Are any of your patients getting tested for swine flu?

BrnEyedGirl, BSN, MSN, RN, APRN · May 5, 2009

We are only testing those who have been in Mexico w/in 7 days,.or have been exposed to a known case (no known cases in my area) AND have tested influenza A positive, so far we have tested no one.

FireStarterRN, BSN, RN · May 5, 2009

So, we could have a lot more cases in the U.S. I don't get why they aren't screening anyone with fever and chills for the swine flu.

I haven't heard much talk at work about it, other than making fun of the whole thing.

PixieWolfe · May 5, 2009

I am a student Nurse working in the Accident and Emergency department, London (UK). Our sister(s) are testing everyone who has the symtoms just in case, as well as putting them in a sideroom. Everyone has to take it serious just in case.

I am surprised that America isnot as well >

indigo girl · May 5, 2009

My hospital is testing anyone with flu like s/s as well. All nursing units received instructions on how to obtain specimens for patients that present with flu like illness.

Keepstanding, ASN, RN · May 5, 2009

so how do you go about getting swine flu tested?

praiser :heartbeat/color]

Multicollinearity, BSN, RN · May 5, 2009

so how do you go about getting swine flu tested?

praiser :heartbeat/color]

you screen for influenza a, since h1n1 swine flu is in the 'a' group. if the sample is negative for type a, you know h1n1 is not possible - it is ruled out. if it is positive for type a, then you send the sample for virology testing for known type a subtypes. if the sample is not typeable, that is suggestive for h1n1 swine flu, and the sample should go to your state health lab or other public health lab. the state lab will perform more testing, trying to find if the sample matches any known types of influenza a. when i say known types of influenza a, i mean types other than h1n1 swine flu that we have standard tests for. if it is still untypeable, it will be sent to the cdc in atlanta where they have the only available testing in the us to determine if the type a strain is h1n1 swine flu.

i would imagine eventually hospitals will have testing capability for h1n1 swine flu just as they do for other strains of influenza. (some hospitals may not have this capability, they may just have screening tests for type a or b and that's it.)

however, we are very fresh into this, and the technology doesn't exist in the us for hospitals to test for h1n1 on their own, independently. i find it interesting that some of the asian countries have already standardized the tests for h1n1 and have it in place at their hospitals. they seem more high-tech and efficient than we are.

Multicollinearity, BSN, RN · May 9, 2009

Just an update to the above: some state/public health labs now have the tests to independently evaluate for H1N1, eliminating the need to send samples to the CDC in Atlanta. Eventually hospitals may have this testing capability.

Pediatric Critical Care Columnist · May 10, 2009

We've had a kid with H1N1 on our unit. But there wasn't any index of suspicion when she first came in; she was swabbed only because she had a severe asthma exacerbation. So there were a few red faces when she tested positive. That just opened the floodgates and now we're testing and isolating every kid with the slightest snotty nose, risk factors be darned. My patient the other day had the most superficial of nebulous contacts with someone who had been in Mexico three weeks ago. There was me in my N95 with the huge red pressure injury on the bridge of my nose and the grooves on my cheekbones, gowned, goggled and gloved... The provincial lab called to say the direct fluorescent antibody screens were negative for influenza A, influenza B, parainfluenza and RSV, so our intensivist said no more airborne isolation. 10 minutes later the infection control nurse strolls in and says only they can discontinue isolation precautions (we were still doing droplet and contact!!) so get that N95 BACK ON!!! And keep it on until the PCR for H1N1 is negative. Stupid or what!! We've got a significant number of staff members on Tamiflu because of Case #1 already.

But get this... about 10 days after the first information about this potential pandemic emerged, our hospital announced that it would be running fit-test clinics for staff so we could all be re-fitted. (We have about 4,000 staff members and the last mass fit-test was 2 years ago.) So they included the schedule of clinics... one day a month from May to August. I was speechless - momentarily. It's totally like our employer to do something so dumb like that. Anyway, because we actually had the only H1N1 patient in the hospital, they came to our unit to fit-test the staff at 10:30 in the morning. (I'd been in the room since 7!! Not that I was worried that this kid was positive - he wasn't, of course, but really!)

indigo girl · May 10, 2009

But get this... about 10 days after the first information about this potential pandemic emerged, our hospital announced that it would be running fit-test clinics for staff so we could all be re-fitted. (We have about 4,000 staff members and the last mass fit-test was 2 years ago.) So they included the schedule of clinics... one day a month from May to August. I was speechless - momentarily. It's totally like our employer to do something so dumb like that. Anyway, because we actually had the only H1N1 patient in the hospital, they came to our unit to fit-test the staff at 10:30 in the morning. (I'd been in the room since 7!! Not that I was worried that this kid was positive - he wasn't, of course, but really!)

We get fit tested yearly with our annual physical exams at employee health. The masks are not fun to wear for any length of time.

The hospital sent everyone a letter this week asking us to conserve N95 masks. If working with patients that have TB, masks can be reused with the same patient that day, but not with influenza cases. What this conservation request signals to me is that they have realized that we could run out of PPE if the situation becomes worse. I am not aware of any cases at our facility yet.

mama_d, BSN, RN · May 10, 2009

Actually, we just had one discharged a few days ago and now have another one in house. That makes it 20% of confirmed cases in our state being treated at my hospital. Makes me get the warm fuzzies just thinking about it...not!

The thing that is really ticking me off is when I read news stories about new cases that are cropping up and in the comments section people are posting things like "My doctor told me that he's not bothering to test anyone for the flu b/c it's too much of a bother if anyone is positive, so he just gave me Tamiflu for my fever and cough." Argh! We're right at two weeks into a potential pandemic, it seems like tracking the actual number of cases would be of a benefit now especially so that the CDC and WHO can get an accurate idea about transmission rates/routes and figure out if there is actually anything to worry about.

indigo girl · May 10, 2009

We're right at two weeks into a potential pandemic, it seems like tracking the actual number of cases would be of a benefit now especially so that the CDC and WHO can get an accurate idea about transmission rates/routes and figure out if there is actually anything to worry about.

http://pandemicchronicle.com/2009/05/sunday-morning-h1n1-musings/

Influenza infections during seasonal epidemics (what we face year in and year out) tend to double every three days (on average). If you have ten cases on a given day, three days later you will (on average) have 20, three days after that you will have 40, three days after that you will have 80, and so on until your community attains “herd immunity”. Herd immunity is when a community, whether our towns and cities, or the small closed communities of nursing homes, have enough recovered or vaccinated cases to no longer support forward transmission of an infectious disease.
We have our first publicly accessible estimation of what the R0 [Reproduction number] for 2009 H1N1. The R0 is important in disease outbreaks because it tells us how many new infections to expect from any other one infected person [on average].