National Nurses United

1 National Nurses United NNU CONVENTION 2018 HOMESTUDY Infectious Diseases and Nursing: Current Trends, Issues, and Solutions Introduction Mycobacterium tuberculosis was first identified as the causal agent of pulmonary tuberculosis (TB) in the 1880s. From that time until the mid-twentieth century, epidemiologists and medical experts debated whether health care workers were at higher risk than the general public for contracting TB. A 1917 pulmonology textbook remarkably concluded that tuberculosis sanatoria repre- sented "the safest place one can be so far as the danger of infection is concerned." The textbook reported that data existed to support the claim that "infection practically never occurs among the workers" in these settings. Around the same time, epidemiologists challenged these experts' claim with data of their own. Nurses were the primary cohort studied to settle the debate. These epi- demiologists claimed that nurses were 500 times more likely to develop TB than the average person in the U.S. A literature review of medical archives from 1882 to 1994 on this debate revealed that it was not until the 1950s that "our [U.S. health care community] current unanim- ity on the issue appears to have been achieved somewhat passively, because no definitive article appeared nor was any consensus paper issued that served to settle the matter." All the while, little was being done to prevent rampant TB exposure in the nurses, doctors, other health care workers, and students caring for patients suffering from TB. It was not until 1997 that Occupational Safety and Health Administration (OSHA) finalized their Respi- ratory Protection Standard (29 CFR 1910.134), which mandated that employers must provide respiratory pro- tection, such as ventilation systems or respirators, to all employees exposed to airborne hazards. Employers must also implement an annual fit testing program to ensure that all exposed health care workers continue to be pro- tected by the respirators provided by their employers. One of common uses of respirators to protect nurses and other health care workers is when in close contacts with those acutely infected with TB. This pattern is not isolated to TB. Much of the medical and public health establishment focus closely, sometimes exclusively, on the interaction between pathogens and hosts leaving aside the importance of environmental factors. But nurses know—and have known for hundreds of years—that the environment impacts disease transmis- sion and that understanding this can be vital for disease prevention. As nurses, we know that infectious disease transmission is determined by the interaction between the characteris- tics of the specific pathogen (e.g., what kind of pathogen, how infectious, how prone to mutation, etc.), the host's immune system integrity, and the environment in which the host and pathogen interact. Researchers often call this the "pathogen-host-environment interplay." To ensure a safe environment and nurses' ability to provide high quality care, each factor must be considered within the context of the other two. Take the coronavirus that causes severe acute respira- tory syndrome (SARS) as an example. This particularly virulent virus might be able to dominate even the most robust, healthy immune system of an exposed person to the point of disease manifestation. During the 2003 SARS outbreak in Toronto, 42% of the total 128 sus- pected and probable cases were hospital staff and other health care workers. The physical and social aspects of the environment both directly and indirectly influence the interactions and out- comes of a host-pathogen exposure. In the Toronto SARS outbreak, there was a 16-day lag period between when the source patient arrived in the Emergency Department and when complete isolation precautions were put in place throughout the hospital. Of the 128 total cases, 42 occurred in nurses and other health care workers prior to the institution of strict isolation and quarantine protections, whereas just 12 cases were identified with suspected or probable SARS diagnoses after the delayed administrative policy change. Environmental conditions are crucial to the life cycle of all organisms, making or breaking their ability to reproduce, metabolize, mobilize, and thrive as species and individuals. Significant changes to local environment may trigger massive destruction for some colonies of microorganisms or exponential growth and virulence evolution in others. Similarly, human populations exposed to major shifts in physical and social conditions must adapt to changes in their environments in order to thrive or suffer if unable to do so effectively. This concept is intuitive to most nurses and other health care workers. And yet there is stark evidence that hos- pitals and other health care facilities do not adequately address the environmental aspects of disease transmis- sion. Rather, hospitals and other health care facilities focus exclusively on the medical model, the interaction between pathogen and human. So why do hospitals and other health care facilities neglect environmental preven- tion? Who bears the brunt of these inadequate programs? That is what this CE program will explore.

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