School Nurses and the Swine Flu Pandemic of 2009-10

Qualitative Analysis of Survey Results Pertaining to School Nursing Practices during the Swine Flu Pandemic V. Ramaswamy, L. Forst, The University of Illinois at Chicago School of Public Health Division of Environmental and Occupational Health Sciences, 2121 W. Taylor Street, Chicago, Il 60612 Objective: This study is a descriptive analysis of risk factors and exposure conditions for development of influenza—like illness (ILI), the implementation of Centers for Disease Control and Prevention (CDC) guidelines, and the impact of policies on implementation of protective measures among school nurses within school settings. Methodology: A 64-item survey was emailed to the entire membership of 14,065 nurse members of NASN. Of the total membership, 2,263 (16.1%) of NASN members responded to the survey. After removing respondents who did not work in schools (i.e., were not exposed to children), 2,151 participants remained. Due to survey and data validity, analysis was limited to descriptive statistics only. Results: The following risk factors/exposure conditions were positively associated with ILI status among the respondents: nurses that chose not to receive the H1N1 vaccination, OR of 1.42 CI95 [1.15, 174], exposure to kindergarten and preschool aged students, OR 1.24 CI95 [1.02, 1.51] and OR 1.3 CI95 [1.06, 1.59] respectively, and PPE being unavailable in office and classrooms, OR 1.64 CI95 [1.29, 2.06]. The presence of a PPE policy was positively associated with PPE utilization among respondents; gown usage, OR 4.01 CI95 [2.44, 6.59], N95 respirator usage, OR 4.11 CI95 [3.17, 5.32] and surgical mask usage, OR 3.38 CI95 [2.83, 4.04]. Conclusions: CDC guidelines written for health care settings are difficult if not impossible to implement within school environments due to functional constraints. Per the CDC’s hierarchy of controls and the results, the use of PPE offers school nurses a flexible means of preventing the presentation of ILI symptoms within the relatively uncontrolled school environment, other than self-vaccination and class dismissal. Such programs would enable school nurses to have consistent funding, training, and access to PPE especially during flu seasons where their school presence is all the more necessary. Guidelines could also benefit from outlining specific health hazards associated with flu vaccines.