H1N1 Influenza Pandemic Frequently Asked Questions
Vaccination
Protecting Nurses and Other Health Care Workers
Employer Policies and Obligations
Reporting to Work During a Pandemic
High-Risk Groups / Preventing Spread of H1N1 Influenza
Vaccination
Q. Does ANA promote getting the seasonal influenza and H1N1 vaccines?
ANA considers vaccines a critical public health measure to decrease the burden of vaccine-preventable disease on individuals and the community. Vaccines not only protect the individual, but enable herd immunity -- the resistance of a group to attack by a disease to which a large proportion of the members are immune. Vaccines also help protect those that cannot be vaccinated or whose immune systems are suppressed, such as infants and cancer patients.
Q. Does ANA advocate that nurses get the seasonal influenza and H1N1 vaccines?
Yes. Nurses have an obligation to protect themselves, and their patients. Vaccination is an important way of doing that. ANA strongly urges all nurses to get a seasonal influenza vaccine every influenza season. It is also crucial that nurses be vaccinated this season against H1N1 to limit illness and death in our patients, co-workers and family members.
Q. What is ANA’s position on mandatory seasonal influenza vaccine policies?
ANA opposes mandatory seasonal influenza vaccine policies.
Q. Does ANA support mandatory vaccination policies for H1N1?
ANA acknowledges that the public health threat posed by the novel H1N1 virus will spur employers to enact mandatory H1N1 vaccination policies for health care workers. ANA does not support such policies unless they adhere to certain guidelines to ensure they are fair, equitable, and not enforced as a condition of employment. Such policies only should be implemented if they:
- Come from the highest level of legal authority, ideally state government
- Include suitable exemptions, such as for those allergic to components of the vaccine
- Prohibit discriminating against or disciplining nurses who choose not to participate
- Comprise part of a comprehensive infection control program that includes personal protective equipment
- Provide vaccinations for free and at convenient times and locations to foster compliance
- Ensure that the employer negotiates with worker union representatives to resolve any differences when the policy is implemented at a health care facility
Q. Has the federal government imposed a mandatory H1N1 vaccination campaign?
No, the federal government’s program is voluntary. Some hospitals and state and local governments are requiring, or considering requiring, health care workers to be vaccinated, but those are jurisdictional decisions.
Protecting Nurses and Other Health Care Workers
Q. What does ANA advocate as the minimum level of respiratory protection for nurses and other health care workers who could be exposed to the H1N1 virus on the job?
ANA advocates for properly fitted N95 (or its equivalent) particulate-filtering face-piece respirators, certified by the National Institute of Occupational Safety & Health, as the minimum level of protection required for all nurses and healthcare workers caring for patients with suspected or confirmed cases of pandemic flu.
Q. What’s the difference between a facemask and an N95 respirator?
A facemask is a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. A facemask does not filter or block very small particles in the air that may be transmitted by coughs or sneezes.
An N95 respirator is a device that is fitted specifically to an individual’s face with no gaps, and designed to filtrate airborne particles. In addition to blocking splashes, sprays and large droplets, the N95 respirator helps prevent the wearer from breathing in small particles.
Q. What should hospitals do if they don’t have a sufficient supply of N95 respirators for nurses and other direct health care workers?
The U.S. Centers for Disease Control and Prevention (CDC) recognizes that some facilities are currently experiencing shortages of respiratory protection equipment, and further shortages are anticipated. A key strategy is to use “source control” -- engineering and administrative measures to limit the number of workers coming in contact with patients who have influenza-like illness to reduce consumption of respiratory protection equipment. Facilities that have made reasonable efforts to obtain a sufficient supply, but still have a shortage of N95 respirators, can consider implementing a “prioritized respirator use” mode.
Q. What is “prioritized respirator use” mode?
“Prioritized respirator use” mode is intended to ensure that healthcare personnel at most risk from H1N1 influenza exposure always have a fitted N95 respirator for use during aerosol generated procedures, such as bronchoscopy, sputum induction, endotracheal intubation and extubation, open suctioning of airways, cardiopulmonary resuscitation and autopsies.
Q. Are more N95 respirators available from the Strategic National Stockpile?
There is a cache of respirators and other supplies that the U.S. Centers for Disease Control and Prevention (CDC) has placed in what is known as the Strategic National Stockpile (SNS). The SNS is released upon certain situations for use. There had been N95 respirators released from this source, but they are released to the states for distribution within the state and not directly to healthcare facilities. Hospitals should not be depending on them to supplement their own stockpile or supplies.
Q. Are surgical facemasks sufficient to protect health care workers against the H1N1 virus?
No. The U.S. Centers for Disease Control and Prevention (CDC) recommends the N95 respirator as the minimum level of respiratory protection.
Employer Policies and Obligations
Q. What policies should employers follow to ensure they are providing adequate protection to health care workers?
Employers should follow Occupational Safety and Health Administration standards and/or guidance from the U.S. Centers for Disease Control and Prevention (CDC) for personal protective equipment use in a pandemic to protect nurses and other health care workers.
Q. What should hospitals do to prevent health care workers’ exposure to the H1N1 virus as much as possible?
Hospitals should implement a “hierarchy of control,” or “source control” policy to prevent exposure to the H1N1 virus as much as possible and prevent its spread. This “hierarchy” is designed to eliminate or reduce exposure to the H1N1 virus from numerous possible sources through workplace policies and procedures, physical and spatial arrangements, and finally, the use of personal protective equipment.
Reporting to Work During a Pandemic
Q. Should nurses be required to report to work under any conditions during the H1N1 pandemic?
Under the Code of Ethics for Nurses, a registered nurse has a primary commitment to the patient, and must balance that commitment with caring for oneself and contributing to a work environment that ultimately facilitates the best health care. If ordered to work, a nurse must consider whether his or her own ill health or fatigue may interfere with providing optimal care for the patients or will ultimately render the nurse unable to care for others for a longer period of time.
However, professional autonomy, as well as the right and obligation to help create the best work environment, can be constrained by employer rights and prerogatives. A nurse who wants to avoid reporting to work – even for the best of reasons—must be aware of the possible consequences of failing to do so. The employer’s policies and procedures may effectively limit the ability of a nurse to make the decision about working, and the law or applicable labor or employment agreement may not give the nurse the latitude that is desired. If a nurse does have to report to work against his or her better judgment, an objection to unsafe conditions can and should be noted to the appropriate persons or department.
Q. Should nurses report to work if they have the H1N1 or seasonal influenza?
Nurses should stay home from work if they are ill to protect others. Employers must have non-punitive sick leave policies to prevent workers from an obligation to come to work even if they are sick.
High-Risk Groups / Preventing Spread of H1N1 Influenza
Q. What are the high-risk groups for H1N1 influenza?
Those most at risk for H1N1 influenza are comparable to those high-risk groups for seasonal influenza, including people with chronic respiratory conditions such as asthma and Chronic Obstructive Pulmonary Disease (COPD).
Pregnant women are at high-risk for influenza, including H1N1 flu. Pregnancy places physiologic strain on the respiratory and immune systems.
Young children and young adults have the highest rates of infection and hospitalization from H1N1 influenza. This epidemiological finding was established early on in the outbreak, and has been holding true.
Q. Why is H1N1 more of a threat than seasonal influenza?
H1N1 is a novel strain of influenza. That means no one has immunity to it; everyone is susceptible. It is very infectious – it spreads easily.
Q. What are some things people can do to avoid contracting and prevent the spread of H1N1 influenza?
- Get the vaccine
- Cover your nose and mouth when you cough or sneeze
- Wash your hands often with soap and water or an alcohol-based hand sanitizer
- Avoid touching your eyes, nose and mouth with your hands
- Avoid close contact with people who have influenza symptoms
- Stay home if you are sick with a flu-like illness for at least 24 hours after your fever is gone
- Follow recommendations from local and state public health agencies