Thoughts on Pandemic Planning for the OHN

             Charlotte Carneiro RN, BSN, MS, COHN-S, CIC

                    September 30, 2008

A critical role for the occupational health nurse during a novel influenza pandemic will be to help sustain infrastructure and mitigate impact to the economy and the functioning of society. Daily, the OHN attempts to limit the spread of any infectious disease but during a novel influenza pandemic, the OHN role will be of enormous and as yet, untested value. With such a challenge, new guidance or recommendations can jump start the PI plans that are in draft, in a dormant state or not yet conceived.

Pandemic flu planners are met with responses stemming from ridicule, apathy, denial, sincere concern or panic. Emerging guidance may be placed in the virtual or a real trash barrel with a quick flick of the wrist. As seasonal flu approaches, it's an appropriate time to review the Health and Human Services (HHS) Pandemic Flu Plan of 2005.

 Two recent draft documents worthy of OHN attention are found at:  http://aspe.hhs.gov/panflu/antiviral-n-masks.shtml:

1.   Proposed Guidance on Antiviral Drug Use During an Influenza Pandemic
2.   Proposed Consideration for Antiviral Drug Stockpiling by Employers

OSHA is working on Proposed Guidance on Workplace Stockpiling of Respirators and  Facemasks for Pandemic Influenza.  The OSHA Pandemic Website will carry the final guidance when it is released, so check back on the OSHA website frequently:  http://www.osha.gov/Publications/influenza_pandemic.html  

The guidance on antivirals from HHS is pithy and can stimulate discussion between OHNs and management. The ethical and legal ramifications for supply and distribution will sustain us long before and after a flu pandemic has occurred.

Many companies have legal counsel but how common is it outside a health care setting to have an ethicist?  The OHN well educated in ethics can at the least, begin the dialogue on ethical distribution of limited supplies and at most lend expertise in this area.

One flu planning assumption among many will be that personal protective equipment and antivirals will be in limited supply during a pandemic. Therefore, despite careful stockpiling and distribution plans, non-pharmacological interventions (NPI) will be most successful.

These NPI include social distancing and reduction of activities of groups, churches and school closures for a short time in the immediate onset of the pandemic. Telecommuting and alternate work schedules to reduce exposure time among workers will be recommended more than currently being implemented. Supply sites may be designated to obtain antivirals, food and other supplies. Neighborhood block representatives may be used to venture out of a cordoned area to obtain supplies.

Many novel ways will need implementation, and the creativity of all health care professionals will be tapped. The OHN is a master at innovation and adaptation in the workplace.

Another critical nursing intervention during a flu pandemic will be to assist workers to maintain their immune systems with health promotion activities to reduce the threat of a secondary bacterial infection once pandemic or even seasonal flu is acquired. OHN practitioners know this intuitively but can be reinforced now.

Two recent articles by scientists in the US and Australian military and the National Institutes of Health reviewed records and actual lung tissue of autopsies of cases from the 1918 Spanish Influenza Pandemic. Both groups concluded that the deaths were not necessarily from a more virulent strain of flu but that the flu created a pulmonary environment where other bacteria could be pathogenic. Therefore the mitigation efforts begin now during seasonal influenza to carry to the pandemic period. These efforts are to reduce deaths from secondary bacterial pneumonia.

How to accomplish the prevention of pneumonia deaths? Really focus on the campaign efforts of the seasonal flu vaccine. Promote the pneumococcal vaccine for all eligible. Those that are challenged with the seasonal flu vaccine may have some cross immunity to pandemic flu.

The OHN might focus on those clients most resistant to prevention efforts of good nutrition, weight reduction, exercise, seeking prompt primary care when needed, reduction of smoking and personal hygiene. The daily habits of cough etiquette and hand hygiene will do more to reduce the spread of pandemic influenza than any other intervention currently available. Furthermore, hand hygiene has been shown to be sorely practiced among all health care workers and if we know better and fail how can we be role models for our clients?

In summary, OHN's have a key role in preparation for a novel flu pandemic:

1. Be engaged at the table of pandemic flu planning; build relationships and pay a part however small or grand in the process.
2. Help workers be prepared at home and at work using the checklists at http://www.pandemicflu.gov.
3. Promote the seasonal flu and pneumococcal vaccine.

References:

Brundage, John and Shanks, G. Dennis, Deaths from bacterial Pneumonia During 1918-1919 Influenza Pandemic, Emerging Infectious Diseases   cdc.gov/eid  vol. 14, no. 8, August 2008.

Morens, David M, Taubenberger, Jeffrey K. and Fauci, Anthony S,Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness JID 2008:198 (1October)