Swine flu: what every nurse should know

The World Health Organization last night raised the alert level for the current swine flu outbreak from four to five, indicating person-to-person transmission of the disease in at least two countries, and suggesting that a pandemic is ‘imminent’.

Currently, five people in the UK have been confirmed to have the virus, and Chief Medical Officer for England, Professor Sir Liam Donaldson, has said he expects ‘many, many more cases’.

Nurses are being asked to play a key role in the process of containment that is key to tackling the disease.

They are being kept up to date on latest developments through their PCT or hospital trust, and Lynn Young, primary care advisor at the RCN, says the college has been working with the Department of Health for two years on plans for flu outbreaks, which are now kicking in.

Algorithms have been produced for the management of flu cases in both children and adults, and ethical frameworks for the treatment of flu outbreaks have been produced.

Health secretary Alan Johnson has said the NHS possesses 33 million doses of antiviral treatment, and it was hoping to increase that figure to 50 million.

In the case of a widespread flu outbreak, frontline NHS staff would be given priority in receiving jabs, he said.

The Department of Health has announced that leaflets describing flu prevention measures will be delivered to all UK households, and calls to nurses working for NHS Direct, and NHS 24 in Scotland, have risen five-fold.

The Health Protection Agency holds the remit for dealing with infectious diseases in the UK, and it is leading on advice for both health professionals and members of the public.

Its key advice to clinicians comes in the form of algorithms for the management of people who travelled from affected countries, and for close contacts of probable or confirmed cases of swine flu.

It says clinicians should consider swine influenza A (H1N1) virus infection for patients who present with febrile acute respiratory illness if they have returned from Mexico or affected areas of the US within the previous week.

If they suspect swine flu they should contact their local Health Protection Unit immediately, and follow the HPA’s algorithm for management of the suspected disease.

This includes taking nose and throat swab for flu testing, starting antivirals, and considering whether the patient is ill enough to need hospitalisation.

Whether sent to hospital or treated at home, respiratory isolation of the patient should be considered, and if the patient is ill enough all staff should wear a correctly fitted high filtration mask, gown, gloves, and eye protection.

The advice says healthcare workers should be considered as possible ‘close contacts’ of suspected or confirmed cases if they examined the patient while not wearing full personal protective equipment, even if they were wearing facemask, plastic apron and gloves.

These staff should be provided with HPU information leaflets, and followed up ‘passively’ for seven days after their last exposure to the case.

The World Health Organisation is regularly updating its advice, and it currently advises no restrictions on travel, although it would be ‘prudent’, for ill people to delay international travel.

The Foreign Office is currently advising against non-essential travel to Mexico, and telling British nationals in the country that they ‘may wish to consider whether they should remain in the country at this time’.

The WHO also says there is no risk of catching swine flu from ‘well-cooked pork or pork products’, but it advises that fundamental infection prevention strategies should be put in place, as the swine flu virus appears to transmitted through droplets.

Neither the WHO or the HPA advises face masks to be worn by the general public.

NHS Choices is also major source of information for members of the public concerned about swine flu.

People are advised to always cover nose and mouth with a tissue when coughing or sneezing, and to dispose of tissues promptly and carefully.

They are urged to maintain good general hygiene, including regular washing of hands, and to clean hard surfaces, such as door handles, with a regular cleaning product.

The virus can survive for up to 24 hours on hard surfaces, and 20 minutes on soft surfaces.

Other advice passed on to the public is to build up a network of ‘flu friends’, who can help if someone falls ill, particularly by collecting medicines and minimising the patient’s contact with others.

Concerned people are also advised to note their NHS number, keep a copy in a safe place, and to keep a fortnight’s supply of food in the house.

The changeable nature of the situation makes it difficult for healthcare professionals at the frontline to keep up to date. RCN primary care adviser Lynn Young says: ‘It’s important to remember that we don’t know how this is going to play out, so we have to wait to see how it develops. But we keep coming back to the best way to deal with it, which is containment.’

‘It’s about executing excellent hygiene and not getting too excited.’

The advice is echoed by Pauline Macdonald, nurse consultant in communicable diseases at Dudley PCT, who is keen to stress that while there are obvious risks, the UK is not in a pandemic situation, and it is important to remain calm and focused.

'People should prepare themselves by reading the national guidance and highlighting the requirement for respiratory and hand hygiene. This is the best way for nurses to protect themselves and their patients.

'There are too many variables to speculate on how bad it is going to be, we are in the preparatory phase and it is not a pandemic. The priority is to identify, isolate and treat suspected cases. Anyone concerned should follow the HPA algorithm. If this suggests a possible case of swine flu, patients will be swabbed and given treatment.'