Pediatric Influenza and “Universal Respiratory Etiquette”: Preparing and Protecting Your Staff and the Public

The 2003-2004 influenza season hit Utah early, and it hit hard. By mid November we were seeing unprecedented numbers in the emergency department at Primary Children's Medical Center. Typically a slower month, November was the busiest month in 2003. It also was the busiest month in our history. Thanks to an ample supply of flu vaccine available early in October and the persistence of the ED charge nurses who strongly encouraged prophylaxis and willingly gave many flu shots, a high percentage of the ED staff had been immunized. Sick calls were not significantly higher than in previous months; had they been, a bad situation quickly could have become a disaster. We share the following information in the hope of helping ED managers mount a coordinated effort to deal with the next flu season.

As the infection control coordinator for the emergency department, I was already involved in a hospital task force addressing severe acute respiratory syndrome (SARS) and an upcoming respiratory season that was predicted to be severe. The Task Force was using the SARS plan developed by the Centers for Disease Control and Prevention as a guide. One of the key concepts was a respiratory infection control strategy called “Universal Respiratory Etiquette.” When I saw the first televised reports of the influenza-linked deaths of 4 children in Colorado, it became obvious we were not going to have an ordinary influenza season. I called my director, and she immediately began implementing the strategy (see Figure 1 ). We followed up with an article in the ED newsletter (see Figure 2 ).

FIGURE 1.

Memo to staff regarding respiratory precautions.

FIGURE 2.

Article in our ED newsletter.

We placed “Fight the Flu” signs in prominent locations throughout the waiting room to educate parents and visitors about respiratory precautions. We also placed signs outlining the difference between influenza and the common cold in each examining room (Figure 3) .

FIGURE 3.

Poster outlining the difference between influenza and the common cold.

Challenges unique to the pediatric setting

Preventing the spread of disease in a pediatric setting presents many unique challenges. Young children usually are not receptive to blowing their noses in a tissue or washing their hands, much less wearing a mask. Their hands go constantly from their mouths to anything within reach. Coming to the emergency department often becomes a family outing when several children are brought for care. Siblings commonly accompany the parent and patient even though they may not need to be examined; many of them may have respiratory symptoms as well. School-aged children are at greatest risk for getting the flu. Children younger than 24 months have an increased risk for hospitalization. Nonetheless, vaccination rates for children remain very low. The American Academy of Pediatrics is now advocating vaccination of children 6 months and older. It is hoped this recommendation will improve vaccination rates and the result in fewer children needing ED care.

Resources

Many disease prevention resources are available. The CDC Web site, http://www.cdc.gov/flu, is one of the best resources. It has signs in both English and Spanish. Most state health departments have excellent Web sites. The American Academy of Pediatrics (http://www.aap.org) is an excellent source of information about pediatric vaccination. If available, the hospital epidemiology department is always a reliable source of information and assistance.

Jeanette H. Walker is Nurse Manager, Primary Children's Medical Center, Salt Lake City, Utah.