protected against H1N1 influenza. These guidelines will be available soon.
If you or your patients get the flu, antiviral drugs are an important treatment option. Antiviral drugs are prescription medicines that fight against the flu by keeping flu viruses from reproducing in your body. They can make your illness milder and make you feel better faster. They may also prevent serious flu complications, which is especially important for people at high risk. Antiviral drugs work best if started within two days of the first flu symptoms. Current guidelines favor reserving antiviral medications for those patients who are at high risk of complications from influenza. Most patients with influenza infection won’t require antiviral medications.
Recognizing Novel H1N1 Signs and Symptoms
Crozer-Keystone’s plan for managing Novel H1N1 influenza includes educational components for nursing staff, physicians and patients. First and foremost, it is essential to recognize H1N1 signs and symptoms. These include fever (usually high), cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea; there has been a higher incidence of these gastrointestinal symptoms with H1N1 than with seasonal flu.
“H1N1 influenza behaves differently than seasonal flu in that it hits young, healthy people very hard,” Young says. “Some young people have become very sick very fast to the point of needing critical care.”
“A large percentage of patients who become very ill have underlying medical conditions, or are in one of the other high risk groups, including very young children (< 5 years of age), pregnant women and the elderly,” Fosnocht says.
H1N1 doesn’t seem to affect older people as much as seasonal flu. According to some health officials, people over age 60 may be spared because they were exposed to a similar virus in the late 1950s. However, if this age group does get the flu, they are still at an increased risk of complications.
What if Crozer-Keystone facilities are swamped with patients during the flu season? What if half the nursing staff becomes ill and must stay home for an extended period of time? The CKHS Pandemic Planning Taskforce has considered these questions and more, and has been developing comprehensive guidelines for surge capacity and staffing, which will be published soon.
“Each hospital in the system has developed its own surge capacity plan by identifying space, staff and supplies that could be deployed if we were faced with a very high number of sick patients,” Fosnocht says. “This involves assessment and preparation for delivering critical care because H1N1 patients who are admitted to the hospital tend to be very sick. We have outlined the necessary steps that must be taken to manage those patients in real time, from testing and treatment recommendations to respiratory isolation and other precautions.”
Crozer-Keystone has participated in regional discussions with other hospitals in the area about ways to manage H1N1 patients, particularly in the high risk groups of pediatrics and pregnant women. “We are making efforts to ensure open and ongoing communications with Children’s Hospital of Philadelphia and Alfred I. DuPont Hospital for Children, and to ensure that our own hospitals are effectively managing resources,” says Fosnocht.
To prepare for significant staffing shortages due to illness, CKHS nurse leaders have been identifying staff with skills that can be used across services, particularly for critical care and pediatrics units. Nursing may also approach recently retired nurses for assistance.
The CKHS Pandemic Planning Taskforce is developing guidelines based on state health department and CDC guidance. These may include, for example, limiting points of entry to CKHS hospitals if H1N1 is spreading in the local community, and posting instructions at all hospital entry points for patients and visitors to notify staff immediately if they have signs and symptoms of febrile respiratory illness. Staff should expect ongoing communication regarding these guidelines.
CKHS guidelines state that healthcare workers should not come to work with flu symptoms that may include fever, cough, body aches, sore throat, and/or diarrhea. Every employee should be free of fever for at least 24 hours, without the use of fever-reducing medications (eg, Tylenol, Motrin) before returning to work. If there is any question about readiness to return to work, staff should consult with their personal physicians, or our occupational health department.
HCWs who provide direct patient care will be expected to undergo a return-to-work evaluation, either by phone interview or appointment with Occupational Health/Employee Health if out sick with an influenza-like illness.
CKHS staff will receive information and updates regarding H1N1 influenza and seasonal flu through face-to-face meetings with nurse leaders as well as e-mail communications, bi-weekly employee newsletters, direct mailings, posters and signage throughout the facilities.
Crozer-Keystone has also established a page on its intranet site for employees to access the most current flu information. This can be accessed by clicking on “Seasonal Flu and H1N1 Information for Employees” link on the intranet.
This website will be updated regularly throughout the flu season.
Flu information is also available on the Quick Links page at www.crozerbenefits.org and from the Pennsylvania Department of Health at http:/h1n1inpa.com. Crozer-Keystone has also established a page for consumers on its external website that can be accessed through a link on www.crozer.org or directly at http://flu.crozer.org.
In addition, CKHS has established a telephone hotline for influenza at 610-447-6730. Staff may call the hotline for recorded information that will be updated regularly.
“It is important for staff to use these resources to keep themselves updated on the evolving guidelines and status of both H1N1 and seasonal flu,” Young says. “This will ensure that we are well prepared to protect and care for our patients and ourselves.
Clinician Decision Aid
Download the Influenza Decision Aid for Clinicians (pdf)