Although the media frenzy over H1N1 waned this summer, the virus has not finished its run. In July, the Centers for Disease Control and Prevention reported 263 Americans died from the virus, including 72 in New York and New Jersey. The area isnt near the highest number of reported cases, but at 57 New York leads the nation in the highest number of deaths, with new cases continuing to rise. Because the virus has a strong presence in the Greater New York area, school nurses must be ready for what’s to come.
Just as they did this spring, our school nurses are working closely with school principals and teachers, says Anna Chu, RN, MPH, NA-BC, director of clinical programs at Lutheran Family Health Centers School-based Health Programs in Brooklyn, N.Y. During the height of the outbreak, Chu says, three of LFHCs participating schools closed. They were closed for three days, she says. The custodians were able to clean the schools and install hand sanitizers.
The Lutheran program has one nurse practitioner and one medical assistant in each of 14 schools. Chu has clinical oversight for all the clinical programs and nursing practice, including the school health-based program, and serves as the infection control person for the network.
We arent really changing the way we practice, she says. Well continue to provide education for the kids, teaching them to wash their hands and cover their mouths when they cough, things that are recommended by the department of health and the CDC.
Jacqueline Kelderhouse, RN, FNP, MSN-BC, is one of 16 NPs in as many Montefiore Medical Center School Health Program sites throughout the Bronx. According to Kelderhouse, Montefiore reacted quickly to the outbreak this spring and is proving to be extremely proactive toward the virus this fall.
Kelderhouse provides healthcare services at P.S. 28, an elementary school in the Bronx, including physical exams, management of chronic diseases such as asthma, and immunizations.
During the outbreak of H1N1 this spring, all our sites followed the Montefiore Policy of Ambulatory Care for Children with ILI [influenza like illness], Kelderhouse says. The policy, initiated in response to the H1N1 virus, precluded that a child with a fever of 100.7 degrees and cough or sore throat would be masked and isolated until a determination could be made regarding his or her status.
Plan of ActionDonna OConnor, RN
In July, CDC head Thomas Friedan, MD, Health and Human Services Secretary Kathleen Sebelius, and some 500 state and school health officials convened at a H1N1 Influenza summit in Bethesda, Md., to discuss the virus and its implications for the upcoming school year. The CDCs Advisory Committee recently announced an H1N1 vaccine would be ready for distribution in mid-October. The first in line to receive the vaccination would be pregnant women, people who live with or care for children younger than 6 months, healthcare and emergency services personnel, people between 6 months and 24 years old, and people age 25 to 64 who are at high risk because of chronic health disorders or compromised immune systems. In total, this group is comprised of about 159 million people in the U.S.
We are initiating a program-wide flu campaign that will begin in September with seasonal flu vaccination and on swine flu vaccination as [the vaccine] becomes available, Kelderhouse says. She says Montefiores approach will be global, but specifically will target those with asthma and children with chronic medical problems.
Chu is confident LFHCs program will meet the demand for vaccination. Students have to be enrolled in our program in order for our nurses to vaccinate them, she says. Although some students have their own primary care physician, we have already increased our order for the vaccine.
Although districts in New York City have been hit hard, school districts on Long Island and in New Jersey must be equally as cautious. According to the New York State Department of Health, there have been 104 and 276 confirmed cases of novel H1N1 in Long Islands Nassau and Suffolk counties, respectively, since the outbreak began last spring. These cases include children from school districts in Deer Park and Dix Hills in Suffolk, and Valley Stream in Nassau, among others.
Because most everyone is aware of the virus and its symptoms, school nurses are in a better position to handle potential cases, says Normadeane Armstrong, RN, ANP-C, PhD, a Long Island nursing instructor at Molloy College in Rockville Centre, N.Y. When the epidemic first hit, people werent aware of [H1N1] and had no idea how to keep it from spreading, she says. People are more educated on how to prevent transmission and the signs and symptoms now. Knowledge is power.
State of New Jersey Department of Health and Senior Services Commissioner Heather Howard attended the federal summit in July. The issue of school preparedness continues to be a focus nationally, she said during a speech after the summit. The [department] worked very closely with the Department of Education during the outbreak in the spring and will continue to do so in preparation for the fall.
Donna OConnor, RN, a nurse at Therapeutic School and Preschool in Belleville, N.J., relied on the Department of Health and Senior Services during the outbreak this spring. I collaborated with the health department, referring students who presented with respiratory illness, she says.
She also reached out to parents by sending them information about the virus and how to keep it from spreading. We provided parents with a letter from [them] and a fact sheet on how to stop germs in the home, at work, and at school, she says. The letter advised parents to seek immediate medical care if their child was exhibiting any respiratory illness symptoms. She also gave the parents links to educational Web sites for more information.
OConnor says she also turned to the CDC and the Internet for prevention tips and education. I provided the staff with a short video about hand washing and the transmission of germs, she says. They were given individual hand sanitizers and boxes of tissue for their classrooms, and the school installed extra waterless hand sanitizers.
In addition to Cover Your Cough posters from the CDC hung throughout the school, OConnor downloaded a video program called the Scrub Club to teach respiratory hygiene. The video provided information on preventing transmission and proper hand-washing techniques.
Students watched the program during their computer time, she says. After watching, the students demonstrated hand washing. Their teachers supervised and had the children properly wash their hands several times a day.
Resources to the RescueSally Schoessler, RN
School nurses who want to arm themselves before the school year begins have a wealth of resources available. The American School Health Association is offering an interactive self-study CE module for school nurses called School Planning for Disease Outbreaks Nurses Role. The third module, Disease Preparedness in Schools A Guide for School Nurses, is designed to assist school nurses in preparing for and responding to disease outbreaks that might affect schools. The course outlines the school nurses role during five stages: prevention, mitigation, preparedness, response, and recovery. The module is free for ASHA members and $30 for nonmembers.
Local organizations are gearing up as well. The New York Statewide School Health Services Center began including a page on its Web site with updates on H1N1 information. The Web site receives about 40,000 hits a month, according to Sally Schoessler, RN, SNT, MSed, executive director of NYSSHSC.
The new page includes links to voluntary H1N1 tracking forms for elementary, middle, and high school nurses to use to help streamline information. Each form was created as an Excel spreadsheet so reports can be generated. The forms were created as a tool to help nurses with building their data to be prepared to report at the state level as needed, Schoessler says.
Everyone agrees communication between school health officials, school nurses, and parents is crucial to keep kids safe. This is important because whether the vaccine will consist of one or two doses has yet to be determined. If the vaccine requires two doses, parents need to understand to avoid compliance issues. It also is important that administrators, teachers, and parents know the H1N1 vaccine is in addition to the seasonal flu vaccine, not in place of it.
To keep school nurses informed, the NYSSHSC also uses a listserv that reaches more than 3,200 nurses. An effective line of communication is vital at this point, Schoessler notes. Everyone needs to realize that this is an evolving situation.
Chu agrees communication is key. We immediately share any information we get from the CDC, the [state] department of health, and the [state] department of education with the NPs in the program through e-mail and our Intranet, she says. And were sending out an informational flyer to parents the first week of school to let them know that vaccination will be available.
Chu says LFHCs student population is extremely diverse. As such, the flyer will be sent out in Chinese, Russian, Arabic, English, and Spanish. We have to be mindful of our population if we want to get to everyone, she says.
The Montefiore program already initiated a protocol to disseminate at a retreat during the first week of school, Kelderhouse says, well before the vaccine is slated to become available. To keep everyone involved in the school community committed to keeping H1N1 away from the kids, Kelderhouse says Montefiore plans to investigate the feasibility of immunizing Board of Education employees as well.
Our goal is to create herd immunity, Kelderhouse says. The more the general population is vaccinated, the less everyones overall exposure.