All About Seasonal Influenza: A Nurse's Guide to Protection and Prevention

1. All About Influenza What nurses need to know about seasonal influenza to protect themselves and their patients

2. 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

3. What nurses need to know . . . • What is influenza? • Isflu vaccine safe? • What are the contraindications to the vaccine? • What if I have a reaction? What questions do you have?

4. General Information: Influenza

5. 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.

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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Influenza Vaccines

13. 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

14. 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.

15. 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!

16. 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!

17. 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!)

18. 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

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

20. Vaccine R&D National Institute of Allergy and Infectious Diseases (NIAID) • Technology to improve production, safety and efficacy Vaccine and Treatment Evaluation Units  Consortium that conducts clinical trials to evaluate treatments and vaccines

21. What about side effects? • Serious side effects are very rare • Observe contraindications • Reporting adverse events improves vaccine safety • Vaccine Adverse Event Reporting System (VAERS)

22. Vaccine injury compensation • Vaccine Injury Compensation Program accepts claims • Compensation may include medical expenses, lost income, death benefits to survivors

23. 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

24. 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

25. 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

26. 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.

27. 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.

28. Infection Prevention and Control

29. 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

30. 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)

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

32. 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

33. Contract language • Relevant sections of contract agreement: • Essential personnel • Sick time/call in policy • Family leave/personal leave • Workers compensation • Disciplinary policy

34. Emergency Preparedness

35. Is your facility prepared? Nurses need to know: 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

36. 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

37. Initial and ongoing training • Patient care protocols for triage in Emergency Department • Nurses’ roles and responsibilities • Triage • Communication • Documentation • Debriefing

38. 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

39. AlternativeCare Sites • Patient care protocols • Available equipment and staff • Security • Patient transportation • Standing orders • Points of Dispensing (PODs)

40. 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

41. 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

42. 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

43. ServNY emergency registry ServNY 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.

44. 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