CDC Updates on Zika Virus

The CDC released several updates on Zika virus disease last week. We have summarized the main points. Follow the links to read the full guidelines.

Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016

  • Occupational transmission of Zika is “theoretically possible”
    • Zika virus has been found in several body fluids, including blood, semen, urine, and amniotic fluid
    • Transmission is primarily through mosquito bites, but sexual transmission has also been documented
    • Occupational transmission has not been documented
  • CDC recommends standard precautions in all healthcare settings
  • Notes that for labor and delivery settings, standard precautions will require more than just gloves/gown due to high risk of exposure to body fluids

Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016

These are guidelines for healthcare providers to counsel women of reproductive age with possible Zika virus exposure on conception.

  • Women who have Zika virus disease should wait at least 8 weeks after symptom onset to attempt conception
  • Men with Zika virus disease should wait at least 6 months after symptom onset to attempt conception
  • Women and men with possible exposure to Zika but no clinical illness should wait 8 weeks after exposure to attempt conception
  • Recommendations on providing preconception counseling and counseling on how to avoid pregnancy for people who reside in areas with endemic Zika
  • Testing for Zika virus is only recommended for people attempting conception with at least one symptom within 2 weeks of exposure—
    • Testing is not recommended for people with exposure but no symptoms because of unknown test performance in people without symptoms
  • New guidance for testing pregnant women residing in area with endemic Zika
    • Testing for pregnant women upon initiation of prenatal care if no symptoms, including a second test for Zika mid-second trimester if 1st was negative
  • See link for full guidelines.

Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, 2016

  • Men who have traveled to or reside in an area with local Zika transmission should use condoms or abstain from sex with pregnant sex partners for the duration of the pregnancy
  • Men and non-pregnant sex partners should use condoms or abstain from sex to reduce the risk for sexual transmission
    • If the man is symptomatic, they should use condoms/abstain for 6 months after onset of illness
    • If the man just has exposure but no symptoms, then they should use condoms/abstain for 8 weeks after departure from area with local Zika transmission
    • If the man resides in an area with local Zika transmission but has no symptoms, they should consider using condoms/abstaining while active transmission persists

Estimating Contraceptive Needs and Increasing Access to Contraception in Response to the Zika Virus Disease Outbreak — Puerto Rico, 2016

  • Local Zika transmission has been increasing quickly in Puerto Rico in recent months
  • This study estimates that 2/3 of the pregnancies in Puerto Rico are unintended and seeks to understand the scope of barriers to contraceptives use
  • Found that access to contraceptives is very limited, due to high cost, limited availability, incomplete insurance coverage, and lack of trained providers
  • The study estimated the number of long-lasting contraceptives needed to prevent unintended pregnancies
    • Estimates were based on studies done in the US on the uptake of long-lasting contraceptives (e.g., IUD, contraceptive implants, depot medroxyprogesterone acetate) with counseling from providers and availability and affordability of contraceptives

NNU Statement on the ANA endorsement of Hillary Clinton

America’s nurses, including the actual largest organization of U.S. nurses, National Nurses United, overwhelmingly support Bernie Sanders for President.

That’s due to Sanders’ stellar record of consistent support for nurses, patients, and working families, exemplified in his campaign for guaranteed healthcare for all, through an improved and expanded Medicare for all, free college tuition and eradicating student debt which is also critical for nurses, and his challenge to Wall Street, which includes many health care corporations.

And Bernie Sanders is the only candidate who supports national legislation, sponsored by NNU, to establish mandatory limits on the number of patients assigned to each RN, Senate S. 864, which he co-sponsors, and the HR 1602.

By contrast, the American Nurses Association, which is supporting Hillary Clinton, is primarily a lobbying arm for the nurse administrators and academics who govern it and functions largely as an adjunct to the health care industry.

ANA’s Foundation, for example, features a corporate advisory board that includes pharmaceutical giants, such as Merck, Pfizer, and McKesson, and health industry technology companies, with major funding also from the health insurance industry, including the nation’s largest UnitedHealth, and hospital corporations.

Three of its advisory board corporate members, Avantos, Lippincott Solutions, and Kronos, actually promote healthcare restructuring techniques that would be harmful to nurses and patients, including cutting nursing hours and the nurse workforce and limiting the role of RN professional judgment. Another corporate board member is Epic, creator of the health IT/clinical decision software systems despised by so many direct care RNs.

Over the past two decades ANA has been hemorrhaging members – its ludicrous claim of 3.4 million members, the total number of U.S. nurses, is not actual ANA membership which is just a miniscule fraction of that number.

Working nurses know the difference. They’re joining NNU – which represents nurses who work at the bedside advocating for improved care and health and safety for nurses and patients – not their employers’ representative, the ANA. 

– Jean Ross, RN, NNU Co-President


OSHA’s New Severe Injury Reporting Requirement: One Year In

Last week, OSHA published a report on severe injuries reported in 2015. A new recordkeeping requirement went into effect January 1, 2015, requiring employers to report all work-related amputations and injuries requiring hospitalization to federal OSHA within 24 hours. This was in addition to the long-standing requirement to report all work-related fatalities to OSHA within 8 hours.

The report sings the praises of many employers who, after reporting a severe injury and being contacted and coached by OSHA staff, conducted their own incident investigations and “went above and beyond” what OSHA required to fix the unsafe situation. OSHA inspected workplaces based on some of the reports: about a third of all injury reports and 58% of amputation reports. For most of the reports, however, OSHA opted for a more cooperative approach, which was:

…guided by the principle that when employers engage with OSHA after a worker suffers a severe injury—whether or not a workplace inspection is launched—they are more likely to take action to prevent future injuries.

We have encountered this principle before—we call it “labor-management partnership.” This new recordkeeping program, while giving OSHA access to important information regarding injury/illness rates, is another step in management-friendly programs, which seriously compromise workers obtaining safer workplaces.

Much of the evidence supplied to support the report’s claims is anecdotal—stories about a severe injury and the rapid and effective abatement in a wastewater treatment plant in Illinois or a tuna cannery in Hawaii. Seven such “success” stories are supplied as compared to two “failure” stories where employers were “continuing practices that put workers at risk” upon investigation (which begs the question whether “failure” stories can be identified through the engagement program at all, or whether they require an inspection to uncover). OSHA claims that,

Most employers who experienced a severe injury to a worker were eager to cooperate with OSHA inspectors to prevent anything similar or worse from happening again.

But how many is “most”—51%? 99%? Perhaps when you give an employer the opportunity to self-report on severe injuries, the conditions that led to those injuries, and the steps taken to prevent future injuries, they will all be “eager” to “cooperate.” But our work experience has shown that self-reporting by employers is often not reliable evidence. If OSHA had released more information about their conversations with employers, we could better understand the process. Workers and their representatives have the right to accompany OSHA during an inspection. So why is there no clear involvement of workers in this engagement program?

OSHA claims in this report that they:

…have found this process to be extremely effective in abating hazards while also using far fewer OSHA resources than are required for on-site inspections. In this way, we are able to use agency resources more efficiently and, ultimately, better protect the safety and health of workers.

OSHA inspections are often detailed, laborious processes (if done well) that require a lot of staff time and attention. It is true; this engagement program does use fewer resources than inspections. And, yes, the new rule provides OSHA with very important data on severe injuries that enables the agency to better protect workers’ health and safety than they were able to before. But we have seen that using fewer resources usually results in weaker protections for workers. So we ask: does this engagement program protect workers’ health and safety better than the traditional program of inspections and citations? The report does not answer this question.

General Medical and Surgical Hospitals ranked 6th for number of severe injuries reported in 2015. Note that this is data only from states covered by federal OSHA, not from states with their own state plans, which had to adopt a similar or more protective reporting requirement. It also does not take into account the total number of workers involved in each industry, which is how OSHA usually reports injuries and illnesses. OSHA estimates that many severe injuries are not being reported, possibly more than 50%.

Here’s the top 10 breakdown:

Top 10 Industry Groups Reporting Severe Injuries (4 digit NAICS)

NAICS Title NAICS Severe Injury Reports
Foundation Structure and Building Exterior Contractors 2381 391
Building Equipment Contractors 2382 343
Support Activities for Mining* 2131 323
Nonresidential Building Construction 2362 271
Postal Service 4911 229
General Medical and Surgical Hospitals 6221 221
Grocery Stores 4451 215
Animal Slaughtering and Processing 3116 213
Utility System Construction 2371 201
Plastics Product Manufacturing 3261 196

Links:

Year One of OSHA’s Severe Injury Reporting Program

OSHA Factsheet Updates to OSHA’s Recordkeeping Rule: Reporting Fatalities and Severe Injuries

State Plan Adoption of OSHA’s Revised Reporting Requirements (29 CFR 1904.39) As of March 8, 2016

Update on Zika Virus Research

The Zika virus epidemic began in Brazil in early 2015 and has rapidly spread in many other South American and Caribbean countries. So far, the United States has seen 193 confirmed cases of Zika virus in travelers returning from countries with local transmission. The international scientific community is working hard to gather information and to better understand the information we already have about Zika virus and the possible risks for microcephaly/other congenital effects and Guillain-Barré Syndrome (GBS). During situations like this, the media often sensationalizes potential risks, spreading misinformation, fear, and panic. This document lays out what we know with some certainty about Zika, what researchers have discovered recently, and what some implications may be.

Click here to read the latest information about the Zika virus

CDC Guidelines for Healthcare Providers Caring for Pregnant Women with Possible Zika Virus Exposure

Updated February 5, 2016  

CDC Interim Zika Guidelines:

http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er.htm_w

 

Summary

  • Includes new information about confirmed sexual transmission of Zika virus and testing recommendations for asymptomatic pregnant women
  • Asymptomatic women who have traveled to an area with local Zika transmission should be tested within 2 to 12 weeks of return.
    • Caveat is that these serum test results may be difficult to interpret because they often co-react to a previous dengue or yellow fever infection.
    • A negative serum result would indicate that intensive monitoring of the fetus is unnecessary.
    • Expanded to include pregnant women residing in areas with local Zika virus transmission
      • If pregnant and symptomatic, test within 1 week of symptoms.
      • If pregnant and no symptoms, testing is recommended at the initiation of prenatal care and mid-second trimester.
      • To prevent continued exposure to Zika throughout the pregnancy, healthcare providers should discuss use of condom or sexual abstinence with pregnant women
      • The CDC states that there is “currently no evidence” to suggest that pre-conception Zika infection will have an effect on the fetus.

Interim Guidelines for Prevention of Sexual Transmission of Zika Virus- United States 2016:

http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1er.htm?s_cid=mm6505e1er_w.htm

 

  • Men who have traveled to area with Zika should use a condom or abstain from sex with a pregnant sexual partner for the duration of the pregnancy.
  • Men with nonpregnant sexual partners—suggested that they “consider” abstinence or condom use but also consider the fact that most infections are asymptomatic or mild if symptomatic.
  • Not recommending testing of men for the purpose of assessing risk of sexual transmission.

Basic Information on the Zika Virus

What is it?

A virus transmitted by a specific mosquito species (Aedes genus), similar to dengue fever and chikungunya.

What are the symptoms and complications?

Fever, itchy maculopapular rash, and joint pain; often in combination with conjunctivitis. Generally mild symptoms that last a few days to a week. Death and severe sickness are rare ,2. The incubation period is currently estimated between three and twelve days. Up to 80% of people infected with the virus have no symptoms.

Zika virus infection in pregnant women may be connected to microcephaly in their infants. The CDC, WHO, and other scientific organizations are working to understand this possible link. Microcephaly (head smaller than average) is related to developmental delay, intellectual disability, vision problems, and other effects.

Infection may also be connected to Guillain-Barré syndrome, a rare auto-immune disorder that results in damaged nerve cells, weakened muscles, and paralysis. Most people recover from GBS, but some suffer permanent damage or death. This possible link is also being investigated.

Who is at risk?

Anyone who has travelled to an area with local transmission of Zika virus by Aedes mosquitoes. Pregnant women are especially at risk because infection may impact their fetus’ development. Women who might become pregnant and their partners may also be at risk. At least one case of Zika virus seems to be sexually transmitted and live virus has been found in semen.

What are the protective measures?

Control of the vector, Aedes mosquitoes, is the most direct protective measure. NNU is currently reviewing available control measures to be prepared in advance of warmer seasons. Consistent and thorough surveillance and screening of all pregnant women, women who might become pregnant, and their sexual partners who have travelled to an area where the virus is transmitted locally is necessary. Early screening, testing and surveillance is key to ensuring that pregnant women are afforded full medical options and choices.

Because Zika virus is an emerging infectious disease, we do not yet have full information about the risks, transmission routes, and complications of infection. Adherence to the precautionary principle in situations such as this is of vital importance, and preparations for full protective measures and thorough surveillance should begin immediately.


SOURCES

CDC, “Zika Virus: Symptoms, Diagnosis, & Treatment.” http://www.cdc.gov/zika/symptoms/index.html

PAHO/WHO. “Provisional remarks on the Zika virus infection in pregnant women: document for health care professionals- 25 January 2016.” http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=33018&Itemid=270&lang=en

European Center for Disease Control. “Rapid Risk Assessment: Zika.” http://ecdc.europa.eu/en/publications/Publications/zika-virus-americas-association-with-microcephaly-rapid-risk-assessment.pdf

CDC. “Birth Defects: Facts about Microcephaly.” http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html

CDC. “Transmission.” http://www.cdc.gov/zika/transmission/index.html

 

 

United States Supreme Court hears oral arguments in the Friedrichs case

Today, a coalition of nurse advocates from Washington to California gathered on the steps of the U.S. Supreme Court to warn that a controversial case targeting worker and union rights poses a significant threat to public health, safety and quality of life.

Friedrichs v. CTA involves a challenge supported by far right, anti-union groups to the right of public unions to require all employees who receive the benefits of representation, including higher wages, safer working conditions and better benefits, to pay their fair share of the cost of representation.

“For nurses, who depend on the protection of their union to be able to advocate, without fear of employer retaliation, for their patients at a time when massive healthcare corporations are placing profits over public and patient safety, the threat is particularly dire,” said NNU co-president Jean Ross, RN.

“As nurses our ability to have a collective voice for our patients is critical. Without the support of our union, nurses have little protection to speak out and challenge unsafe staffing or other eroding patient care conditions that happen all too often in our hospitals,” said Martese Chism, RN (above, left of center) who works in a major Chicago public hospital.

“We know that in states that allow for the scheme Friedrichs is attempting to impose on all public sector nurses, that infant mortality rates are 17.7 percent higher and life expectancy is lower,” said Chism. “For nurses, these appalling numbers are unacceptable.”

“The clear goal behind Friedrichs has nothing to do with individual rights, and everything to do with the larger far right and corporate goals of defunding and crippling all unions and their ability to represent their members and the public interest,” said Ross.

Click here to see more images from today’s Supreme Court hearing