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December
2006: VOLUME
1, NUMBER 3
Prevention
and Control of Influenza in the Healthcare Setting
Because you asked...
We are now accredited for Pharmacists
by The University of Tennessee
College of Pharmacy.
For more information see the
new Pharmacy section of our Credit
Designation section.
In this issue...
The
threat of pandemic influenza and potentially virulent strains of avian
origin is forcing infection control and public health professionals
to review currently recommended strategies to prevent transmission of
influenza virus in healthcare settings. This focus is particularly important
in settings that serve patients at increased risk of influenza complications,
i.e. where medical care requires close contact or the use of procedures
that facilitate transmission of the virus, and where individuals may
not recognize they are infected and thus contribute to viral transmission
among patients, visitors, and healthcare workers. Interestingly, little
new data have emerged about influenza transmission in healthcare settings
or the efficacy of commonly used strategies. However, a body of evidence
from the SARS epidemic can provide us with clues about these potential
risks.
In this issue, to guide practitioners
in developing strategies for those who are at the highest risk of exposure,
transmission, and complications, we focus on the efficacy of vaccination,
types of vaccination, and the use of personal protective equipment (PPE). |
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GUEST
EDITORS OF THE MONTH |
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Commentary
& Reviews:
Trish
M. Perl, MD, MSc
Associate Professor
of Medicine, Pathology, and Epidemiology
Hospital Epidermiologist
Johns Hopkins University
School of Medicine
Baltimore, MD |
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Guest
Faculty Disclosure
Trish
M. Perl, MD, MSc, No relationship with commercial supporters.
Katie
Passaretti, MD, No relationship with commercial supporters.
Unlabelled /Unapproved Uses
The authors have indicated that there will be no reference
to unlabeled/ unapproved uses of drugs or products in this presentation. |
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Reviews:
Katie
Passaretti, MD
Fellow Infectious
Diseases
Johns Hopkins University
School of Medicine
Baltimore, MD |
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LEARNING
OBJECTIVES |
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The
Johns Hopkins University School of Medicine and The Institute for
Johns Hopkins Nursing take responsibility for the content, quality,
and the scientific integrity of this CE activity.
At the conclusion of this activity, participants should be
able to: |
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Describe
evidence-based procedures healthcare workers can use to prevent
transmission of influenza; |
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Identify
potential strategies to prioritize influenza vaccine among patients
and healthcare workers; |
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Explain
how the influenza virus is transmitted and various situational factors
that can impact transmission. |
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COMPLETE
THE POST TEST
Step 1.
Click on the appropriate link
below. This will take you to the post-test.
Step 2.
If you have participated in a
Johns Hopkins on-line course, login. Otherwise, please register.
Step 3.
Complete the post-test and course
evaluation.
Step 4.
Print out your certificate.
Pharmacy credit is only available via PDF mail-in form:
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COMMENTARY |
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Four
key issues are relevant to influenza prevention and control efforts
in healthcare settings. The first is the question of how the virus
is transmitted. Experts agree that influenza virus is transmitted through
large droplets which are generally transmitted 3 to 6 feet. In addition,
influenza virus is known to survive on hard and porous surfaces for
hours, a fact that supports the role of the environment and direct
contact as a source of infection among humans. More recently, however,
investigators have been reviewing epidemiologic and experimental data
that support virus transmission via small particles and the airborne
route. Tellier’s 2006 report for the CDC, reviewed herein, provides
important new data that can impact decisions for the types of protection
proposed.
The second issue involves preventing
transmission of the virus, and is especially important in the context
of a virulent virus where vaccine and/or anti-influenza drugs may not
be available. While we all agree that influenza vaccination is one of
the primary mechanisms of prevention, we must be prepared not to have
vaccine for 4 to 6 months and when available to have it in limited quantities.
The 2005 JAMA article by Cosgrove et al provides guidance for practitioners
on how to most effectively distribute a limited vaccine supply so that
those who are likely to respond to it and those who are at greatest
risk of complications from influenza infection receive it, as well as
prioritizing those who will not respond to receiving antiviral agents.
Adding further to our understanding is a 2006 report from the BMJ by
Hayward et al on a controlled clinical trial evaluating how vaccination
of healthcare workers affects patient mortality, the rate of influenza-like
illness, and the use of healthcare resources.
The third issue, also focused
on preventing transmission, relates to respiratory protection. Practitioners
need to understand the most current data regarding respirators, so that
should (or when) a pandemic influenza event occurs, they can best protect
healthcare workers who will be key in the diagnosis, care, and management
of influenza cases. It is this understanding that will promote the best
use of limited resources and the adoption of public health recommendations.
Balazy’s 2006 series of experiments, using manikins to evaluate the
efficacy of two different types of N95 masks and two different types
of surgical masks in preventing penetration of aerosolized MS2 virus,
provides some surprising (and concerning) results.
Finally, there is the difficult
issue of healthcare worker compliance with prevention and control recommendations.
Moore provides an extensive review of the literature that looks at the
organizational and personal characteristics that promote compliance
with precautions. Although much of the data is drawn from the SARS epidemics,
its relevance to influenza is obvious.
Preparation for seasonal and
pandemic influenza requires an understanding of the disease and its
epidemiology, as well as an ability to implement key prevention and
control strategies. The role of hand hygiene within the home and healthcare
setting cannot be overemphasized in prevention of any respiratory disease.
Strategies to prevent transmission such as respiratory etiquette programs
will be critical in our prevention efforts. The data presented herein
will provide key background to allow practitioners to go beyond the
traditional prevention strategies to minimize transmission and provide
optimum patient care. |
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AEROSOL
TRANSMISSION OF INFLUENZA A VIRUS |
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Tellier,
R. Review of Aerosol Transmission of Influenza A Virus.
Emerging Infect Dis. 2006 Nov;12(11).
(For non-journal subscribers, an additional fee may apply
for full text articles.) |
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Traditionally,
large droplet transmission has been thought to be the primary mode
of spreading influenza A. Increasingly, however, contact with aerosols
and contaminated secretions and fomites are being recognized as significant
modes of influenza transmission. Tellier reviews the available evidence,
through both experimental influenza infection and epidemiologic studies,
that support the hypothesis that aerosol transmission of influenza
may play a significant role in the spread of the virus. In addition,
the author highlights the implications that aerosol transmission
of influenza has with regards to infection control, and specifically
discusses the type of personal protective equipment that should be
used by healthcare workers caring for patients with influenza, especially
in a pandemic setting.
An aerosol can be
defined as a suspension of solid and/or liquid particles in gas,
typically <5µm, that remains airborne for a prolonged period
of time. Coughing, sneezing, and even laughing generates a large
number of pathogen-containing aerosols that have the potential to
cause infection in a human host. Some of the strongest laboratory
evidence linking the role of aerosols to transmission of influenza
infection results from an elegant series of studies performed by
Alford et al in the 1960s[1]. Alford exposed a group of
human volunteers to carefully titrated aerosolized influenza virus
suspensions and then monitored the study subjects for either serologic
conversion or recovery of virus from throat swabs taken daily. The
investigators were able to show that not only did subjects exposed
to aerosolized influenza particles develop clinical signs of infection,
but that the 50% human infectious dose for the aerosolized influenza
was significantly less than that observed when subjects were inoculated
with intranasal drops (a proxy for large droplet transmission).
Additional epidemiologic
observations support the hypothesis that aerosols are a source of
transmission for influenza A. Moser et al reported on an influenza
outbreak among 54 people who were aboard a commercial airliner with
a nonfunctional ventilation system[2]. 72% of the passengers
developed clinical signs/symptoms and/or serologic evidence of influenza
infection within 3 days of the implicated flight. Additionally, at
the Livermore Veterans Administration Hospital during the 1957-58
influenza pandemic[3], the seroconversion rate for influenza
A was 19% for patients on a typical ward, as compared to only 2%
on a ward with ceiling-mounted UV lighting (a technology that would
kill viruses that are airborne). Staffing, illness, and all other
factors were similar between the two wards. Interestingly, UV irradiation
is very effective at killing viruses in aerosols but ineffective
at surface decontamination or for large droplets. Both the Livermore
and the airplane outbreaks strongly suggest aerosolization of influenza
A virus leads to transmission among humans.
Tellier, after reviewing
the available evidence for aerosol transmission of influenza, suggests
that the use of surgical masks to protect healthcare workers caring
for patients with influenza, particularly in a pandemic setting where
a vaccine and prior immunity may not play a role in attenuating the
disease, may not be sufficient. N95 or other respirators are more
effective at preventing transmission from aerosolized viruses and
as such, could be potentially lifesaving in the event of an influenza
pandemic.
Although the debate
continues with regards to the nature of transmission of influenza
from person to person, Tellier’s review provides considerable experimental
and epidemiologic evidence that aerosols likely play a significant
role in the transmission of the influenza A virus. Given this evidence
and the risk of transmission in healthcare settings, personal protective
gear that includes highly filtered respirators (N95 or PAPRs) should
be used by healthcare workers when caring for patients with highly
virulent strains of influenza or where vaccine is delayed or not
available. While not specifically discussed, gowns and gloves decrease
the risk of contamination from environmental sources and should remain
central components of infection control efforts to prevent influenza.
References
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METHODS
OF MAXIMIZING A LIMITED INFLUENZA VACCINE SUPPLY |
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Cosgrove,
SE, Fishman, NO, Talbot, TR, et al. Strategies for use of
a limited influenza vaccine supply. JAMA. 2005;293(2):229-232.
(For non-journal subscribers, an additional fee may apply for
full text articles.) |
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Vaccination
continues to be the primary prevention method for influenza, a virus
that infects 10-20% of the U.S. population yearly. The severe shortage
of influenza vaccine during the winter of 2004-2005 and the ever-present
threat of H5N1 or pandemic influenza has brought the issue of vaccine
supply and its distribution to the forefront of the medical, public
health, legal, and ethical arenas. Cosgrove et al recognized the immediacy
of these issues, and reviewed the existing literature on influenza,
influenza vaccine, and response to vaccine, in order to determine the
most effective approaches for maximizing the distribution of the vaccine
supply that is available.
The authors propose a tiered
approach to vaccine distribution that includes those individuals that
are exposed to infected patients (healthcare workers), those who commonly
transmit infection to patients who are at high risk of influenza complications
(healthcare workers and caregivers), and those that are at risk of complications
but likely to respond to vaccine (patients with some ability to develop
immunity). The authors’ primary recommendations include: 1) the appropriate
use of available influenza vaccine, including strategies to prolong
the supply of injectable vaccine and effectively include intranasal
live attenuated influenza vaccine (LAIV) into distribution plans, and
2) proposals about the use of non-vaccine methods to prevent influenza
among persons who may not or can not respond to vaccine.
The importance of preferentially
vaccinating those persons at extremes of age, those who are residents
of long-term care facilities, or those with chronic medical conditions
that place them at highest risk of the complications of influenza, seems
obvious. It is important to note, however that due to impaired immunity,
these individuals may not respond as efficiently as other members of
the population to vaccination. A number of studies[1,2] have
shown that patients who have recently received a bone marrow or solid
organ transplant, or who have HIV with a CD4 count of less than 100,
have markedly diminished immune responses to vaccination. In these circumstances,
vaccination of the health care worker and patient contacts (children,
family members) is required to more fully protect the patient.
Cosgrove et al also address the
controversy over the appropriate use of LAIV. Given the lack of documented
cases (in adults) of symptomatic transmission of the vaccine virus and
the reduced rate of viral shedding, the authors propose that the use
of LAIV could be extended to otherwise healthy individuals aged 50-65
(the vaccine is not currently FDA-labeled for persons over age 49),
those with stable chronic illnesses (i.e. hypertension, well-controlled
diabetes), and healthcare personnel who work with immunosuppressed patients
(with the exception of those that mainly care for the most highly immunosuppressed
groups such as neonates or patients with bone marrow transplants or
acute leukemia). Infection control measures such as hand hygiene, use
of droplet precautions (including wearing a surgical mask, gown and
gloves when working within 3 feet of a patient with known or suspected
influenza), and furlough of febrile employees remain crucial to the
prevention of influenza transmission.
Summarizing Cosgrove’s findings: despite the fact that the influenza
vaccine is an indispensable health resource, the structure and organization
of the current vaccine manufacturing system has led to recent distribution
delays and vaccine shortages. In this setting of a limited vaccine supply,
the expanded use of LAIV would allow increased vaccination of important
groups who would otherwise go unvaccinated and are potential sources
of significant nosocomial transmission. Among these groups, healthcare
workers should be vaccinated[3], and are generally good candidates
for LAIV. Those patients at highest risk of morbidity and mortality
from influenza who cannot take LAIV should preferentially receive the
injectable vaccine.
References
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BARRIERS
TO HEALTHCARE WORKERS' ADHERENCE TO INFECTION CONTROL GUIDELINES |
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Moore,
D, Gamage, B, et al. Protecting healthcare workers from
SARS and other respiratory pathogens: Organizational and individual
factors that affect adherence to infection control guidelines.
AJIC. 2005;33(2): 88-96.
(For non-journal subscribers, an additional fee may apply for
full text articles.) |
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The
well-documented 2002-2003 nosocomial outbreaks of SARS in Canada, China,
Hong Kong, Vietnam, and Singapore served as a wakeup call with regards
to infection control practices among healthcare professionals throughout
the world. The willingness and/or ability of healthcare workers to adhere
to infection control practices, protocols, and guidelines varies widely
from institution to institution and individual to individual. Behavioral
scientists suggest that all individuals must have the knowledge, understanding,
and the appropriate attitudes to comply with institutional (or national/federal)
recommendations, and that effective behaviors need to be facilitated
by providing supplies, engineering solutions, and reinforcing good practices.
Moore et al reviewed 168 publications over the past 15 years to determine
organizational and individual factors, beyond masks and standard procedures,
which protect health care workers from acquiring or transmitting respiratory
infectious diseases such as SARS or influenza while at work.
The authors identified a number
of organizational factors that contribute in varying degrees to healthcare
worker compliance with infection control practices. Perhaps most importantly,
they found that a favorable institutional safety climate (i.e. worker
perceptions about the importance of safety in their institution and
the institution’s level of commitment to safety) correlated with knowledge
of and compliance with standard precautions, and resulted in a decrease
in blood and bodily fluid exposures[1,2]. Moore’s review
summarizes several available studies that show how feedback to workers
about how their adherence to precautions improves compliance with infection
control practices and procedures[3], and reinforces the importance
of effective communication, training, and feedback in improving adherence
to infection control policies. However (and unfortunately), the authors
also found the long-term effectiveness of educational and feedback programs
to be limited.
Additionally, factors attributed
to the individual healthcare worker were reviewed. Increased knowledge
(acquired both through training programs and through personal experience)
and lower risk-taking tendencies were found to be associated with improved
compliance. Not surprisingly, perceived barriers (i.e. interference
with performing tasks, decreased ability to communicate while wearing
masks, feeling overworked, lack of supplies, and lack of time with patients)
decrease healthcare worker compliance with infection control practices[4].
In summary, Moore’s extensive review of the available literature provides
important insight into the barriers to healthcare worker compliance
with infection control policies and practices. While the availability
of personal protective equipment and standardized procedures are important
components of an infection control prevention and control program, organizations
that have the best compliance have well-managed training, feedback of
compliance data, and an organizational-wide climate that promotes safety.
The authors also point out the relative paucity of data in this area,
especially with regards to respiratory pathogens, and the need for future
research.
References
| 1. |
Gershon
RR, Karkashian CED, Grosch JW, Murphy LR et al. Hospital
safety climate and its relationship with safe work practices and
workplace exposure incidents. Am J Infect Control. 2000;28:211-21. |
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| 2. |
Gershon
RR, Vlahov D, Felknor SA, Vesley D, et al. Compliance
with universal precautions among health care workers at three regional
hospitals. Am J Infect Control. 1995;23:225-36. |
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| 3. |
Moongtui
W, Gauthier DK, Turner JG. Using
peer feedback to improve handwashing and glove usage among Thai
healthcare workers. Am J Infect control. 2000;28:365-9. |
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| 4. |
DeJoy
DM, Searcy CA, Murphy LR, Gershon RR. Behavioral-diagnostic
analysis of compliance with universal precautions among nurses.
J Occup Health Psychol 2000;5:127-41. |
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VACCINATION
OF HEALTHCARE WORKERS |
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Hayward,
AC, Harling, R, et al. Effectiveness of an influenza vaccine
programme for care home staff to prevent death, morbidity and health
service use among residents: cluster randomized controlled trial.
BMJ. 2006; 333: 1241. Epub 2006 Dec 1.
(For non-journal subscribers, an additional fee may apply for
full text articles.) |
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Nosocomial
transmission of influenza was described in the 1970s and is increasingly
acknowledged as a cause of substantial morbidity and mortality. A number
of studies over the past several years have documented the importance
of vaccinating healthcare workers and have shown that this practice
decreases not only mortality among patients but also worker absenteeism
and illness[1,2]. The findings of the available studies,
however, have been limited by small sample
sizes[3]. Most recently, Hayward et al performed a large,
cluster randomized, controlled clinical trial evaluating whether vaccination
of healthcare workers affects patient outcomes, including mortality
and the rate of influenza-like illness, as well as the use of healthcare
resources.
During the winters of 2003-2004
and 2004-2005, the investigators randomized 44 long-term care facilities
(involving 1703 staff members and 2604 residents) to either an intervention
arm where healthcare workers were offered and encouraged to take the
influenza vaccine or a control arm where healthcare workers were not
offered the vaccine. Control and intervention arms were matched for
size of facility, percentage of high-dependency residents, and baseline
mortality of residents. In both the control and intervention arms, home
residents were routinely offered vaccination.
Influenza vaccine coverage in
full-time staff was 48.2% in 2003-4 and 43.2% in 2004-5 among personnel
at intervention hospitals, versus 5.9% in 2003-4 and 3.5% in 2004-5
in the control hospital personnel. In 2003-4, intervention hospitals
had significantly lower all cause mortality (11.2 deaths per 100 residents)
as compared to control homes (15.3 deaths per 100 residents, weighted
rate difference per 100 residents per period -5.0, 95% confidence interval
-7.0 to -2.0, p=0.002). Similarly, residents in the intervention care
homes as compared to control facilities had significantly decreased
rates of influenza-like illness as well as general practitioner consultations
and admissions to a hospital for influenza-like illnesses. Using these
statistics, the authors predict that in order to prevent one care home
resident death, 8 staff members would need to be vaccinated, and to
prevent one case of influenza-like illness, 5 staff members would need
to be vaccinated. No significant differences in influenza-like illness
death rates were noted between the two groups in any other time period.
Interestingly, in periods with no influenza activity and in 2004-5 (a
year in which national influenza infection rates were considerably lower
than average and approximately half of the rate seen in 2003-4), no
significant differences were seen between the intervention and control
arms in any of the outcomes of interest.
According to the NHIS, in 2003
only 40% (approximately) of healthcare workers in the United States
received an influenza vaccine[4], despite longstanding recommendations
for routine vaccination in this group by health authorities in many
countries. Hayward’s recently published data reinforces findings from
two previously published studies[1,2], showing that vaccination
of healthcare workers not only improves outcomes for the workers themselves,
but can also significantly reduce rates of all cause mortality and the
use of influenza-related healthcare resources in the patients. In addition,
the increasing benefit of healthcare worker vaccination seen in the
year with higher rates of influenza suggests that in the event of pandemic
influenza, vaccination of health care workers will be even more essential.
Sources for Additional Information
The 2006 CDC's HICPAC evidenced-based
recommendations for influenza prevention in healthcare settings can
be accessed at: www.cdc.gov/MMWR/preview/mmwrhtml/rr5502a1.htm
References
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EFFECTIVENESS
OF N95 AND SURGICAL MASKS IN PREVENTING PENETRATION OF VIRAL
PARTICLES |
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Balazy
A, Toivola M, Adhikari A, Sivasubramani SK, Roponen T, and Grinshpun
SA. Do N95 respirators provide 95% protection level against
airborne viruses, and how adequate are surgical masks? Am
J Infect Control. 2006;34:51-7.
(For non-journal subscribers, an additional fee may apply for
full text articles.) |
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While
appropriate cough etiquette, good hand hygiene and use of personal protective
equipment consisting of gowns, gloves and masks are essential components
of influenza prevention efforts, the appropriate type of mask to use,
especially in a setting of pandemic influenza, remains controversial.
Currently a number of institutions recommend use of a surgical mask
for seasonal influenza. Balazy et al. performed an elegant series of
experiments using manikins to evaluate the efficacy of two different
types of N95 masks (one with a high fit-factor value and one with a
lower fit-factor value) and two different types of surgical masks in
preventing penetration of aerosolized MS2 virus (virus particles ranging
in size from 10 to 600 nm). Of note, fit factor value is defined by
OSHA as a quantitative estimate of the fit of a particular respirator
to a specific individual, and typically estimates the ratio of the concentration
of a substance in ambient air to its concentration inside the respirator
when worn. Balazy’s study used manikins with the mask of interest sealed
to the manikin’s face by silicon sealant to prevent any leaks around
the mask that could affect the outcome; they then evaluated the penetration
of virus particles through the N95 mask at both low and high flow rates.
Viruses are some of the smallest
known agents, often ranging in size from 20 to 300 nm. Typically, N95
masks are certified if the penetration of an aerosol of 300 nm-sized
sodium chloride particles is less than 5%. The investigators found that
the higher fit-factor value N95 respirator met industry standards of
less than 5% penetration even when challenged with the smaller MS2 viral
particles. However, the lower fit-factor value N95 mask did not; at
a high inhalation flow rate, the mean penetration of MS2 was 5.6%. In
comparison to the N95 masks, the surgical masks, as could be expected,
showed significantly increased penetration, with values as high as 20.5%
for one mask type and 84.5% for the other. Interestingly. both surgical
masks were manufactured by the same company, yet demonstrated very different
rates of particle penetration.
This study has several implications
for infection prevention and control to limit transmission of influenza.
Firstly, the authors demonstrated that some but not all N95 masks available
in the healthcare setting meet the industry standard of providing 95%
protection. In other words, not all respirators met standards when challenged
with the smaller sized viral particles. Secondly, and perhaps more significantly,
surgical masks provide much less protection against aerosolized viral
particles. Given the increasing data that aerosols may be a significant
mode of transmission for influenza, this observation is particularly
relevant to healthcare settings where it is likely patients who are
symptomatic and more infectious will receive care. Additionally, procedures
such as intubation, nebulization of medication (and other aerosol generating
procedures) occur with increasing frequency in healthcare settings;
healthcare workers protected only by surgical masks are likely to be
more vulnerable to unintended/unwanted inhalation. |
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CME/CNE/CPE
INFORMATION |
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| Accreditation
Statement · back
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This
activity has been planned and implemented in accordance with the
Essential Areas and Policies of the Accreditation Council for Continuing
Medical Education through the joint sponsorship of the Johns Hopkins
University School of Medicine and The Institute for Johns Hopkins
Nursing. The Johns Hopkins University School of Medicine is accredited
by the ACCME to provide continuing medial educaiton for physicians.
The Institute for
Johns Hopkins Nursing is accredited as a provider of continuing nursing
education by the American Nursing Credentialing Center's Commission
on Accreditation. |
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| Credit
Designations · back
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Physicians
The Johns Hopkins
University School of Medicine designates this educational activity
for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.
Physicians should only claim credit commensurate with the extent
of their participation in the activity.
Nurses
This 1.2 contact
hour Educational Activity (Provider Directed/Learner Directed) is
provided by The Institute for Johns Hopkins Nursing. Each Newsletter
carries a maximum of 1.2 contact hours or a total of 7.2 contact
hours for the six newsletters in this program.
Pharmacists
 This
program is approved for one hour credit (1.0 CEUs) and is co-sponsored
by the University of Tennessee College of Pharmacy who is approved
by the Accreditation Council for Pharmacy Education as a provider
of continuing pharmacy education. A statement of CE credit will be
mailed within 4 weeks of successful completion and evaluation of
the program. ACPE Program #064-999-06-272-H01.
Grievance Policy: A participant, sponsor, faculty
member or other individual wanting to file a grievance with respect
to any aspect of a program sponsored or co-sponsored by the UTCOP
may contact the Associate Dean for Continuing Education in writing.
The grievance will be reviewed and a response will be returned within
45 days of receiving the written statement. If not satisfied, an
appeal to the Dean of the College of Pharmacy can be made for a second
level of review. |
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| Post-Test
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| To
take the post-test for eInfluenza Review you will need to visit The
Johns Hopkins University School of Medicine's CME website or The
Institute for Johns Hopkins Nursing. If you have already registered
for another Hopkins CME program at these sites, simply enter the
requested information when prompted. Otherwise, complete the registration
form to begin the testing process. A passing grade of 70% or higher
on the post test/evaluation is required to receive CME/CNE/CPE credit. |
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| Statement
of Responsibility · back
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| The
Johns Hopkins University School of Medicine and The Institute for
Johns Hopkins Nursing take responsibility for the content, quality,
and scientific integrity of this CME/CNE/CPE activity. |
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| Target
Audience · back
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| This
activity has been developed for the Primary Care Physician, Internist,
Infectious Disease Specialists and Nurse. There are no fees or prerequisites
for this activity. |
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| Learning
Objectives · back
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The
Johns Hopkins University School of Medicine and The Institute
for Johns Hopkins Nursing take responsibility for the content,
quality, and the scientific integrity of this CE activity.
At the
conclusion of this activity, participants should be able to: |
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Describe
evidence-based procedures healthcare workers can use to prevent
transmission of influenza; |
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Identify
potential strategies to prioritize influenza vaccine among patients
and healthcare workers; |
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Explain
how the influenza virus is transmitted and various situational
factors that can impact transmission. |
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| Internet
CME/CNE/CPE Policy · back
to top |
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The
Offices of Continuing Education (CE) at The Johns Hopkins University
School of Medicine and The Institute for Johns Hopkins Nursing are
committed to protect the privacy of its members and customers. The
Johns Hopkins University maintains its Internet site as an information
resource and service for physicians, other health professionals
and the public.
The Johns Hopkins
University School of Medicine and The Institute for Johns Hopkins
Nursing will keep your personal and credit information confidential
when you participate in a CE Internet based program. Your information
will never be given to anyone outside The Johns Hopkins University
program. CE collects only the information necessary to provide you
with the service you request. |
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| Faculty
Disclosure · back
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It
is the policy of The Johns Hopkins University School of Medicine
and The Institute for Johns Hopkins Nursing that the faculty and
provider disclose real or apparent conflicts of interest relating
to the topics of this educational activity, and also disclose discussions
of unlabeled/unapproved uses of drugs or devices during their presentation(s).
Johns Hopkins School of Medicine OCME and The Institute for Johns
Hopkins Nursing has established policies in place that will identify
and resolve all conflicts of interest prior to this educational
activity. Detailed disclosures will be made in the course handout
materials.
The presenting faculty
reported the following:
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John
G. Bartlett, MD, has disclosed that he has served on the HIV
Advisory Board for Glaxo Smith Kline, Abbott and Bristol-Myers
Squibb. |
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Jason
E. Farley, PhD(c), MPH, NP has disclosed that he has no relationship
with commercial supporters. |
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Statement · back
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opinions and recommendations expressed by faculty and other experts
whose input is included in this program are their own. This enduring
material is produced for educational purposes only. Use of Johns
Hopkins University School of Medicine name implies review of educational
format design and approach. Please review the complete prescribing
information of specific drugs or combination of drugs, including
indications, contraindications, warnings and adverse effects before
administering pharmacologic therapy to patients. |
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COMPLETE
THE POST TEST
Step 1.
Click on the appropriate link below. This
will take you to the post-test.
Step 2.
If you have participated in a Johns Hopkins
on-line course, login. Otherwise, please register.
Step 3.
Complete the post-test and course evaluation.
Step 4.
Print out your certificate.
Pharmacy credit is only available via PDF mail-in form:
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Copyright
© JHUSOM, IJHN, and eInfluenza Review
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