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CE:8 page 2/8/08 2:25 PM Page 20 CE Home Study Course Public Health and Retail Clinics Submitted by the Joint Nursing Practice Commission and Hedy Dumpel, RN, JD etail clinics surfaced several years ago in multi-state retail stores such as Target, Wal-Mart, Rite Aid, and Longs Drugs, to name a few. All are conveniently located next to the store's pharmacy. They are touted as easy and affordable healthcare services staffed by physicians, nurse practitioners, or physician assistants. These clinics provide selected services to everyone 18 months of age and older. The pitch: "You're sick, we're quick" or "Real healthcare. Real quick." or "See a doctor for $49 now." A new medical kiosk is generally installed next to the pharmacy. Patients are lined up in the aisle, mostly standing. In addition to the usual retail shoppers, the store now has a new targeted population: the healthcare shopper. The "Menu of Services" could include a range of conditions, such as: Illness: colds and flu, bladder infection, upper respiratory infection, bronchitis, infection of inner and/or outer ear, sinus infection, strep throat, mononucleosis and laryngitis; Injuries: sprains and strains, minor neck and back pain, muscle strains, minor ankle sprains, swimmer's ear, stitch removal, and tendonitis; Allergies & skin conditions: seasonal allergies, itchy eyes, rashes and skin infections, acne, athlete's foot, ringworm, cold sores, eczema, impetigo, psoriasis, warts, chicken pox, minor burns, hair disease/loss, head lice, insect bites, sunburn, poison oak and ivy, and swimmer's itch; Physicals: school, sport, and camp physicals; Screening: blood pressure, diabetes, height, weight, and body mass index, hearing tests, lipid panel/cholesterol, pregnancy, and tuberculosis; Vaccinations: flu, hepatitis A and B, pneumonia, diphtheria, and tetanus; Minor stomach upset/ diarrhea R Question: Do retail clinics pose a threat to the health, welfare, and safety of the public? Focus: The focus of this analysis is solely on the impact of "quick" or "express" care, provided in a retail clinic setting, on the health, welfare, and safety of the public which includes retail and healthcare shoppers. PUBLIC HEALTH, WELFARE, AND SAFETY all members of the public are vulnerable if proper safeguards are not in place to prevent the transmission and acquisition of infection and the spread of epidemics and pandemics (e.g. Canada's recent experience with Severe Acute Respiratory Syndrome/ SARS and the imminent avian influenza). Every medical facility, including physician offices and medical clinics must have a proper infection control infrastructure in place to meet universal 20 REGISTERED NURSE infection prevention and control measures.The rapid increase of examinations and procedures being performed in outpatient settings with its attendant long waits, the presence of diverse age and immunosuppressed groups, including the presence of existing and new types of infections (SARS, diverse influenza strains, the imminent avian flu) have rapidly changed the face of infection control, critically needed to protect the public's health, welfare, and safety. By definition, sick people are seeking medical help, and the waiting room of a physician practice or retail medical clinic creates a unique concentrated environment of communicable diseases.Infection is not only spread person-to-person, but can also be spread through inanimate objects also known as fomites (including toys, shopping carts, magazines, or any merchandise). There are four key routes by which organisms are transmitted: contact (direct, indirect, or droplet); airborne; vehicle; and vectorborne (e.g. mosquito). Universal precautions must be adhered to at all times, the premise being that all patients are potentially infectious, even if they show no symptoms.The Centers for Disease Control require that "a sick child is advised to stay at home during the first day of illness when symptoms are most severe and the infection most contagious."Children may spread infections to older adults. Herpes Zoster causing shingles in adults is often caused by exposure to droplets from the cough or sneeze of a sick child. Examples–Mostly Provided by the CDC: Rotavirus can cause serious diarrhea and dehydration, even death in the elderly. Most cases occur in young children. Spread occurs when hands, objects (such as toys), food, or water, contaminated by tiny amounts of feces from infected people, are put into the mouth of an uninfected person. It is also possible that the virus can be transmitted by coughing and sneezing. Respiratory Syncytial Virus (RSV) is a common and highly contagious disease. For a certain population such as babies up to the age of 2 or high-risk kids (Immunosuppressed kids or those with a cyanotic heart or pulmonary over-circulation), the consequences are extremely serious. Prevention guidelines include avoiding exposing these kids to crowded areas like shopping malls, day care centers, etc. Hepatitis A (HAV) is a liver disease caused by the hepatitis A virus. Hepatitis A can affect anyone. In the United States, hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics. HAV is usually spread from person to person by putting something in the mouth (even though it may look clean) that has been contaminated with the stool of a person with hepatitis A. Salmonellosis is an infection with a bacterium called Salmonella. Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. Most persons W W W. C A L N U R S E S . O R G JANUARY | FEBRUARY 2008