Ebola, One Year Later: What We Learned for the Next Big Epidemic

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

U.S. hospitals have not seen a case of Ebola virus disease since November 11, 2014, when Dr. Craig Spencer was discharged from Bellevue Hospital Center in New York City. While the number of new infections has declined dramatically in the West African countries where the 2014–2015 epidemic began, it is virtually certain that the disease will continue to resurface.

This epidemic was by far the largest and most geographically widespread Ebola epidemic to date, with approximately 28,000 cases (suspected, probable, or confirmed) and more than 11,000 deaths in Liberia, Guinea, and Sierra Leone, the three hardest-hit countries. The seven other countries affected account for a combined total of 34 confirmed (and two probable) cases and 15 deaths.

According to a recent WHO report, these numbers include (through March of this year) 815 confirmed or probable cases among health care workers, more than half of whom were nurses or nurses’ aides. (Doctors and medical students made up about 12% of total health care worker cases.)

This epidemic has been, for some, a wake-up call about the ease of global disease transmission. […]

Sexually Transmitted Infections in the U.S.: Updates and a Nurse’s Guide

By Sylvia Foley, AJN senior editor

Sexually transmitted infections (STIs) are the most common infectious diseases in the United States, with an estimated national prevalence of 110 million cases. More than 20 million people are infected annually. Last June, the Centers for Disease Control, std screening services, OC and Prevention (CDC) issued updated treatment guidelines.

The CDC's 2015 Treatment Guidelines boxIn their September CE article “Sexually Transmitted Infections in the United States: Overview and Update,” authors Hayley Mark and Amit Dhir provide nurses with a closer look at the symptoms, screening methods, and means of treatment for the six most common STIs: human papillomavirus, herpes simplex virus, trichomoniasis, chlamydia, gonorrhea, and syphilis. They also describe the most recent relevant findings and treatment recommendations. As they note,

STIs have enormous human consequences, including severe reproductive complications, neonatal injury, and death; and because STIs are associated with social stigma, they also have substantial psychological impact. The economic consequences are also enormous: it’s estimated that STIs cost the nation about $16 billion in annual health care costs. All communities are affected, although significant racial, ethnic, and other disparities persist. Nurses play a critical role in educating patients on STIs, screening for disease, and providing treatment. Nurses can also help minimize the impact of social stigma by providing informed, confidential, and sensitive care, and by promoting sexual health.

Recent developments. The article specifically addresses such matters as

  • the rise of antibiotic-resistant […]
2017-07-27T14:37:50+00:00 September 18th, 2015|infectious diseases, Nursing|1 Comment

AJN in September: Pain Management in Opioid Use Disorder, STIs in the U.S., Teaching Vs. Unit Needs

AJN0915.Cover.OnlineOn this month’s cover, perianesthesia nurse Carolyn Benigno helps prepare a young patient for surgery at Children’s National Medical Center in Washington, DC. The photo, the first-place winner of AJN’s 2015 Faces of Caring: Nurses at Work photo contest, shows Benigno practicing “Caring through Play.” The art of working at a pediatric hospital, she says, is “learning how to play with children so that part of your nursing care is play.” Such play can both distract a child in the moment and help the child cope with the disorienting experience of hospitalization.

For another piece on how nurses try to make hospitalization less stressful for children, see this month’s Cultivating Quality article, “Improving Pediatric Temperature Measurement in the ED.”

Some other articles of note in the September issue:

CE Feature:Acute Pain Management for Inpatients with Opioid Use Disorder.” Inpatients diagnosed with opioid use disorder (OUD) commonly experience acute pain during hospitalization and may require opioids for pain management. But misconceptions about opioids and negative attitudes toward patients with OUD may lead to undermedication, unrelieved pain, and unnecessary suffering. This article reviews the current relevant literature and dispels common myths about opioids and OUD. […]

As with Ebola Outbreak, Social Determinants of Health Crucial in Recent Rural U.S. HIV Outbreak

Rachel Parrill, PhD, RN, APHN-BC, is an associate professor of nursing at Cedarville University in Ohio

by banditob/flickr creative commons by banditob/flickr creative commons

This past fall, with the world watching, a crisis unfolded in West Africa that challenged our understanding of sociocultural environments, epidemiology, and health. The spread of Ebola and the intercontinental transmission of the disease exposed weaknesses in our epidemiological defense system. It also drew attention to the powerful role that cultural beliefs and practices can have on disease transmission during outbreaks.

In that same time frame, and with similar cultural etiologies, another infectious crisis played out much closer to home. The setting: the rural Midwest, in and around the small town of Austin, Indiana. The disease: HIV. The crisis: an unprecedented outbreak—one with incidence rates (up to 22 new cases a day at the height of the outbreak) estimated to be higher than those in many sub-Saharan African nations and transmission rates through injection drug use higher than in New York City. Contributing to this “perfect storm” were socioeconomic factors characteristic of many rural settings, including poverty, low education levels, limited access to health care, and few recreational or employment opportunities.

In my work as a faculty member in a rural Midwest setting, I introduce undergraduate and graduate nursing students to concepts of public health nursing and try to provide opportunities for them to engage […]

Legionnaires’ Outbreak in New York City: Some Basics for Nurses

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

11148_loresIn the largest U.S. outbreak of Legionella infection since 1976, when there were 221 cases and 34 related deaths in an outbreak at a Philadelphia American Legion convention, more than 113 cases of the disease have been diagnosed in New York City since mid-July. Twelve people have died.

Legionnaires’ disease is neither rare nor exotic; it is a type of community-acquired pneumonia (it can also be hospital acquired). Symptoms include fever, cough, and progressive respiratory distress. Legionella can also cause a milder, flulike illness known as Pontiac fever that generally resolves without treatment. Because many cases of Legionnaires’ disease are never actually diagnosed, mortality rates are difficult to determine, but the rate currently is estimated at 5% to 30%.

The CDC estimates that 8,000 to 18,000 people are hospitalized with Legionnaires’ disease each year in the U.S., yet only about 3,000 cases are diagnosed and reported. Most cases of Legionnaires’ disease are sporadic, unlinked to any outbreak. The infections often are not recognized as Legionnaires’ disease, for several reasons.

  • Legionella infection is easily treated empirically (that is, without confirmatory lab testing) with common antibiotics, with the patient usually recovering. This is a practical and cost-effective approach to community-acquired pneumonia, but many cases of Legionnaires’ disease are never diagnosed as anything more specific than “pneumonia.”
  • When Legionnaires’ disease is suspected, the most common test ordered—Legionella urinary antigen—tests for […]