Risk to healthcare workers

At this present time, nurses in Cambodia, Indonesia, Thailand, China, and Viet Nam have had to care for clients that have been infected with Avian influenza H5N1. WHO (2005) suggest “transmission [of the avian flu] requires very close contact with an ill person.” This information is supported and proven in a study called “Concise communication. Risk of influenza A (H5N1) infection among health care workers exposed to patients with influenza A (H5N1), Hong Kong” (Bridges, Katz, Seto, Chan, Tsang, Ho, Mak, Lim, Tam, Clarke, Williams, Mounts, Bresee, Conn, Rowe, Hu-Primmer, Abernathy, Lu, Cox, & Fukuda, 2000). The study conducted by Bridges et al. (2000) indicated that “exposure of health care workers (HCWs) to H5N1 case-patients was associated with having H5-specific antibody” (p. 346). These seropositive HCWs had either bathed or changed the patient’s bed linens (Bridges et al., 2000).

If you are a nurse, it is not possible to avoid infected clients but, precautions can be initiated and practiced to prevent contracting and spreading the virus. Standard precautions (hand hygiene), contact precautions (glove and gown), airborne precautions (isolation room and respirator use by healthcare workers and visitors), and eye protection if within one meter of the client is suggested. (Sheff, 2005 and National Institute of Occupational Safety and Health, as cited by Trampuz et al., 2004).

An additional detail that healthcare workers should be aware of is that in an epidemic, a neuraminidase inhibitor called oseltmivir, can be given within 48 hours of symptom onset as this drug prevents influenza viruses from replicating and shortens the duration of illness (Sheff, 2005). City of Ottawa (2006, para. 5) confirmed, “These medications will be given to hospitalized patients and front-line health care workers.”

How to identify patients with avian influenza

How to identify patients with avian influenza It is important to identify and report cases of pandemic influenza (City of Ottawa, 2006). In order to identify cases, a nurse must know what signs and symptoms to look for during an assessment. In people, bird flu usually begins much like conventional influenza, with fever (above 37.7`C in adults), cough (nonproductive), sore throat and (mylagia) muscle aches (Mayo Clinic, 2005 and Sheff, 2005). Other symptoms include: pneumonitis, lymphopenia, (Trampuz et al., 2004), diarrhea (Trampuz et al., 2004 and Sheff, 2005), headaches, light sensitivity, eye infections, and rhinitis (Sheff, 2005). Interestingly, Trampuz et al. (2004, p. 527) noted, “sore throat, conjunctivitis, and coryza were absent in the first human cases of H5N1.”

The CDC (2004, p. 99) has recommended that health care workers request that their clients get tested for AI if “the patient presents with 1) a temperature greater than 38`C, 2) a cough, sore throat, or shortness of breath and 3) history of contact with poultry or domestic birds, or person with suspected or confirmed influenza A, within 10 days of symptom onset.” In addition, the CDC (2004, p. 98), stated that a patient should be tested for H5N1 if the patient has “radiographically confirmed pneumonia, acute respiratory distress syndrome, or other severe respiratory illness”, as well as, a history of travel (within 10 days of symptom onset) to a H5N1 infected country.

Treatment for avian influenza

Once a person has been identified as suffering from H5N1, treatment can begin. Treatment for patients with avian influenza includes administrating antiviral medications, maintaining fluid and electrolyte balance, and providing respiratory support; these actions are mainly supportive. (Sheff, 2005). According to Mayo Clinic (2005), the primary treatment for H5N1 is a neuraminidase inhibitor called oseltamivir (also known as Tamiflu or Relenza). This type of drug is effective in preventing the virus from escaping its host cell if it is taken within two days after the appearance of influenza symptoms (Mayo Clinic, 2005). Early literature stated that oseltamivir was effective for prophylaxis and treatment of H5N1 (Trampuz , 2004). In contrast, more recent literature argued that effectiveness of oseltamivir against H5N1 seems to be weakening, as resistance to the drug seems to be developing quickly in Southeast Asia (Mayo Clinic, 2005 and Wong et al., 2006). Oseltamivir is not the first antiviral medication that has been used to prevent and treat H5N1, amantadine and rimantadine were previously used. These drugs are no longer used as the avian influenza virus has already developed a resistance to amantadine and rimantadine (CDC, 2004, Trampuz et al., 2004, and Wong et al., 2006).

In order to prevent further spread of the virus, the patient should be placed in an airborne isolation room (Sheff, 2005) or an isolation center should be created for many severely ill clients (City of Ottawa, 2006). The name of the illness may sounds harmless however the complications from this virus are severe and the “bird flu” can lead to life-threatening complications such as viral pneumonia and acute respiratory distress (Mayo Clinic, 2005).