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Environment, health, & safety – Nurses have the power to protect


You were just informed that in the near future there will be thousands of deaths and hundreds of thousands of hospitalizations, and you hold a key to reducing this loss and suffering. Would you act on this information?
Far from a hypothetical scenario, seasonal influenza—a highly contagious respiratory illness—is a very real threat as we enter another seasonal influenza season.

The nurse’s comprehensive influenza tool kit includes vaccination, proper handwashing, respiratory etiquette, and when necessary, respiratory protection. Using these elements in a coordinated manner can enable nurses to reduce the annual devastation suffered from seasonal influenza.

The nurse

ANA urges all registered nurses (RNs)—especially those involved in direct patient care and particularly those caring for vulnerable patient populations—to receive the seasonal influenza vaccination annually. ANA’s “Seasonal Influenza Vaccination for Registered Nurses” policy supports implementation of aggressive and comprehensive influenza vaccination programs for RNs that aim for 100% vaccination rates. The policy also provides an opt-out with completion of an informed declination form, and encourages healthcare organizations to provide influenza vaccination to RNs and other healthcare personnel with direct patient contact at no charge and at convenient times and locations. Typically, fewer than 50% of healthcare personnel have been vaccinated against seasonal influenza annually—a rate ANA finds unacceptably low. If you do become sick, stay home.

The patient

In 2010, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices expanded the influenza vaccination recommendations to universal vaccination for all persons ages 6 months and older who do not have a contraindication to the vaccine. The recommendations added new risk groups for serious influenza-related complications and included people who were morbidly obese (those with a body mass index greater than 40). Pregnant women should get vaccinated to protect themselves and their newborn infants, and adults who are sick should not go to work. Children who are sick need to stay away from day care and school until their fever has been gone for a full 24 hours without fever-reducing medication.

The vaccines

The 2011-2012 influenza vaccine is composed of the same components as the 2010-2011 vaccine, including A/California/7/2009 (H1N1)-like virus, an A/Perth/16/2009 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus. However, the CDC strongly recommends that the public receive the 2011-2012 vaccine even if they received the 2010-2011 vaccine, because immunity declines between vaccinations. Receiving the 2011-2012 vaccine ensures maximum protection.

This year, a new type of intradermal influenza vaccine is being introduced in the United States for adults ages 18 through 64. Administered with a significantly shorter needle, the vaccine injects antigens into the dermal skin layer. This is the third of three influenza immunizations currently offered, the first two being the traditional intramuscular vaccine and the nasal-spray flu vaccine. ANA reminds nurses to always use a safety needle when administering injectable vaccines.


Handwashing is an important way to stop the spread of disease and illness. Use proper handwashing technique. Wash your hands often with soap and water for 20 seconds. A hand sanitizer containing at least 60% alcohol can be used if soap and water are not available. Remember: Sanitizers do not eliminate all types of germs.

Respiratory hygiene/cough etiquette

Respiratory etiquette is another important measure for preventing the spread of illness. Cover your mouth and nose with a tissue when coughing or sneezing, or cough or sneeze into your upper sleeve or elbow, not your hands. Follow by handwashing if secretions get on the hands. Teach patients about respiratory etiquette, as well.

Be sure you have been fit-tested annually for an N-95 respirator and know how to use it to protect yourself, especially if you are performing a high-risk procedure on a patient with a known case of influenza, or according to your organization’s exposure control plan.

For more on seasonal influenza, go to www.nursingworld.org/influenza and http://www.nursingworld.org/immunize/

Holly Carpenter is a senior staff specialist at ANA. Nancy L. Hughes is the director of the Center for Occupational and Environmental Health at ANA.

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