Bioterrorism and Nursing Responses

1. Bioterrorism and Nursing Responses Nursing 454 Dr. Schoolmeesters Queens University of Charlotte 2010 Dawn Hall, Caroline Cate and Christy Olloh

2. Bioterrorism • Terrorism is defined in the United States Code, Title 18, section 2331(18 USC 2331) as “Violent acts or acts dangerous to human life that…appear to be intended: • To intimidate or coerce a civilian population; • To influence the policy of a government by intimidation or coercion; or • To affect the conduct of a government by assassination or kidnapping.

3. Bioterrorism • Biological weapons used in bioterrorism are living microorganisms such as bacteria, viruses, fungi, that can kill or incapacitate.

4. BIOTERRORISM ACT • The events of Sept. 11, 2001, reinforced the need to enhance the security of the United States. Congress responded by passing the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (the Bioterrorism Act), which President Bush signed into law June 12, 2002. • Bioterrorism agents are classified as Category A, B, or C in descending order of priority.

5. Category A • Category A poses the greatest risk • Easily disseminated person to person • High mortality rates • Potential for major public health impact • Require special action for public health preparedness

6. Category A Agents/Diseases • Anthrax • Botulism • Plague • Smallpox • Tularemia • Viral Hemorrhagic Fever (e.g Ebola, Marburg) • Arenaviruses ( e.g Lassa, Machupo)

7. Category B Agents/Diseases • Second highest priority agents include those that are moderately easy to disseminate; • result in moderate morbidity rates and low mortality rates; and • require specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance.

8. Category B • Brucellosis (Brucella species) • Epsilon toxin of Clostridium perfringens • Food safety threats ( e.g., Salmonella species, Escherichia coli O157:H7, Shigella) • Glanders (Burkholderiamallei) • Melioidosis (Burkholderiapseudomallei) • Psittacosis (Chlamydia psittaci)

9. Category B Agents/Diseases CONTINUED • Q fever(Coxiellaburnetii) • Ricin toxin from Ricinuscommunis (castor beans) • Staphylococcal enterotoxin B • Typhus fever (Rickettsiaprowazekii) • Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis]) • Water safety threats (e.g., Vibriocholerae)

10. Category C • Third highest priority agents include • emerging pathogens that could be engineered for mass dissemination in the future because of availability • ease of fabrication and distribution • potential for high morbidity and mortality rates and major health impact. • Emerging infectious diseases such as Nipah virus and hantavirus

11. Bioterrorism • Health care facilities may be the initial site of recognition and response to bioterrorist activity. • Each facility is required to have a readiness plan with all internal and external departments to contact.

12. Response to bioterrorism agents: • Internal reporting requirements (within a facility): • Infection control personnel • Epidemiologist (local and state) • Administration (health care facility and health department) • Office of public affairs in the health facility

13. Response to bioterrorism agents: • External contacts (outside of facility) • Local health department • State Health Department • FBI • CDC • Local police • EMS

14. Containment of Bioterrorism Agents • Isolation Practices- standard precautions. • Patient placement – routine if isolated, grouping if large scale. • Patient transport –only essential movement. • Cleaning, sterilization of environment using standard precautions.

15. Containment Continued: • Discharge management – patient must be noninfectious. • Home care if possible with education on barriers, hand washing, waste management, cleaning and disinfection.

16. Interventions • Hand washing • Vaccinations • Rapid recognition of patients with potentially contagious conditions and isolation with appropriate precautions. • Secondary prevention measures include post exposure prophylaxis , medical screening, and surveillance to identify and treat people. • Education of personnel.

17. Interventions • “In addition to improving implementation of known interventions, basic and applied research is needed in a variety of areas to assess and/or improve the efficacy of potential preventive measures and to improve the evidence base for public health recommendations .” (http://www.cdc.gov/niosh/docs/2009-139/pdfs/2009-139.pdf)

18. Nursing Roles in Disaster Preparedness: • Increased funding and development for disaster and emergency management education programs for nurses is needed • Individual, personal preparedness is essential • Nurse managers must plan and participate in disaster preparedness exercises

19. NURSING Roles in Disaster Preparedness: • Provide volunteer support efforts • Practice stringent adherence to infection control practices • Increased bioterrorism training for Nurses is required. • Early infectious disease detection and surveillance. • Respond to individual and community mental health aspects of terrorism

20. Post- Mortem Care • Notification of Pathology. • Provide instructions to funeral director.

21. Recognizing Category A Agents • Anthrax • Plague • Smallpox • Botulism • Tularemia • Viral Hemorrhagic Fever (e.g Ebola, Marburg) • Arenaviruses ( e.g Lassa, Machupo)

22. Anthrax • Acute infectious disease caused by bacillus anthracis.

23. Anthrax Modes of transmission • Inhalation of spores • Skin contact • Ingestion of contaminated food

24. Anthrax Cutaneous signs and symptoms: • Local skin involvement with direct contact • Commonly seen on head, forearms, or hands • Localized itching followed by popular lesion that turns vescular within 2-6 days – develops into depressed black eschar Prognosis: • Good if treated with antibiotics.

25. ANTHRAX may also be transmitted via ingestion Gastrointestinal signs and symptoms: • Abdominal pain, nausea, vomiting, fever • Bloody diarrhea, hematemesis • Positive culture after 2-3 days • Prognosis: • If progression to toxemia and sepsis, prognosis is poor.

26. Anthrax may also be inhaled • Person-to-person transmission of inhalation disease does not occur.

27. ANTHRAX Pulmonary signs and symptoms: • Flu-like symptoms that may briefly improve two to four days after initial symptoms • Abrupt onset of respiratory failure • Hemodynamic collapse • Thoracic edema

28. ANTHRAX Pulmonary signs and symptoms: • Positive blood culture in 2-3 days of illness • Widened mediastinum on xray • Positive blood culture in 2-3 days of illness • Prognosis: Good if treated early. Increased mortality rate if treated after respiratory onset.

29. Anthrax Incubation period • Pulmonary: 2-60 days • Cutaneous: 1-7 days • Gastrointestinal: 1-7 days

30. Anthrax Transmission • Anthrax is not airborne person to person. Direct contact with infectious skin lesions can transmit infection.

31. Anthrax Prevention • Vaccine available-limited quantities.

32. Plague • Plague is an acute bacterial disease caused by Yesinia Pestis.

33. Plague Mode of Transmission: • Plague normally transmitted from an infected flea

34. Plague Mode of Transmission: • Can be aerosol-probable use in bioterrorism

35. Plague Incubation period: • Flea bite – 2-8 days • Aerosol – 1-3 days

36. Plague Prognosis: Good if treated with antibiotics early.

37. Plague Signs and Symptoms: • Fever • Cough • Chest pain • Hemoptysis • Watery sputum • Bronchopneumonia on xray

38. Viral Agents • Small Pox Virus

39. Viral Agents • Small Pox Virus • Smallpox is an acute viral illness caused by the variola virus. Mode of transmission: Airborne: droplets

40. Smallpox Signs and symptoms: • Flu like symptoms-fever, myalgia • Skin lesions appear quickly progressing from macules to papules to vesicles • Rash scabs over in 1-2 weeks • Rash occurs in all areas at once, not in crops

41. Smallpox

42. Smallpox Incubation period: • From 7 to17 days, average is 12 days • Contagious when the rash is apparent and remains infectious until scabs separate (approx. 3 weeks)

43. Smallpox Prognosis: • Vaccine available and effective post-exposure • Passive immunization is also available in the form of vaccina- immune-globulin (Vig) • Smallpox has a high mortality rate.

44. Toxins Botulism • Potent neurotoxin caused by an anaerobic bacillus- clostridium botulinum.

45. Botulism Transmission: • Contaminated food • Inhalation

46. Botulism Signs and symptoms: • Gastrointestinal symptoms • Drooping eyelids • Weakened jaw clench • Difficulty swallowing or speaking • Blurred vision • Respiratory distress

47. Botulism Signs and symptoms: • Gastrointestinal symptoms • Drooping eyelids • Weakened jaw clench • Difficulty swallowing or speaking • Blurred vision • Respiratory distress

48. Botulism Incubation period: • Neurological S&S for food borne botulism – 12-36 hours after ingestion • Neurological S&S for inhalation botulism – 24-72 hours after exposure

49. Botulism Prevention: Vaccine available • Botulism cannot be transmitted person to person

50. Tularemia • is a potentially serious illness that occurs naturally in the United States. It is caused by the bacterium Francisella • tularensis found in animals (especially rodents, rabbits, and hares). Symptoms include: • sudden fever • chills • headaches • diarrhea • muscle aches • joint pain • dry cough • progressive weakness • chest pain, • bloody sputum Dyspnea