Zika—Implications for Home Care and Hospice
By Barbara B. Citarella RN, MS, CHCE, CHS-V RBC Limited Healthcare & Management Consultants
August 4, 2016 11:25 AM
In an effort to prevent Zika virus and the terrible birth defects it causes, the National Institute of Allergy and Infectious Diseases (NIAID) has begun a national clinical study of a vaccine for Zika. The experimental vaccine was developed earlier this year. The study will be conducted at three sites.
Zika virus disease continues to dominate news headlines as the Centers for Disease Control and Prevention (CDC), in an unprecedented move, issued a travel warning advising pregnant women and their partners against travel to specific areas in Miami. To date we have 15 cases of Zika virus in Florida. The cases are likely the first known occurrence of local mosquito-borne Zika virus transmission in the continental United States. Zika was first identified in 1947 in Uganda. There is no approved vaccine for Zika. Treatment is supportive with rest, fluids, and antipyretics.
Zika virus spreads to people primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus), but can also be spread during sex by a person infected with Zika. There is also an indication that Zika can spread through blood transfusions. It is still undetermined as to the possibility of transmission through breast milk, organ or tissue transplantation. Currently, animals do not appear to be involved in the transmission of the disease.
There is still one case in Utah in which the mode of transmission has not yet been determined. This particular case involves a family member caring for his infected father.
Most people infected with Zika are asymptomatic. The illness is usually mild. Symptoms include fever, rash, joint pain, and conjunctivitis. There has been rare association with Guillain-Barre syndrome. Zika infection during pregnancy can cause a serious birth defect of the brain called microcencephaly and other severe fetal birth defects. Long term effects, if any, of Zika are not yet known.
In home care and hospice the reality is, much like H1N1, some of our patients may have Zika virus without being symptomatic. It is imperative for agencies to reinforce hand hygiene, the use of standard precautions, and the use of personal protective equipment. As with many of these new diseases, since travel is a contributing factor in the spread, a complete travel history of our patients and, if possible, of their family is vital. If a patient is suspected of possibly having Zika, providers should contact the local department of health for guidance. Zika is a nationally notifiable disease. Some local and state health departments may have specific guidance for their geographic location.
Patients and family members should be advised about travel in areas where Zika is present. The CDC has great teaching tools and handouts. Agencies should instruct caregivers, especially family care givers, to use standard precautions, wash hands frequently and use personal protective equipment (PPE) as indicated. PPE will depend on the patient’s care needs.
Agencies should provide education to all employees about Zika virus. Employee travel history (as with Ebola) is important as many of our employees travel out of the country for vacation and to visit family. Providers should monitor employee illnesses for possible signs and symptoms of Zika especially when working in an area at risk for Zika. This is becoming more crucial as Zika spreads throughout the United States.
Home care and hospice providers should stay current on the Zika situation as it seems to be changing rather quickly. Please go to your state website frequently and to the CDC website for information and updates. Place Zika informational posters in conspicuous spots throughout your offices.
Educate both patient and employee concerning:
Eliminating and avoiding standing water;
Avoiding areas with a lot of high grasses, leaves, wooded areas;
Use only EPA approved insect repellent as appropriate;
Use of condoms or abstaining from sexual activity for those diagnosed with the virus.
Remember this is a newly emerging disease with significant birth defects and we are learning more about it everyday. These mosquitoes bite during the daytime, therefore day long protection in areas identified with Zika is necessary.
Infection prevention is imperative.
Editor's Note: NAHC has set up a page for the Infection Prevention and Practice Group to include resources for the home care and hospice community as well as emergency preparedness documents. Please visit it here for the most recent updates.