Make plans, hold meetings, educate staff
If you’ve been worrying about staff quarantines and whether smallpox vaccination will be mandatory, you can breathe a sign of relief. Neither would be required, based on new recommendations for smallpox vaccine from the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices. The updated guidelines have jump-started the planning process in many EDs.
"We are struggling with many of these issues, both citywide and specific to the hospital," reports Ann Stangby, RN, CEM, emergency response planner at San Francisco General Hospital and member of the city’s bioterrorism working group. Making concrete plans to vaccinate ED staff is a daunting task, Stangby says. "It is a very complex issue to try to operationalize," she says. "The guidelines may be there, but making it work is a much more difficult issue to tackle."
Susan Smith, RN, base hospital nurse coordinator at Sharp Memorial Hospital in San Diego, says that her main goal is to learn more about the realities of the smallpox threat. "We need to ensure we can respond effectively if our services are needed treating this dreadful disease," she says. "But first, we have to get a better sense of what we’re up against."
Here are the panel’s key recommendations:
• Special quarantines would not be required. The fact that quarantines would not be required was a major relief for ED nurses, who already are grappling with the nursing shortage and feared that mandatory quarantines would effectively bring operations to a halt. "Furloughs would not have been acceptable," says Kathy Hendershot, RN, MSN, CS, director of clinical operations for the ED at Methodist Hospital in Indianapolis. "It would be very difficult to stagger work schedules, but we would space the vaccinations,"
• Fifteen or more ED staff members per hospital would receive the vaccine. The panel recommends that each hospital identify a group of health care workers to be vaccinated and trained in managing patients who present to the ED with suspected smallpox. These Smallpox Health Care teams would include ED staff, intensive care unit staff, general medical unit staff, medical house staff, infectious disease specialists, and respiratory therapists. The panel estimates that the team would consist of 40-45 or more individuals, with 15 or more ED nurses and physicians. However, Hendershot’s goal is to have all ED staff vaccinated if possible. "I would need about 75% or better of our staff vaccinated to make this thing work and still run an ED," she says. Fifteen vaccinated staff members would not be nearly enough for her ED, Hendershot says. "That’s not enough people to cover a six-hour shift here," she says.
• Immunocompromised patients will be protected from vaccinated staff with the use of bandages. Stangby is not convinced this strategy will be effective. "Typically, dressings do fall off and have to be changed," she says. She is concerned about liability and risk management issues for this scenario, she says. "What happens if my site causes vaccinia in someone else?" she asks. "I am also concerned about persons who are vaccinated who then develop side effects. Is this covered under workmen’s comp?"
• The vaccine program would be voluntary. Staff who should not receive the vaccine must be clearly identified, Stangby says. "Again, if a health care worker volunteers to get the vaccine, then becomes ill, will the hospital cover their time off?" she asks. You also must identify individuals who will be giving the vaccine if there is a need for mass immunization, she notes. "This will take a large number of staff," she says.
Here is what some ED nurses are doing to prepare:
— Working with agencies in the community. Hendershot’s ED is working closely with local agencies, including the state and county departments of health, state and city emergency medical services coordinators, several area hospitals, and Indiana Poison Control to plan for the vaccination, with input from the hospital’s infectious disease physicians and physician leaders from the local board of health.
— Sharing the new recommendations with staff. "I have put together a special team of nurses and medics who are working on this project," reports Hendershot. "We have been anxious to get these recommendations from the CDC, and we will be communicating them to our staff."
Smallpox is "the hot topic" in the ED and at county disaster preparedness meetings, Smith reports. However, until she has more information regarding vaccination plans from the federal government, she says her facility’s primary focus is educating the ED staff on the signs and symptoms of smallpox infection. "Increasing awareness is key to early detection and subsequent isolation, and isolation is the best way to stop the spread of this disease and prevent an epidemic," she says.
— Explaining the risks of the vaccine. A survey is being conducted with ED staff that asks if they would receive the vaccine should it become available, Smith reports. The potential complications are being discussed with each staff member. (For more information on potential complications of the vaccine, go to www.bt.cdc.gov and click on "New Smallpox Vaccination & Adverse Events Training Module," which is free.)
The hospital’s infectious disease physicians will explain the risks of vaccination at staff meetings and will include information on how to minimize exposure after vaccination, such as providing a barrier guard of the vaccine site until scab formation, changing dressings, and hand washing between all patients, Hendershot says. "I do not think I will have problems with people not wanting the vaccine," she says.
Resources
For more information about the smallpox vaccine plans, contact:
• Kathy Hendershot, RN, MSN, CS, Director of Clinical Operations, Emergency Medicine and Trauma Center, Methodist Hospital, I-16 at 21st St., P.O. Box 1367, Indianapolis, IN 46206-1367. Telephone: (317) 962-8939. Fax: (317) 962-2306. E-mail: [email protected].
• Susan Smith, RN, Manager, Prehospital, Base Hospital Nurse Coordinator, Sharp Memorial Hospital, 7901 Frost St., San Diego, CA 92123. Telephone: (858) 541-3422. E-mail: [email protected].
• Ann Stangby, RN, CEM, Emergency Response Planner, San Francisco General Hospital. Telephone: (415) 206-3397. Fax: (415) 206-4411. E-mail: [email protected].
The updated recommendations from the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices can be accessed at the CDC’s Public Health Emergency Preparedness & Response web site (www.bt.cdc.gov). Click on "Smallpox" and "Oct. 2002 ACIP Vaccination Recommendations."
If youve been worrying about staff quarantines and whether smallpox vaccination will be mandatory, you can breathe a sign of relief.
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