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CE Article: Stay vigilant: Pandemic influenza is more likely than ever*

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After reading this article, you will be able to:

  • Describe the current threat of pandemic influenza
  • Identify at least two reasons why the country is better prepared for a pandemic than it was three years ago
  • Recall strategies to prepare for pandemic influenza and prevent it from spreading

Three years ago, pandemic influenza was a hot topic. Many facilities were focused on preparing for a potential pandemic. However, interest now appears to be waning, despite the fact that top scientists believe that the risk of pandemic influenza is on the rise.

The virus has spread farther around the globe in birds, putting more people in contact with it and making it more likely that it will mutate and become easily transmittable from person to person.

The challenge is to keep this topic on the minds of staff members and to be sure the hospital remains focused on preparation.

"We certainly understand that people can't be in a constant state of alarm," says Toby Merlin, MD, deputy director of the influenza coordination unit at the Centers for Disease Control and Prevention (CDC) in Atlanta. "At the same time, we need to ward off complacency."

Staff member education is a critical component of preparedness.

"We don't want to scare [staff members], but inform them and keep this fresh in their minds," says Joe Cappiello, CEO of Simulation Education Services in Oakbrook Terrace, IL, and former vice president of field operations for The Joint Commission (formerly JCAHO), who helped develop the accreditor's emergency management standards.

The threat remains real

Although the public may not be as focused on pandemic influenza as they were in 2004-2005, the strain of avian flu H5N1, which sparked initial concerns, remains a threat, Merlin says. "I think there is a general consensus at CDC that the risk of a pandemic, and even the risk of H5N1, has not decreased from 2004-2005. In fact, it may have increased."

The influenza strain is still highly lethal in infected humans, but has so far proved difficult to transmit from person to person. This difficulty, Merlin says, is what has kept the strain from becoming pandemic.

But although the virus may not be spreading from human to human, it has spread farther around the world in birds. The flu is now in Asia, the Near East, parts of Europe, and Africa.

"It has actually become fairly endemic in the bird population in Indonesia, and possibly Bangladesh, India, and Nigeria. So there are areas of the world now where people are constantly exposed to the virus in birds," Merlin says.

This makes it more likely that a person might be infected with bird and human flu viruses simultaneously, which could create a virus that has the characteristics of both. If this occurs, the virus might be transmitted easily from person to person.

Preparations at home

In the United States, officials believe that the country is better prepared for a pandemic than in 2004-2005, Merlin says. "The national antiviral stockpile includes more than 50 million courses," he says. Individual states also have pandemic flu operation plans.

A substantial vaccine stockpile of H5N1 prepandemic vaccines exist, Merlin says. These vaccines are based on the current strain of the virus, although he notes that there is no way for scientists to know what strain of the virus would be circulating during a pandemic.

Another impressive accomplishment during the past three years has been the development of adjuvants that might allow officials to stretch the 23 million courses of the vaccine currently stockpiled to 275 million doses, almost enough for the entire U.S. population, Merlin says.

Community mitigation strategies have also been devised, which experts believe could substantially reduce the infection rate during a pandemic. These mitigation strategies will call on those with influenza symptoms (and their family members) to stay at home. They would also use techniques such as social distancing and infection control methods to reduce the risk of transmission. "We feel that this could substantially reduce the attack rate during a pandemic," Merlin says.

International systems have been bolstered and would be more likely to result in a rapid response than a few years ago, he adds.

How to apply this information

With this information in mind, staff members need to be reminded that the threat of a pandemic has not decreased and be educated about precautions to prevent the spread of the infection within their healthcare facilities.

The U.S. Department of Health and Human Services recommends hospital staff take the following precautions when in contact with an infected patient:

  • Isolate infected persons (i.e., confine patients to a defined area as appropriate for the healthcare setting).
  • Limit contact between nonessential personnel and other persons (e.g., social visitors) and patients who are ill with pandemic influenza.
  • Promote spatial separation in common areas (i.e., sit or stand as far away as possible—at least three feet—from potentially infectious persons) to limit contact between symptomatic and non-symptomatic persons.

Read about other U.S. Department of Health and Human Services infection control recommendations.

Eye protection is another vital precaution for staff to take when working with infected patients. Common forms include:

  • Goggles
  • Face shields
  • Safety glasses
  • Full-face respirators

The CDC recommends staff members use eye protection in conjunction with other personal protective equipment such as gloves, gowns, and masks or respirators. Read more background about eye protection to prevent the spread of infection.

It is critical that staff members are educated about the practical steps they can take to prepare for pandemic influenza at home. "This doesn't mean buying duct tape and plastic sheets to seal yourself in your basement," Cappiello says. "It's making sure you have adequate supplies, water, food, and other essentials that could get you through several weeks. There are a number of government Web sites with excellent family checklists." Access a pandemic flu planning checklist.

Facilities also need to anticipate that the majority of employees, if given the choice between staying home with a sick relative or going to work, will probably say family comes first. Consequently, Cappiello explains, pandemic flu planning is not only about planning for staff members, but for their families as well. Put systems in place to encourage staff members to come to work and to be able to provide medical support for family members.

Focus on pandemic planning

Nurse managers can assist infection control professionals in ensuring that their facility is adequately prepared for a pandemic. Promote the stockpiling of antivirals and prophylaxis for use by caregivers during a pandemic, Merlin says.

"I think hospitals have a moral and ethical responsibility to test and exercise their pandemic flu plans. It's certainly a Joint Commission requirement, and I think it's an ethical requirement," Cappiello says.

Hospitals should consider what they would do if they had hundreds of patients come to their facilities wanting care. "The leap of the H5N1 virus from birds to humans hasn't occurred on a grand scale. When that leap occurs, we're going to have a significant issue, Cappiello says.

The challenge will be ensuring that your facility and staff members are prepared when that leap occurs. "We are much better prepared, but we are far from being fully prepared," Merlin says.


  1. The Centers for Disease Control and Prevention. (2004). "Eye protection for infection control." Available at
  2. (2008.) "Pandemic Flu Planning Checklist for Individuals and Families." Available at
  3. (2008.) "HHS Pandemic Influenza Plan Supplement 4 Infection Control." Available at

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