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Download pdf - Melissa Sweet

Photo courtesy of Royal Melbourne Hospital ArchivesIn the fight againstflu, forewarned isforearmedNurses will need to be well informed and prepared if an avian influenzapandemic eventuates. They will be called upon to provide leadership to thecommunity as well as caring for patients, writes Melissa Sweet.When an aged care service in South Australiabegan developing its response to thepotential threat of an avian influenzapandemic, the magnitude of the task soonbecame clear.How would clients be cared for if half thestaff were absent? How would staff manageif the electricity or water supply failed? Howwould waste management systems copewith the increased demand? Would staffhave to live onsite? What medicines shouldbe stockpiled? How might the budget beaffected? Who would be in charge if seniormanagers were absent?These are some of the tough questions thatstaff at Helping Hand Aged Care have beenattempting to answer as they develop theirorganisation’s pandemic plan, which isdivided into four phases – preparation, alert,pandemic, and recovery.‘We’ve tried to consider every single thing wepossibly could,’ said Robyn Murray, an RNand one of the agency’s project officers.‘There’s lots of creative problem-solving goingon at the moment.’Helping Hand Aged Care which has about7000 community clients and 550 residentialclients, began work on the plan late last yearto develop strategies for reducing transmissionshould a pandemic occur, and ensuringcontinuity of care. ‘We thought it was time todo something about it,’ said Megan Corlis,the executive officer and an RN.Workshops have been held to raise staffawareness and knowledge, and a responseteam established, which includes clinicalnurses skilled in infection control. Plans areunderway to conduct regular infection controlaudits and improved training, and to developkits to help each site respond appropriately.An audit will identify which staff may be26May 06 | volume thirteen | number ten | Australian Nursing Journal

unavailable if schools and child care servicesclose during a pandemic, and also theextracurricular skills that staff or volunteersmight have.Ms Corlis says work on the plan has alreadyhad positive spin-offs, in refocusing attentionon the importance of infection control andseasonal influenza vaccination for staff andclients (see breakout – Vaccination is vitalnow). She stresses, however, that there ismuch more to do.Nurses on the front-lineWhile Australian governments have alreadyspent more than $150 million on preparationsfor a potential pandemic, many believe now isthe time for greater involvement of those whowill be the front-line troops.Nurses will be at the forefront of managingthe pandemic, in hospitals, communityservices, general practices, patients’ homes,immunisation clinics, special ‘fever clinics’ orscreening travellers at airports, says ProfessorChris Baggoley, the chief medical officer inSouth Australia. ‘They will have a major frontlinerole,’ he said.Dr Dominic Dwyer, a medical virologist atWestmead Hospital, Sydney, who is closelyinvolved in national planning, said nursesneed to become informed about pandemicinfluenza no matter where they work. ‘Allnurses need to be aware of what is going onwith influenza and to have an awareness ofwhat their local plans are,’ he said.‘It doesn’t matter whether they’re in anursing home in western Sydney or acasualty department at St Vincent’s Hospital[in the city].’No time for heads in the sandVictoria Gilmore, the ANF’s federal liaisonofficer, said nurses need to know abouttransmission and management of avianinfluenza, infection control measures, andtheir workplace’s plans. Nurses should ensurethey are involved in policy and planningwherever possible. ‘We can’t afford to haveour heads in the sand about this,’ said MsGilmore. ‘We are gong to be critical playersin helping this country get through apandemic should it occur.’The ANF and Royal College of NursingAustralia (RCNA) are working closely todevelop joint communication strategies, andthe ANF website now has a special link toupdated information.Lynne Andrewartha, a nursing representativeon a primary care working group of theNational Influenza Pandemic ActionCommittee (NIPAC), said a pandemic wouldlead to intense professional and personalpressures for nurses right across theworkforce. ‘A lot of them will find they areasked to work outside of their comfort zonesand to work in areas they are not accustomedto,’ says Ms Andrewartha. It is critical, sheadds, that nurses are well informed abouthow to protect themselves, their patientsand their families from the risk of infection.‘The more informed they are, the easier thingsare going to be if anything happens,’ she said.An invisible workforceSome nursing leaders are disappointed theprofession has not been more specificallyengaged in preparations at the highest level,pointing out the lack of formal representationon NIPAC, although nurses are active on anumber of its sub committees and workinggroups.‘There are 250,000 nurses in Australia andyet we are still an invisible part of theworkforce,’ said Elizabeth Foley, directorof policy at RCNA. ‘Given that we alreadylobby around the whole area of nursesbeing involved in policy decision-making at alllevels, it is disappointing that nurses arenot on NIPAC.’Meanwhile, Lynne Walker, president of theAustralian Practice Nurses Association(APNA), is concerned practice nurses havenot been formally involved in national orstate pandemic preparations, despite theirimportant role in general practice andtriage. ‘National and state authorities needto involve practice nurses and practicemanagers more in planning,’ she said.Nurses will provide information andstem panicMany experts believe nurses will have acritical role in helping to allay communityfears by providing practical information.Being well informed will also help nursesmanage their own anxieties. ‘The thingswe don’t understand we always fear morethan those we do,’ said Susan Sherson, anurse educator in Melbourne who has aparticular interest in nursing ethics.Ms Foley says nurses will be called uponto provide reassurance and informationto their communities, whether that becorrecting misinformation or giving publictalks. ‘Nurses need to understand they willbe taking a lead role if the pandemic hitsour shore. We want them to be a calminginfluence, to say to people there are somepractical things you can do, like washingyour hands.’Beware of media over-statementAssociate professor Anne Gardner, whorepresents nurses on the NIPAC clinical caresubcommittee, encourages colleagues toidentify reliable sources of information, suchas government and professional websitesand journals, and to be cautious aboutmedia sources. ‘Don't rely on what you readin newspapers or hear on TV,’ she said.Professor Gardner also suggests that nursesstart talking with their families and communitiesabout what they would do if therewas a pandemic – about who, for example,would care for their children if schools or childcare services close.History has some lessons for usKirsty Harris, a doctoral student at theUniversity of Melbourne, considers thepotential pandemic from many perspectives.She wonders what it will mean for her sister,who is a nurse. In her role as a corporatecommunications consultant, Ms Harris isconcerned that her informal surveys ofnurses suggest many are not well informed;and as a military historian she pondersthe implications of the Spanish influenzapandemic of 1918-1919.Much has changed since that epidemic,which is estimated to have killed between20 and 40 million people worldwide andinfected about one quarter of people in theUnited Kingdom and United States. On thepositive side, medical technologies arenow much more sophisticated. Australiangovernments have stockpiled antiviral drugsand protective equipment, and there aredetailed plans for containing the pandemicto ‘buy time’ while vaccine manufacturersspring into production.On the other hand, some social changes,including increased population densities, maymake containment more difficult. Ms Harrissays in the Spanish pandemic, nurses weresingle and lived onsite where their uniformswere washed. Now they may have to jugglecompeting priorities of caring for patients andtheir own families. The decline of extendedfamily networks also means many people willrely on nurses to care for them at home.Ms Harris says in the previous pandemic,nurses were more used to infectious diseasesand quarantine arrangements. ‘Now we havevery small infectious diseases wards, if atall,’ she said. She advises nurses to becomefamiliar with personal protection equipmentor PPE and to trial wearing it for long periodsat a time.Australian Government modeling predictsthat a pandemic affecting one quarter of theMay 06 | volume thirteen | number ten | Australian Nursing Journal 27

population could lead to tens of thousandsof deaths and hospitalisations if vaccines ortreatments were not available. However, MsHarris says nurses should be reassured bythe level of preparation. ‘If we do the rightthing and learn about avian flu and practisegood infectious disease control, we will beprotecting ourselves.’Well prepared to ride the waveProfessor John Horvath, the AustralianGovernment’s chief medical officer, saysAustralia is well prepared if a pandemic arises,by virtue of its planning, excellent publichealth and surveillance systems, and closeinternational cooperation. ‘It’s not going to belike a bomb,’ he said.‘What it will be, is like a wave. It will build up –sometimes it comes in two waves – and theaim of the exercise is to stretch that wave outand flatten it for as long as possible.‘All our evidence suggests that the containmentphase most probably will last longerthan we originally anticipated. Our modelingsays that if we aggressively treat andprophylaxis contacts [and] practise a lot ofsocial isolation, [then] you reduce the abilityof this virus to spread and the wave may wellbe blunted and by the time it really accelerates,we may have a vaccine.’Infection control will be the keySo many uncertainties surround the pandemicbut experts say one thing at least iscertain: improving infection control will havemany immediate benefits.‘We should be ensuring that we’re tryingto achieve best practice for what we’redealing with now,’ said Dr Ashley Watson, asenior specialist in infectious diseases atCanberra Hospital. ‘We could do a wholelot better. The problem is that it sometimestakes a major new outbreak to mobilisepeople into doing what’s necessary.’Dr Watson said health professionals needto maintain constant low level vigilance ratherthan panic about the possibility of apandemic. ‘If, in 12 months time, no flu hashappened and everyone forgets about theresponse and basic preventive measures andwe go back to business as usual, then oneday it could happen and we’re not ready forit,’ he said.‘So it’s a matter of maintaining a low level ofvigilance and preparedness because that issustainable,’ said Dr Watson.Stay home if you’re sickDr Paul Dugdale, the ACT chief healthofficer, says the possibility of a pandemic alsoreinforces the importance of longstandingadvice for health professionals to stay homewhen they have an infectious cough orsneeze. ‘The nursing profession has a verystrong work ethic and there’s an idea of“I can’t let the team down”,’ he said. ‘But it’simportant that when people are infectious,then they shouldn’t spread it around.’Meanwhile, nurses may gain a glimpse ofwhat a pandemic could mean during a trialrun later this year to test Australia’s preparations.The exercise, still in early planningstages, is expected to result in considerabledisruption to services.Robyn Murray, at Helping Hand Aged Care inAdelaide, hopes that all their work onpandemic preparations never faces a realworldtest. ‘I sincerely hope that all of thisplanning that we’re doing is just an exercise,’she said. ‘I’d rather have all of this in placeand never have to use it.’Vaccination is vital nowWhile so much attention is being focused on a potentialfuture threat, much more could be done to reduce mortalityand morbidity from a current problem – seasonal influenza.Ensuring nurses and other health professionals are vaccinatedagainst seasonal influenza is important for minimising the spreadof the infection, protecting patients and ensuring a healthy, fitworkforce, experts say.Professor Chris Baggoley, the chief medical officer inSouth Australia, says it is of concern that only 20-50% ofthe health workforce is vaccinated annually againstseasonal influenza.Dr Barry Gilbert, a public health consultant and chair of theWorkplace Infectious Disease Prevention Group, which is fundedby vaccine manufacturers, says the low vaccination rates reflectthe lack of systematic, well-resourced occupational healthservices in health workplaces.‘I don’t know of any hospital which achieves greater than 30%vaccination of nurses and health care workers,’ he said.Many experts also emphasise that nurses have an importantrole in promoting and supporting vaccination of high riskgroups. The National Institute of Clinical Studies (NICS) haslaunched a campaign to encourage vaccination of at riskgroups under age 65, including people with chronic illnessessuch as asthma, diabetes, cardiovascular disease and thosewith suppressed immune systems.While vaccination rates among older Australians have improvedto about 80%, NICS cites research showing only about 42 % ofyounger people – at risk of complications from influenza – arevaccinated annually.NICS also cites research showing that more than 13,000Australians died from influenza and its complications in 2004,and that up to two thirds of people who are hospitalised forinfluenza are under 65.Dr Jan Davies, executive officer at NICS, said research suggestsnurses can play an important role in boosting vaccination rates,by helping to dispel uncertainty about who is at risk and somecommon myths, including that vaccination is ineffective orcauses influenza.She said there already are many creative examples of nurses’work in this area. Practice nurses have set up reminder systemsfor general practitioners and patients, as well as otherapproaches to promoting vaccination including establishingafter hours clinics and visiting workplaces.Lynne Walker, president of the Australian Practice NursesAssociation, says nurses are increasingly playing a direct role inadministering the vaccine and establishing immunisation clinics.For more information visit the NICS site: 06 | volume thirteen | number ten | Australian Nursing Journal

Some of the people behind the preparationsProfessor Chris BaggoleyLynne WalkerRDNS – Linda Hayford (centre)John HorvathMegan Corlis and Robyn MurrayAnne GardnerWhere to find more information DugdaleMay 06 | volume thirteen | number ten | Australian Nursing Journal 29

A community issueWhen Linda Hayford gives presentations about what a pandemicmight mean for community nursing, she shows a series ofphotographs of the squalid and impoverished living conditions ofsome of her service’s clients.They graphically illustrate the challenges that community nursingfaces in implementing effective infection control procedures inuncontrolled environments short of even basic hygiene facilities,such as a clean sink.A clinical nurse consultant in infection control, Ms Hayford hasbeen helping her Adelaide-based organisation, the Royal DistrictNursing Service (SA) and Metropolitan Domiciliary Care, with thecomplex task of preparations for a potential pandemic.Many of the best ideas have come from staff workshops, shesays. Staff have, for example, suggested the RDNS pizza andfamily information evenings to help engage nurses’families in planning. Information leaflets for clients are alsobeing developed, and plans are underway to assist staff towork from home wherever possible.PPE kits will also be kept in all service cars, so they are easilyaccessible if needed, and high filtration masks will also be ‘fittested’ to ensure their effective use.Ms Hayford said the preparations are having a positive impactin heightening infection control awareness but that much morework is needed to improve understanding of infection control,in both health care worker education and the workplace.‘We should be doing this all the time, not just waiting foran outbreak,’ she said.The facts about avian influenzaAvian influenza is an infectious disease of birds causedby the influenza A virus. The first documented infection ofhumans was reported in Hong Kong in 1997 and was dueto close contact with live infected birds. Since then a numberof other cases have been reported around the world. So far,none of the avian influenza viruses have developed the abilityto spread easily from person to person. If this happens,however, it could lead to a pandemic as it would be a newsubtype of the virus which could spread quickly becauseno one would have immunity to it.Pandemics of flu are spread from person to person byrespiratory secretions through: spread of droplets from personto person (eg. coughing, sneezing); touching things that arecontaminated by respiratory secretions and then touchingyour mouth, eye or nose; and spread of particles in the airin crowded populations in enclosed spaces.The National Incident Room, in the Australian GovernmentDepartment of Health and Ageing, is closely monitoring thesituation overseas for any signs of a pandemic. Symptoms ofpandemic flu are the same as the seasonal flu virus, includingsudden onset of high temperature. Symptoms may developtwo to seven days after infection.Mainstays of treatment include rest, adequate fluid intake andnutrition and medications to relieve fever and pain such as aspirin(but not in children) and paracetamol. Complications, such asbacterial pneumonia, can be treated with antibiotics. Those whoare severely affected may need hospitalisation, supplementaloxygen therapy and respiratory support through artificialventilation.General measures for preventing all respiratory diseases,including pandemic flu, include:• general hygiene measures such as regular handwashing;• cough hygiene (turning away from other people and coveringthe mouth with tissues when coughing or sneezing, disposingof the tissues afterwards and washing hands after disposal ofthe tissues;• when unwell, avoiding public places and contact with childrenor people with underlying illnesses;• when attending a medical practice, alerting the receptionist toyour symptoms so you can be seated away from others andpossibly be given a surgical mask; and• maintaining good general health and staying up-to-date withthe recommended vaccinations, such as the pneumococcaland seasonal flu vaccine for those in high risk groups.(Source: Australian Government)30May 06 | volume thirteen | number ten | Australian Nursing Journal

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