BE PREPARED

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BE PREPARED!

• Dealing with Suspected Bioterrorism at
  Willow Creek Rehabilitation and Care
  Center

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Willow Creek Rehabilitation and Care Center -
Somerset, NJ
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Willow Creek Rehabilitation and Care Center
(lobby)
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The Time is Now!

• Why Now?
• It can happen at any time.
• If not prepared, the results can be disastrous.
• Ease the mind of clients and families who
  ask...what if?
• Save lives!
• Avoid PANIC!

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Nursing Care Addressing Fear

• It is important to address fears of the
  patients/residents, families, general public and
  staff!
• To help avoid panic.
• Explain risks, offer rapid medical evaluation and
  treatments (nurse as educator).
• Avoid unnecessary isolation (nurse as advocate).
• Provide reassurance (nurse as clinician).

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If Bioterrorism is Suspected

• Administrator notified.
• Meeting with all department heads.
• Brandywine Senior Care notified.
• Contact local and state health departments.
• Local police, FBI field office, CDC.

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Is it Bioterrorism?

• Identifying an Outbreak
• Rapid increase in disease incidence within hours
  or days, not related to admitting diagnosis.
• elevated fever
• respiratory /or GI complaints.
• Epidemic curve that rises and falls during a
  short period of time.

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Most Common Types of Bioterrorist Agents

• Biological (3 highly contagious forms)
• Inhalation Anthrax
• Pneumonic Plague
• Smallpox
• Chemical
• Blister Agents (4)
• Blood Agents (4)
• Choking Agents (3)
• Nerve Agents (4)
• Radioactive Material

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3 Types of Inhalation Agents

• Inhalation Anthrax
• Pneumonic Plague
• Smallpox

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Inhalation Anthrax

• Transmission
• Associated with bioterrorism exposure to
  aerosolized spores.

Bacillus anthracis bacterium that forms spores
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Inhalation Anthrax (contd)

• Initial Symptoms
• Cold or flu-like symptoms (sore throat, mild
  fever 100.0 degrees F, muscle aches)
• Later Symptoms
• Cough, chest discomfort, SOB
• Fatigue
• Symptoms after several days
• There may be progression to severe breathing
  problems
• Shock

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Inhalation Anthrax (contd)

• Treatment
• Antibiotics
• ciprofloxacin,
• doxycycline,
• or PCN
• Course of treatment - 60 days

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PNEUMONIC PLAGUE

• Transmission
• Person to person (w/in 6 feet)
• Breathing in Y. pestis particles released into
  the air by a terrorist.

Yersinia pestis flea (plague)
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PNEUMONIC PLAGUE (contd)

• Symptoms
• Fever, weakness
• Pneumonia with SOB, chest pain
• Cough, and sometimes bloody or watery sputum
• N V
• Abdominal pain

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PNEUMONIC PLAGUE (contd)

• Diagnosis
• EARLY SYMPTOMS CAN BE MISTAKEN FOR THE FLU!
• Only the CDC some state laboratories can
  confirm a suspected diagnosis.

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PNEUMONIC PLAGUE (contd)

• Treatment
• Antibiotics such as tetracycline, doxycycline,
  sulfonamides, and chloramphenicol must be started
  early in the course of the disease.
• People with symptoms who have been in close
  contact (less then 6 1/2 feet from contagious
  person) need antibiotic treatment for 7 days as a
  preventative step.
• When antibiotics are not available, symptoms
  management is a must.

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SMALLPOX

• Transmission
• Spread from person to person by droplet or
  aerosol.

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SMALLPOX (contd)

• Symptoms
• No latent symptoms until exposed after 7-17 days.
• High fever and malaise.
• H/A, backache, and generalized weakness.
• Severe abdominal pain and delirium.

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SMALLPOX (contd)

• Symptoms (contd)
• Rash that appears in the mouth, face and
  forearms. These lesions are tiny pus-filled
  blisters that later spread to trunk and legs.

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SMALLPOX (contd)

• Treatment
• Vaccination within 3 days of exposure will
  completely prevent or significantly modify
  smallpox.
• Antibiotics

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Infection Control Practices for Patient
Management

• Maintain Standard Precautions
• Hand washing
• Gloves
• Mask/eye protection (or face shield, if patient
  care activities may cause splashes of blood, body
  fluid, excretions or secretions.
• Gowns
• Additional precautions might be needed if the
  disease is Inhalation Anthrax, Pneumonic Plague,
  and Smallpox.

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Infection Control Practices for Patient
Management (contd)

• Patient/resident placement
• Cohort patients/residents who present with
  similar syndromes.
• If more room is needed, the gym may be utilized.
• The cohort sight must have controlled entry to
  minimize transmission to the other
  patients/residents and staff members not directly
  involved in managing the outbreak.
• Keep doors to affected unit closed. Dedicate
  same staff to residents/patients!

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Infection Control Practices for Patient
Management (contd)

• Transport
• Patient/resident transport should be done for
  those with any epidemiologically important
  infections that cannot be handled in our facility
  (eg., pulmonary T.B., chickenpox).
• Cleaning disinfectant and sterilization of
  equipment and environment
• Standard precautions are applied to the
  management of patient/resident care, equipment
  and environmental control.

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Infection Control Practices for Patient
Management (contd)

• Routine care, cleaning and disinfection of
  environmental surfaces (beds, bedrails, bedside
  equipment and other frequently touched surfaces
  and equipment) will be done using an approved
  germicidal cleaning agent.
• Approved germicidal cleaning agents will be used
  for cleaning spills of contaminated material and
  disinfecting non-critical equipment.
• Patient linen should be handled in accordance
  with standard precautions!
• Contaminated waste will be discarded in
  accordance with federal, state, and local
  regulations.

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Post-Mortem Care

• Who to Contact
• The funeral Director will be notified regarding a
  bioterrorism occurrence.
• They will use appropriate Personal Protective
  Equipment (PPE).

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Decontamination

• Decision to Decontaminate
• Made in consultation with the state and local
  health department.
• Dependent upon the agent and the likelihood of
  re-aerosalization or cutaneous exposure, to
  remove exposed persons clothing.

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Decontamination (contd)

• Decontamination Process
• Contaminated clothing will be removed and handled
  by people wearing appropriate Personal Protective
  Equipment (PPE) and placed in impervious bags.
  This will be followed by a shower in the Unit 3
  shower room.
• Soap and water will be used on contaminated
  residents/patients.
• Female and male locker room showers will be
  utilized for staff members.

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Transportation of Patients/Residents

• R/T Large-Scale Exposure
• Make use of established network of communications
  with local hospitals
• RWJ
• St. Peters

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Diagnosis

• Laboratory diagnosis will be followed up with
• County
• State
• If a positive test results, the CDC must be
  contacted!

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Visitor and Public Information

• Information will be provided to visitors in the
  form of a brochure, by the lobby door.
• Visiting will be strictly limited.
• If you are sick or think you might be, do not
  visit.
• Do not visit if you have a weakened immune
  system.
• The Administrator will communicate with state and
  local agencies to decide how public information
  will be handled.

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In Closing

• Please Remember
• IF YOU FAIL to PREPARE, YOU PREPARE to FAIL!
• so
• BE PREPARED!

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THANK YOU!

• We wish to thank the staff at
• Willow Creek Rehabilitation and
• Care Center
• for their support and cooperation in allowing us
  to present our research.

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With Special Thanks to

• Allyson Brown Administrator
• Patricia Brown Director of Nursing
• Annette Elbaum Asst. Dir. of Nursing

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• This has been an RVCC Service Learning Project
• Nursing Student Contributors
• Gigi Limosnero
• Imnas Bathan
• Linda Nwokonko
• Mark Elbaum
• Nadine Mulvaney