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scenario:
h5n1 (the bird flu) mutates to become efficient at transmitting human to human causing a pandemic, with a case fatality rate of 60% and with 80% of the cases in the 0-40 year old age range.
hospitals will be quickly overrun. hospital staff shortages are 50%. the government orders all nurses to work. there is not enough personal protection equipment (n95 masks, gloves, goggles, tamiflu, vax, etc)
home quarantines become common (in the fed plans).
your family is also quarantined in your home. you are running out of food and the government promises you will be "taken care of" if you report to work.
I'm a PCA. I'm not going to the ER when/if this surges in the Fall/Winter. If I'm working, I'll work until I can't, then I'm staying home unless I'm dreadfully ill.
Ummmmm, does that mean that you'd go to work sick, possibly with H1N1? That would make you like "Typhoid Mary!"
Better to have the 2 shot vaccine!!!!! It will be available in the fall, although you'd need to get in line behind the pregnant women and those with preexisting conditions....... (that last sentence was a jab to the anti new medical system - yes, I mean you!)
Ummmmm, does that mean that you'd go to work sick, possibly with H1N1? That would make you like "Typhoid Mary!"
Better to have the 2 shot vaccine!!!!! It will be available in the fall, although you'd need to get in line behind the pregnant women and those with preexisting conditions....... (that last sentence was a jab to the anti new medical system - yes, I mean you!)
Meanwhile, stay out of crowded places!
Nope, definitely not going to work if I'm sick. Besides, the hospital is the last place I want to be if I'm sick anyway, but especially to work. If I'm dreadfully ill, I will go to the ER - to receive treatment. I will not go to the ER, as I've seen many do, for something that's not emergent or at least urgent.
I must've missed something because I don't understand your "jab" comment - I don't think I know enough about Obama's plan(s) for the hc overhaul to be anti or pro. I've been buried up to my eyeballs for months in school books and tests.
The 39-year-old woman who died of swine flu in Wellington Hospital this week was a front-line health worker at Hutt Hospital, officials have confirmed.
The woman understood to have been a nurse in the children's ward is believed to be the first health worker to die from the virus in New Zealand.
Her death from a rare complication on Monday, after 11 days in intensive care, is the 13th to be officially recorded.
The coroner is investigating another 20 suspected deaths from the virus.
The woman had suffered a miscarriage within the previous two months. Pregnancy is a known risk factor for viral complications. However, it is not known whether she had the virus at the time she miscarried.
I am not understanding the healthcare model jab either, but if its to say that the ER will be the new primary care-George W already said that when he said there were no medical problems all Americans had access to healthcare in their ER!
Not exactly a good choice for citizens or for an American President to tout as the answer to health problems!
Specializes in ER - trauma/cardiac/burns. IV start spec.
actually i was responding to a note about how the brit's are handling the patients arriving at the local clinics or er's - "just wait in the car and we will come get you". ergo the teapot.
but can you explain part of this statement::anbd:
better to have the 2 shot vaccine!!!!! it will be available in the fall, although you'd need to get in line behind the pregnant women and those with preexisting conditions....... (that last sentence was a jab to the anti new medical system - yes, i mean you!)
my hubby is on home hemodialysis 6 days a week, stage 5 esrf, cabg, stints x2. i am cardiac patient, uncontrolled htn, diabetic, latex allergy, neoprene allergy, multi chemical allergies, cardiomyopathy, cervical fusion and repeat surgery with hardware, lumbar problems needing surgical interventions and none of the surgeons will touch me. we have before now always been among the first to receive our flu shots - are we to be skipped now?:sfxpld:
So no N95 masks is what is coming down the pike? Currently my facility is using them, but if they go to regular surgical masks, I shudder to think of the outcome as we start hearing about HCW fatalities. Not so many yet, but it is still early yet in the pandemic.
The infection control nurse would explode if we didn't have PPE in normal times. But now? We really may not have enough PPE. Are there even 5 billion masks in the world?
About those PPE, there is a lot controversy about what is the safest protection, and you need to know that not everyone agrees.
Keeping in mind that a certain percentage of patients will go on to develop severe s/s, some of whom have no prior health conditions, and some who have negative rapid flu test and PCR yet test positive by viral culture, which is the definitive test. You as the HCW, deserve the best protection. I heard several clinicians in this meeting today voicing concern about being coughed or sneezed on by kids in particular when wearing only the surgical mask which has no seal.
The second day of the IOM meeting on PPE for HCW meets tomorrow. I am very concerned for your safety. When CDC starts the beginning of a meeting saying that they will not recommend something that is not available, what does that say to you?
A pulmonary clinician describing what happenened in Utah the first two months of the pandemic came right out, and said that they ran out of N95 masks in May, though they have since restocked. He also said that a patient tested negative twice via PCR, and was taken out of isolation only to infect 6 HCW, and then test positve via viral culture for swine flu.
A task force of the Institute of Medicine (IOM), charged with making recommendations about how to protect healthcare workers against novel H1N1 influenza, today heard a variety of evidence that respirators and masks can shield healthcare workers (HCWs) and others from getting respiratory illnesses.
The IOM panel learned, for example, that N95 respirators--whether fit-tested or not--reduced respiratory illnesses in a recent multiple-hospital study in China, whereas surgical masks were not effective. But other studies, focusing on household transmission of flu, suggested that both surgical masks and N95-type respirators are valuable.
Still another study, involving students at the University of Michigan, suggested that the combination of surgical masks and hand sanitizers may reduce the risk of respiratory illness, but the results didn't achieve statistical significance.
The committee also heard about the problems that some HCWs have with face protection--including a concern among pregnant HCWs in Singapore that wearing an N95 may cause fetal hypoxia.
Evidence on the clinical effectiveness of personal protective equipment (PPE) has been notoriously fuzzy. In the face of the murky science, the IOM has been asked to provide a recommendation to the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) by Sep 1.
The CDC currently recommends that HCWs who enter the room of a patient in isolation for suspected or confirmed novel H1N1 flu should wear an N95 respirator or equivalent protection.
Today's day-long workshop, which was streamed over the Web, was dedicated to examining what's known about H1N1 flu and about the effectiveness of masks, gowns, gloves, respirators, and eye protection in preventing H1N1 and seasonal flu transmission.
Hospital study in China
In an afternoon session on preventing flu transmission with PPE, Raina MacIntyre of the University of New South Wales presented a few findings from an as-yet-unpublished study of respiratory protection in hospital workers in Beijing.
The study compared the effectiveness of surgical masks, fit-tested N95 respirators, and non-fit-fit-tested N95s in protecting HCWs from respiratory illnesses. The trial involved 1,936 workers in 24 hospitals, including physicians and nurses, who wore the equipment for 4 weeks last winter. The Chinese location was chosen because the team wanted a site where workers are used to wearing protection, making for high compliance, MacIntyre said.
The researchers looked at several outcome measures, ranging from clinical respiratory illness and influenza-like illness (ILI) to lab-confirmed flu.
She said she the detailed results of the trial are being saved for a meeting in September and journal publication, but she revealed a few findings: An intention-to-treat analysis showed that the surgical masks had no efficacy against any outcomes, whereas the N95s provided 75% protection against lab-confirmed flu. She also said the N95s were 42% more effective than the surgical masks overall.
MacIntyre also reported that the fit testing did not improve the effectiveness of the N95s, as there was no difference between the results for the fit-tested and non-fit-tested groups.
Household transmission studies
MacIntyre also reviewed the findings of a recent study that compared the use of surgical masks and P2 respirators (the equivalent of N95s) in households where a child was diagnosed with a respiratory illness. The randomized controlled trial was reported in Emerging Infectious Diseases in February.
The Australian researchers recruited 145 families, who were assigned to wear surgical masks, P2s, or no respiratory protection. The outcome measures were ILI and confirmed respiratory virus infections.
The scientists found no difference in illness rates between the P2 and surgical mask groups overall. However, mask use in the intervention groups was fairly low, and when the team looked only at the families that actually used the respiratory protection, they found a four-fold reduction in clinical illness for both groups, MacIntyre reported. No clear difference between the P2 and surgical mask groups was found.
A somewhat similar study, recently published in the Annals of Internal Medicine, was reviewed by Ben Cowling of the University of Hong Kong. He and his team used rapid flu tests to recruit patients from outpatient clinics and then studied the effects of interventions in their households.
The researchers recruited about 250 households and divided them into three groups: basic health education only, hand hygiene with soap and an alcohol hand rub, and hand hygiene plus surgical face masks.
The study produced some evidence that the interventions made a difference in flu transmission, but it varied depending how soon the interventions were initiated, Cowling reported.
Overall, 10% of contacts in the control group households contracted confirmed flu, versus 5% of contacts in the hand hygiene group and 7% in the hand hygiene plus face masks group. In a subanalysis focusing on households where interventions were started within 36 hours of the index patient's illness onset, the respective proportions were 12%, 5%, and 4%.
Cowling concluded, as stated in a slide, that the study showed "substantial and significant benefits of face masks and hand hygiene if implemented within 36 hours of index case symptom onset." He said it wasn't possible to distinguish which of the two interventions was more effective.
Pregnant women and N95s
The panel also heard Paul Ananth Tambyah of Singapore National University hospital review the SARS (severe acute respiratory syndrome) experience at his hospital, where full PPE, including N95s and gowns, was found to provide good protection.
In a question period, Tambyah revealed that pregnant HCWs in Singapore do not wear N95s. They are exempted from the requirement because gynecologists believe there will be fewer incidents of fetal hypoxia if pregnant workers don't use the devices, he said. Pregnant women appear to be at increased risk for complications from novel H1N1 flu.
"I think the general consensus with university obstetricians is to use surgical masks rather than N95s" in pregnant women, except when they are involved in intubation or other aerosol-generating procedures, Tambyah said.
Dr. Howard J. Cohen, a member of the IOM panel, commented later that, assuming the concern about fetal hypoxia is valid, "It seems the solution is to put them in a PAPR [powered air purifying respirator], where they have plenty of room to ventilate."
So no N95 masks is what is coming down the pike? Currently my facility is using them, but if they go to regular surgical masks, I shudder to think of the outcome as we start hearing about HCW fatalities. Not so many yet, but it is still early yet in the pandemic.
Since patients with H1N1 have been coming into hospitals in grave condition, the fear that a deficit in N95 masks might occur has been voiced on other threads. Pharmacists and pharmacy store managers were told early on, by suppliers that they would not receive many of them at the stores, because the DHS wanted to keep as many as possible in reserve (aka stockpile), to use appropriately if it became pandemic (which it is now). Factories have been at peek production of N95 masks, since last April. We'll have plenty!
That was wise, as so many lay people would wear them everywhere, even after they became moist, rendering them ineffective to block inhaled disease causing organisms. Their presumed false sense of safety could render them supremely infectious, if they caught it, blowing droplets through moist material. The best thing if you have H1N1 flu, is to stay at home (in your room if you live with a/your family)
So don't panic if you're continuing to work and have patients with H1N1 assigned to you (unless you're pregnant - then refuse to care for those patients - I would). If your facility insists that you care for them anyway, have some of the articles about deaths in cases wherein the patient was a pregnant woman with you that you printed in advance; and tell the admin. that you wouldn't want them to be seen as responsible for your demise! Believe me the fear of a potential lawsuit could possibly get you paid leave until the vaccine arrives in Sept./Oct. (according to WHO), and be first in line for it (both doses, 3 weeks apart).
Now I can foresee the faint possibility that female nurses who don't want their assignment, could just say they were pregnant......... but without the subsequent protuberance, etc. they might endanger their jobs......
I read something about pregnant nurses in Singapore who care for patients with H1N1 flu, who purposely don't wear facial masks/respirators, due to the prevailing belief there that masks/respirators could cause fetal anoxia.
My immediate reaction was, get those women portable oxygen and nasal tubing for it, inside the mask/respirator.
Then I thought, why are they caring directly for those patients, since they are at highest risk of death from H1N1 flu?
I still feel the latter way. If I was the person assigning patients, the last nurse I'd put with someone with H1N1 flu, would be a pregnant nurse!
Hopefully you're not experiencing a population explosion among your female nursing staff! By the way, as HCWs, this period of time before the H1N1 flu vaccine is available, isn't a good time to become pregnant. I haven't seen any reports of maternal or fetal loss in the first trimester of pregnancy, but that could be due to its lack of visibility then......
The major issues in the spread of novel h1n1 are non-compliance and lack of training. Insufficient evidence exists to show whether or not there is a difference between, universal precautions, droplet precautions and particulate precautions in the spread of pandemic flu. Intuitively, I think we all agree that some difference must exist, just the evidence is currently not available.
Reasonable conclusions from the IOM workshop are very empowering for the individual health care worker. Always practice universal precautions. practice cough etiquette. know how to use your equipment. Teach your patients and their families those principles, follow them yourself, and you, as an individual, will be greatly reducing the spread of novel h1n1.
The major issues in the spread of novel h1n1 are non-compliance and lack of training. Insufficient evidence exists to show whether or not there is a difference between, universal precautions, droplet precautions and particulate precautions in the spread of pandemic flu. Intuitively, I think we all agree that some difference must exist, just the evidence is currently not available.
Reasonable conclusions from the IOM workshop are very empowering for the individual health care worker. Always practice universal precautions. practice cough etiquette. know how to use your equipment. Teach your patients and their families those principles, follow them yourself, and you, as an individual, will be greatly reducing the spread of novel h1n1.
Thank you for your report on the workshop. It is helpful to know that experts and HCWs are "on the same page".
The difference between all precautions lies in the location of infective organisms. Universal precautions deal with organisms in blood and body fluid sources; and droplet and particulate precautions deal with organisms in the air. There is plenty of evidence regarding the source of these infective organisms, as cultures of surfaces and places where patients cough have been taken, measured for #s of colonies, length of life in various circumstances, etc.
Whether it's a droplet or a particle makes no difference in the necessary action taken to prevent spread. Any airborn particle or droplet requires an impermeable fit tested for size mask/respirator worn correctly by the patient; and a backup mask for the health care worker (HCW). Each mask/respirator must be changed when it becomes moist, as infective organisms penetrate through water quickly, and are blown out forcefully with each exhalation or cough. That endangers HCWs and visitors.
Also, if the HCW is developing a URI that isn't H1N1, the patients' weakened conditions make that a greater hazard to their recovery, if microorganisms are escaping on moisture laden air, and they might develop a multi-organism pneumonia. Masks/respirators must not be discarded anywhere other than a covered garbage container.
That would make you like "Typhoid Mary!".thumb.jpg.755b83f43c9f3860c778e2fcb2022ecb.jpg){kind=small}
lamazeteacher
2,170 Posts
Ummmmm, does that mean that you'd go to work sick, possibly with H1N1?
That would make you like "Typhoid Mary!"
Better to have the 2 shot vaccine!!!!! It will be available in the fall, although you'd need to get in line behind the pregnant women and those with preexisting conditions....... (that last sentence was a jab to the anti new medical system - yes, I mean you!)
Meanwhile, stay out of crowded places!