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Swine flu: what every nurse should know

With the NHS gearing up to tackle a potential swine flu pandemic, Graham Clews looks at advice from the key agencies and examines the crucial role that nurses must play

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.

WHO guidance

  • Confirmed or suspected patients should not be crowded together.
  • A medical or surgical mask should be worn by health professionals.
  • Effective hand hygiene is vital.

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 hygeine. 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.'

Readers' comments (7)

  • I am currently working in a gp surgery and am more than a litlle concerned about the lack of guidance we have had as a surgery. The algorithm states community staff can wear any face mask - good job because you cannot get them however if patient is in hospital the staff are to wear a ffp3 mask. The patient may then have a diagnosis when they reach hospital but there is nothing to say they have not got swine flu when they are tested in the surgery. I have a problem with undertaking swabs without the necessary protection. I have a family to go home to and loved ones to protect.

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  • TheSingingNurse

    Hi, Found your article via twitter from a fellow nurse. Thanks for the helpful information. It is awesome to hear how others around the world are handling the Swine Flu. Just wanted to give you a resource concerning washing hands and not spreading your germs around. I have written some fun upbeat health songs that would be appropriate for young children. They could be utilized in the school setting, in the home or in the pediatricians office. Go to iTunes and put The Singing Nurse in the search to download "Rubba, Dub, Dub" or "Don't Spread Your Germs Around" Songs for Healthy Living! Sincerely for Healthy Children, Ms Dawn, The Singing Nurse

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  • Hi,

    Thanks for your comments Dawn,

    readers can visit http://www.myspace.com/msdawnthesingingnurse to see more of Dawn's work.

    Thanks, Victoria
    Nursing Times

  • I felt that i wanted to comment re the hand hygeine songs suggested by the singing nurse. My own opinion is that this is a fab idea, as a nurse working in an acute hospital setting, and also a mother, i see many 'lay' people who do not wash their hands enough, if at all. Indeed, my youngest daughter who is 11 commented whilst we were watching the news about the precautions to be taken to prevent the spared of swine flu, that most girls in her school do not wash their hands after washing the toilet,this she felt was discusting, incidently, these are also the gilrs who seem to always be off sick with colds. Start hand hygiene as young as possible and if the mothers arent teaching the children, let the children teach the mothers through their songs from nursey and school!

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  • As with the first letter. I too am a practice nurse in primary care. The first possible line of approach when unwell. Todate, we have received absolutely no guidelines or protocols to follow in the event of a patient with suspected swine flu presenting in the surgery.

    I am absolutely appauled at my Pct., and now wonder just how many more out there are dragging their feet.

    Lets see some action and not just idle lip service.

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  • Hi. Interesting to read everyone's comments. I'm a student nurse working in an emergency unit and therefore 1st/ 2nd point of contact for most patients.
    We've received no info regarding masks or anything as of yet. We were supposed to be having the training yesterday which never happened...how long will they put this off for! If we're supposed to be looking after patients who could possibly have the swine flu, surely we should have some kind of protection asap, either masks or a jab.
    Does anyone know whether we're supposed to wear masks only with suspected patients or all the time? By the time we find out whether a patient has it surely it would be too late as we're looking after them whilst they're waiting for their swab results.....
    I'm very disappointed as it always seems we're the last people to be looked after in such situations when we're possibly the most at risk!
    Anyone any advice?
    Thanks, Hannah

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  • Kadiyali Srivatsa

    "Easier said than done"

    Heath authorities and HPA are yet again wasting time and money talking about washing hand as the only solution to end the crisis of hospital infection.

    Biocides (disinfectants and antiseptics), are universally used in hospitals to clean surfaces, sterilise medical instruments, wash hands and equipment, and decontaminate skin before surgery. At the right levels, the chemicals destroy most microorganisms but if weak doses are used the bugs can survive and grow stronger. (http://www.telegraph.co.uk/health/3141079/Hospital-bacteria-such-as-MRSA-becoming-resistant-to-disinfectants.html)

    Bacterial count is said to increase when you wash hands more than ten times every day. Dermatitis, allergic reactions and dry skin are a major problem and help colonize bacteria like MRSA. Using alcohol gel is not the answer because the low concentration kills good bacteria and help resistant once to grow stronger.

    Washing hands using soap & water for thirty seconds one minute (duration - singing happy birthday song help) is important. Observation of "Drying Time" (http://www.medifix.org/safec/files/Canada%20Nurse%20Reduce_Vascular_Access_Complications.pdf) before injecting a needle through skin, is not well publicised in UK.

    Most healthcare workers forget the gloves will be contaminated if they touch any part of patient’s skin. Vigorously rubbing swab on the skin and then touching this sterilised skin-using index finger to palpate a vein can make the area un-sterile. (http://www.medifix.org/safec/files/reduceinf.pdf)

    Swine flu is likely to bring medical profession down on our knees because the number of children who have died last year common flu epidemic in USA were from a combination of influenza infection and bacterial pneumonia – 64% of these cases were due to the super bug methicillin-resistant Staphylococcus aureus (MRSA). The increase is said to be five folds since 2004. ( http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct0708flumrsa.html)

    We need to be very meticulous and observant before blaming or pointing our fingers at cleaners for spreading infection knowing they are not trained clinicians or nurses. We must watch what we do and not expect miracles cure to end this war with bugs.

    I feel ethically uncomfortable when puncturing a skin of a patient knowing this simple procedure could help entry of Antibiotic resistant bacteria that could kill.

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  • For gods sake. Everyone just calm down!

    Remember avian flu? Remember SARS? Exactly!!!!

    The media should be banned from whipping up frenzies like this!

    Most of the cases are just normal flu, but people are panicking! Just stop it!

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