Home health should prepare for smallpox

Though not frontline, some areas are involved

Although the recently announced smallpox vaccination plan doesn’t identify home health workers as members of first response teams to receive possible smallpox patients, the home health industry stills needs to pay attention to the issue and prepare to serve a role if needed, says Steven Christianson, DO, MM, medical director of the Visiting Nurse Service of New York in New York City.

The current draft of the plan calls for febrile contacts to be initially monitored in a facility then discharged to home for further monitoring, he points out. Although the plan allows for telephone monitoring, the guide states that if resources are available, closer monitoring such as daily visits would be good, Christianson says. Because the public health system could be overloaded if it attempted this type of monitoring with a significant outbreak, it makes sense that home health could help, he adds.

"I still believe that in a serious outbreak, people with mild cases of smallpox may be cared for in their homes, especially if the entire community is quarantined," Christianson says. Home health agencies and public health agencies should be working together to make plans for this scenario, he adds.

Home health agencies also may play a part in the vaccination program, he says. "We will be helping the New York Department of Health vaccinate health care workers and first responders."

While teaching nurses the 15-prick vaccination process is simple, it’s also important to make sure nurses know how to handle the vaccine, he says. "The vials need to be stored in a temperature between 0 and 4 degrees Celsius, and each vial contains 100 doses," he says.

Discarding empty vials must be a controlled process to avoid exposure of the live virus to unvaccinated people; normal precautions taken for other biohazard materials are appropriate, Christianson says. Nurses also need to know to tell people they vaccinate to keep vaccination site covered to prevent spread of the live virus, he adds.

In addition to helping with vaccination efforts, home health agencies that are located close to hospitals that are designated as treatment facilities must have a rapid admissions process that can be implemented in the case of a large outbreak, Christianson suggests. "A hospital will be trying to discharge as many patients as possible to make room for smallpox victims, and a number of these patients may require home health care," he says.

Agencies need to have plans to handle a large volume of admissions in a short amount of time, he adds. (For more information on other emergency issues to consider, see Hospital Home Health, November 2002, p. 121.)

Home health nurses should also be educated on other issues that are related to smallpox as well, Christianson suggests.

"Wound care, signs of infection, quarantine requirements, and infection control should all be addressed," he says. "There are still a lot of post-event issues for which we need to plan but now we can make sure we know how to take care of the patients."

[For more information on home health and smallpox plans, contact:

  • Steven Christianson, DO, MM, Medical Director, Visiting Nurse Service of New York, 107 E. 70th St., New York, NY 10021. Telephone: (212) 290-4802. E-mail: schristi@vnsny.org.

For information about the smallpox vaccination plan, the vaccine, identification of smallpox, and other clinical information, as well as patient education materials in English and Spanish, contact:

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