bioterrorism Flashcards
Bioterrorism/disaster nursing
Now terrorism is an ongoing concern.
Involves overt actions such as dispensing disease pathogens or other agents as weapons for the express purpose of causing harm.
Bioterrorism is the use of microorganisms with deliberate intent of causing infection to achieve political goals.
Other agents that are used are chemicals, radiological, nuclear, and explosive devices.
vulnerability of the US
September 11th attack
Delivery of anthrax spores through the postal system
Whereabouts of weaponized biological agents has increased national anxiety level concerning bioterrorism.
Since 1998, ANA has work with the American College of Emergency Physicians (ACEP) to develop strategies for health-care providers to respond to nuclear, biological, and chemical incidents.
early recognition of bioterrorism
Recognizing and treating outbreaks early on is critical for rapid implementation of measures to prevent the spread of disease.
Response to a bioterrorist attack is similar to a traditional public health response to naturally occurring outbreaks of communicable diseases but the focus is on early detection.
clues to a biological attack
Presence of a large epidemic with an increased number of people seeking care from their primary physician or the emergency room.
Unusually severe disease or unusual routes of exposure.
Unusual geographic area, unusual season or absence of normal vector.
Multiple simultaneous epidemics of different diseases.
Unusual strains of resistant microorganisms.
Outbreak of zoonotic disease.
Higher attack rates in persons exposed.
Direct evidence of biological attack
credible threat
Is determined by authorities of biological attack
Health-care workers will be in the front line of attack and need to develop a heightened level of suspicion when epidemiological clues are present.
biological agents highest risk
Categorized into category A ( highest risk), category B
(next highest risk), and category C (potential biological risk but not an immediate threat).
Category A examples: Anthrax, Smallpox, Botulism, Plaque, Tularemia, and Hemorrhagic Fever.
Category B examples: Coxiella burnetii (Q fever), Brucella species (Bruceellosis), Burkholderia Mallei ( Glanders), Burkholderia pheudomallei (Melliodosis),
Alphaviruses, Toxins, Chlamydia psittaci ( Psittacosis), food and water safety threats.
Category C examples: Nipah and Hanta viruses
anthrax
Respiratory- bacillus spores multiply in alveoli. Toxins cause hemorrhage and destruction of lung tissue. High mortality.
Cutaneous- 95% of all infections. Least lethal form. Spores enter skin through cuts or abrasions or by handling contaminated animal skin products. Toxins destroy surrounding tissue. Small papule resembles insect bite. Then progresses to depressed, black ulcer. Swollen lymph nodes in adjacent areas with edema.
anthrax continued
Gastrointestinal- Ingestion of contaminated undercooked meat. Causes intestinal lesions in the ileum or cecum causing acute inflammation of the intestines. Nausea, vomiting, hematemesis, diarrhea, abdominal pain, ascites and sepsis are symptoms.
Transmission- No person to person spread. Found in nature and most commonly infects wild and domestic hoofed animals. Spores that are dormat encapsulated bacteria become active when entering a live host.
anthrax continues
Treatment- antibiotics prevent systemic manisfestations. Effective only if treated early.
a. Ciprofloxin (Cipro) is the treatment of choice.
b. Penicillin, Doxyclycline.
Post exposure prophylaxis for 30 days if vaccine available. 60 days if vaccine not available.
smallpox
United States ended routine vaccination in 1971. Global eradication declared in 1980.
Incubation- 7 to 17 days.
Sudden onset of fever, headache, myalgia, lesions that progress from macules to papules to pustular vesicles, malaise, and back pain.
Transmission- highly contagious. Direct person to person contact by air droplets or by handling contaminated materials.
smallpox treatment
No known cure. Cidofovir (Vistide)- under testing. Isolation for containment. Vaccine available for those exposed. Can prevent smallpox or improve the outcome even when first given after exposure. Vaccinia Immune Globulin (VIG) available
botulism
Spore forming anaerobe found in soil. Has seven different toxins. Has a lethal bacterial neurotoxin and can cause death in 24 hours.
Incubation period- 12 to 36 hours.
Symptoms- abdominal cramps, diarrhea, vomiting, cranial nerve palsies (diplopia, dysarthria, dysphonia, dysphagia, skeletal muscle paralysis and respiratory failure.
Transmission-spread through air and food. No person to person. Improperly canned foods & contaminated wounds
treatment of botulism
Induce vomiting. Enemas
Antitoxin-no vaccine available.
Mechanical ventilation, penicillin
Toxin can be inactivated by heating food & drink to
212 degrees F. or 100 degrees C. for at least 10 minutes.
Plaque (Yersinia Pestis)
Bacteria found in rodents and fleas.
Form:
a. Bubonic- most common
b. Pneumonic
c. Septicemic-most deadly
Symptoms-hemoptysis, cough, high fever, chills, myalgia, headache, resperatory failure, and lymph node swelling
Incubation-2 to 4 days.
Transmission- direct person to person spread. Also transmitted through flea bites and ingestion of contaminated meat.
Treatment- antibiotics only effective if administered immediately.
a. Streptomycin or gentamycin drugs of choice
b. Vaccine under development
c. Hospitalization with isolation for containment.
Tularemia-francisella tularensis
Bacterial infectious disease of animals. Mortality rate is 35% without treatment.
Incubation-3 to 10 days with sudden onset.
Symptoms- fever, swollen lymph nodes, fatigue, sore throat, weight loss, pneumonia, pleural effusion and ulcerative sore from tick bite.
Transmission- no person to person. Aerosol or intradermal route. Spread by rabbits and ticks, contaminated food, air, and water.
Gentamycin is treatment of choice. May also use Streptomycin, doxycycline and ciprofloxin.
Vaccine in developmental stage.
hemmoraghic fever
Caused by several viruses including Marburg, Lassa, Junin and Ebola
Symptoms: fever, conjunctivitis, headache, malaise, prostration, hemorrhage of tissues and organs, nausea, vomiting, hypotension and organ failure.
Transmission- carried by rodents and mosquitoes, direct person to person spread by body fluids and virus can be aerosolized.
Treatment-No IM injections, no antiplatelet drugs, isolation for containment.
Ribavirin (Virazole) effective in some cases. No known treatment available.
chemical agents of terrorism
Chemicals are categorized by target organ or effect.
Nerve – Sarin, Tabun, Soman, GF and VX
Sarin is highly toxic nerve gas that can cause death within minutes of exposure. It enters through the eye and skin and acts by paralyzing respiratory muscles.
Antidotes for nerve gas poison:
a. Atropine
b. Pralidoxine chloride (2-PAM chloride)
c. Multiple doses may be needed.
chemicals continued
Blood-Hydrogen cyanide and Cyanogen chloride
Pulmonary- Phosgene, Chlorine, Vinyl Chloride
Phosgene is a colorless gas used in manufacturing. If
inhaled in high concentrations for long enough, it will cause severe respiratory distress, pulmonary edema and death.
Blister/Vesicants- Nitrogen and sulfur mustards, lewisite ( arsenic compound), phosgene oxime.
Mustard gas is yellow to brown in color. Has garlic-like odor. Irritates eyes, causes skin burns & blisters.
Protocols vary in treating exposure to specific agent.
radiologic nuclear agents
Radiologic dispersal devices (RDDs)
a. “Dirty Bombs” consist of a mix of explosives &
radioactive materials (pellets)
b. When detonated blast scatters radioactive dust,
smoke & other material into the surrounding
environment, resulting in radioactive
contamination.
c. Main danger results from explosion causing serious
injuries and casualties.
d. Agents used ( uranium, iodine 131 ) do not usually
generate enough radiation to cause immediate
serious illness except to those in close proximity.
e. Radioactive dust & smoke can spread and cause
illness if inhaled.
f. Radiation cannot be smelled, seen, felt or tasted
or measured to limit contamination so covering
nose & mouth & decontamination shower needed
Ionizing Radiation
a. Such as from a nuclear bomb or damage to a reactor
is serious threat to safety of casualties and
environment.
effective response of bioterrorism
If there is a widespread terrorist attack, nurses at all levels and types of health care settings have the potential to become involved.
Health care providers must know modes of transmission, incubation periods, symptoms and communicable periods of these diseases as outlined by the CDC.
Once an outbreak is detected it is brought to the attention of the appropriate health care agency or specialist in infectious diseases. All nurses should
effective response of bioterrorism (cont)
have accurate around the clock info on resource available in their geographic area.
Nurses will use skills of clinical evaluation & history taking to ID infective organism, mode of transmission and source of explosion.
Nurses will also play an important role in managing post-exposure prophylaxis & its complications, as well as psychological and mental health problems brought by the event.
response training
American College of Emergency Physicians in alliance with the American Nurses’ Association submitted a list of recommendations to Health and Human Service Office of Emergency Preparedness in April 2001.
a. Nurse education programs need to include this
in their curriculums
b. ER nurses should have self-study modules and
other specialty programs for this
ANA actively involved in preparing nurses to respond to bioterrorist events. With Dept. of Human Services a National Nurse Response Team (NNRT)started
activation and deployment
In event of bioterr0rist disaster, NNRT activated to respond by providing mass immunizations or chemoprophylaxis to population at risk
NNRT under the Dept. of Health & Human Services will quickly be deployed in response to a major national event.
Goal: recruit 10 regional teams of 200 nurses.
When deployed, NNRT becomes federalized and federal government pays salaries, housing costs etc.
Limited to 2 week deployment. Nurses will have key role in educating public.
