Forewarned is forearmed

Will you know Zika when you see it? Debra Cooper, senior risk specialist for Coverys, outlines how to prepare for patient safety.

The outbreak of the Zika virus has led providers and patients to be on high alert due to the fairly limited amount of available information as well as the varied impact it can have on patients.

What we do know? The Zika virus is an infection spread via two known species of mosquitoes, Aedes aegypti and Aedes albopictus, both aggressive daytime biters. In addition to infection through mosquito bite, the virus can be transmitted through many different body fluids.

An experimental vaccine for a Zika infection is currently in clinical trials. Additionally, new ways to prevent contraction and spread of the disease are surfacing regularly. Because Zika is difficult to identify, it is important that providers are armed with the appropriate information and tools to best screen and educate patients, while being able to recognize and respond to the virus.

Recognizing and responding to Zika

1. Connect the dots with symptoms

When dealing with Zika, it is important for providers to be hyper alert and connect the dots with symptoms such as headaches and rashes that may have previously been addressed as isolated events. If you have a patient with any of the following symptoms, and they have also been to an area of known Zika outbreak or had sexual contact with someone who has had Zika, consider testing for the virus.

Symptoms can include fever of 100.4°F or higher, rash (usually beginning on the face and spreading elsewhere), conjunctivitis (pink-eye), joint pain, muscle pain, or a headache. The Centers for Disease Control and Prevention (CDC) notes pain behind the eyes and vomiting are also symptoms of Zika infection. Although many of these are visible, patients that have contracted the virus typically do not feel the need to be tested or even go to the hospital for one of these symptoms alone. In fact, many Zika patients are entirely asymptomatic, so it’s crucial to screen for risk factors.

2. Screen patients with Zika in mind

Preventive measures begin with providers ensuring they ask the right questions while taking a patient’s history—be it medical, travel, or sexual history. It is important for physicians and healthcare professionals to ask patients these types of screening questions to determine who has been at risk and who could potentially be carrying the disease, especially if they display one or more of the symptoms previously mentioned. When screening patients, consider asking these three main questions:

• Have you recently traveled to an area that is known to have local transmission of Zika virus? (You can download a map of these areas from the CDC. As of September 2016, the newest maps should include two areas in Florida.)
• Have you recently had sexual contact (protected or unprotected) with a person who recently traveled to an area that is known to have local transmission of Zika virus? (This could be any type of sex, including genital, anal, or oral sex.)
• Have you recently had sexual contact (protected or unprotected) with a person who has recently been diagnosed with Zika virus?

3. Leave nothing unsaid

The incubation period for Zika is approximately two days. As such, providers should give patients a comprehensive list of symptoms that may be associated with Zika so they can address these during screening. In addition to the symptoms mentioned above, additional symptoms such as chills, loss of appetite, sweating, and lethargy can also be signs of Zika infection.

4. Know the scope of diagnostic testing

It’s imperative that providers contact their local and state health department in advance to know what testing options for Zika are available. At this time, there are four major diagnostic tests available to identify Zika. Providers are responsible for knowing specific information like what specimens should be collected as well as any special procedures for collecting and sending specimens for testing to local facilities.

5. Serve the patient’s and the public’s health

Finally, if Zika testing is positive, this is a reportable illness that must be reported to the local health department. Should the infected patient be a pregnant female (for whom an infection could result in microcephaly or other severe brain defects for her baby), a provider should be aware that the CDC has established the U.S. Zika Pregnancy Registry to collect information and learn more about pregnant women in the US with Zika and their infants. A 24/7 consultation service for health officials and healthcare providers caring for pregnant women is available.

Education is key

In order to properly serve patients and address their concerns about the Zika virus, education is key. Keep these points in mind when discussing the potential risks and preventive measures that can and should be taken to reduce the risk of exposure to the Zika virus:

• Self-protection with mosquito repellent, clothing that covers arms and legs, and by staying indoors

With the Zika outbreak reaching the continental US, many patients are wondering what they can do to protect themselves from the risk of mosquito bites that could transmit the virus. The CDC has shared several Environmental Protection Agency (EPA) - registered insect repellents that have been approved and proven safe for children, pregnant and breastfeeding women.

The CDC has also provided additional guidance on preventive measures providers should be aware of and advise to patients including: wearing long-sleeved shirts and long pants; staying indoors when possible to avoid the risk of mosquito bites; and checking inside and outside of your house to clean out areas of standing water and other natural breeding grounds for mosquitos which may carry the disease.

• Avoid sexual contact with potentially infected individuals

As we’ve come to learn that the Zika virus disease can be transmitted through sexual interactions in addition to mosquito bites, it is extremely important to convey these risks to patients. As Zika virus can be transmitted through many body fluids, self-protection is of the utmost importance; patients should be advised that even protected sex with an infected partner still carries a risk of spreading the disease.

• Avoid travel to areas that could put you at risk

Patients who are pregnant, planning to become pregnant, or have a pregnant partner should avoid traveling to Zika areas. If traveling to an active Zika area is a must, have an open conversation with the patient to cover potential risks and preventive measures for protection noted above. For couples who may be traveling to or living in Zika areas, the CDC recommends different wait periods for men and women trying to conceive. For women with symptoms, it is recommended they wait at least eight weeks after symptoms start. For men, the recommendation is six months after the start of symptoms before trying to conceive. The longer period is due to the unknown of how long Zika virus remains present in semen.

Train staff to protect themselves

As a provider, it’s important to ensure staff members are familiar with the symptoms and follow proper procedures and processes for reporting Zika cases to avoid transmission of the virus. Since Zika is found in body fluids, healthcare employees should follow standard precautions to prevent unprotected exposure to blood and body fluids such as vaginal secretions and semen, in keeping with the Bloodborne Pathogen Standard from Occupational Safety and Health Administration (OSHA).

Staff should also follow proper procedures when it comes to the collection of samples and following sharps precautions when necessary. The appropriate personal protective equipment should be worn if there’s a risk of coming in contact with the bodily fluids of a patient who has been diagnosed or is suspected of having Zika infection.

In August 2016, the Food and Drug Administration (FDA) issued further precautionary recommendations for Zika testing which recommends universal testing of donated whole blood and blood components for Zika virus in the US and its territories. This recommendation comes as there is still a lot to be learned of this disease and its transmission. Through this recommendation, the hope is that there will be greater surety of safe blood transfusions for those who are in need. Making sure you and your staff are up to date on latest developments and advisories like this is important to keep patients informed and protected.

Do your part to stop the spread

Knowledge is power. As a healthcare provider, be sure to stay on top of the news and developments put out by the FDA, CDC, the World Health Organization, and your state health department. As a provider, it’s your responsibility to ensure all staff and patients are aware of the symptoms, risks, and preventive measures that can and should be taken in order to reduce the potential spread of the Zika virus disease. The sharing of knowledge and findings will support the efforts to limit continued transmission and may ultimately help lead to a possible vaccine.

Debra A. Cooper, RN, MSN, MBA/HCM, CIC, CPHRM, is senior risk specialist for Coverys.