Prevention and Treatment of Influenza (Flu)

This study focuses on the prevention and treatment of influenza (flu), particularly in hospital settings. It explores the strategies to combat hospital-acquired influenza and emphasizes the importance of personal protective equipment. The study includes qualitative interviews with nurses to gather insights and develop evidence-based practices for effective influenza control.

Running head: NURSING
Prevention and Treatment of Influenza (Flu)
Name of the Student
Name of the University
Author Note

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Part: 1
Influenza Control and Prevention in Hospital
Introduction
Influenza or Flu is a viral borne respiratory disease. It is caused by influenza virus or
human influenza virus (influenza A and influenza B) and results in seasonal outbreak of flu
epidemic per year. It is highly contagious disease and is transmitted from one infected person
to a healthy individual through direct contact, through the droplets of sneezing and via cough
as the virus is airborne. An infected individual is capable to spreading infection to another
person at least 6 feet apart. Common signs of flu are fever, cold and cough along with runny
nose and body ache (CDC, 2019). As per CDC report, 37.4 million to 42.9 million people
encounters flu infection per year leading to 531,000 to 647,000 flu associated hospitalization
and 36,400 to 61,200 flu deaths per year. However, CDC (2019) highlights that the seasonal
occurrence of flu is preventable by the administration of flu vaccine per year. This vaccine is
termed to be life saving for children.
The study undertaken by Jhung et al. (2014) highlighted that hospital acquired cases
of influenza is associated with greater length of stay at the hospital along with high rate of
mortality in comparison to the hospital acquired cases of influenza. Hospital acquired
influenza play an important role in modulating the clinical outcome of the hospitalised
patients mainly among the individuals with chronic medical conditions. Thus the aim of this
paper is to highlight the approaches of combating hospital acquired influenza (HAI). The
approaches will mainly highlight protective measures that must be taken by the hospital
authority in order to reduce the chances of hospital acquired infections.

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Research hypothesis
Kaye et al. (2014) are of the opinion that hospital associated infection or noscomial
infection are detrimental for the life of the patients as it increase the risk of mortality,
increased length of stay at the hospital along with increased cost of care. Mehta et al. (2014)
have reported in the study that use of the WHO’ five step of the hand hygiene protocol is
helpful for the prevention of the hospital-acquired infections and thereby helping to improve
the overall quality of care. However, use of proper hand hygiene protocol or the use of the
personal protective equipments is not comprehensive for the prevention of the spread of the
HOI among the patients as the virus is air borne and can travel through air with a distance of
6 feet (CDC, 2019).
Elucidation of the proper approach for the prevention of the HOI will help in the
generation of the evidence based practice for effective influenza control and thereby helping
to refine quality of care for patients. The evidence based practice is defined as the process of
integration of clinical practice guidelines, patients’ values and other evidences of research
towards decision making process for the patients’ care plan (Kaye et al., 2014).
The main research hypothesis issue of protective measures other hand hygiene is
effective for the prevention of the HAI.
Self-evaluation
The process of the self-evaluation under this practice will deal with the assessment of
nursing knowledge in the domain of influenza, its mode of transmission, the seasonal
outbreak and the occurrence of hospital acquired influenza is fatal of the immune-
compromised patients’. The knowledge and the level of understanding will also be assessed
in the domain of importance of hand hygiene and the use of the personal protective
equipments for the prevention of the hospital acquired infection. The nursing professionals

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who are found to be lagging behind the knowledge and the expertise of the infection control
policies will be trained and educated in order to provide comprehensive care to the patients.
In this practice by defining the role of the nurses in control and prevention of the HAI will
help to bring a difference in the work practice.
Literature review
The review of the literature conducted on the basis f the papers published during the
last five years highlighted some of the measures undertaken by the hospital administration of
the nurse managers in order to avoid the chances of the HAI. One them, one research that
directly coincided with the scope of this research proposal is the study undertaken by
Amodio, Restivo, Firenze, Mammina, Tramuto and Vitale (2014). Amodio et al. (2014)
collected from seven consecutive influenza seasons during 2005 to 2012 under the Italian
healthcare perspective and analyzed those data retrospectively. The analysis of the data
highlighted that risk of nosocomial influenza like illness (NILI) among the patients admitted
under the acute care of hospital can be reduced by increasing the overall vaccination coverage
among the healthcare workers. The study mainly offered a reliable yet cost-saving approach
for the effective management of the HAI. The systematic review undertaken by Dancer
(2014) focused on controlling the chances of the hospital-acquired infections. The review
proposed that simple cleaning methods must be upgraded to non-manual disinfections by the
use of the standardized sampling and surveillance techniques. However, this approach has
sudden limitations for giving protection to HAI as the cleaning approaches for the prevention
of HAI mainly targeted towards the multi-drug resistant bacteria and virus causes influenza.
Moreover, the use of the technology-based approach for the process of disinfection might
increase the overall cost of the hospital. Mehta et al. (2014) review helped in the
identification of the other general procedure of the infection control under the hospital

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settings and this include keeping the immune-compromised patients in isolation like in
separated cabin in order to prevent the risk of the HAI. The tenure of isolation precautions,
and restricting activity area for patients with prospective cases or confirmed cases of
influenza is ascertained by the anticipated period of overall viral shedding and infectivity.
Moreover, Mehta et al. (2014) also recommends that the vents of the air conditioner machine
must be disinfected regularly along with fumigation of the room after one patients’ is
discharge and new patient is admitted in order to skill the susceptible bacteria and virus
causing the infection.
The main gap in the literature is, the review fails to highlight any definite evidence-
based strategy for controlling and preventing influenza in hospital. The only strategy that is
being identified is the use of vaccination of the healthcare professionals. However, such
vaccination strategy of the healthcare professionals might hamper the autonomy of the
professionals. Moreover, the research approach was conducted based on the perspective of
the Italian healthcare organization.
Thus the aim of this proposal will be elucidate the evidence based strategy for the
effective protection and control of HAI via conducting the face-to-face qualitative interview
of the nurses in five different hospital units in Australia. The selection of the hospitals will be
done on the basis of the vulnerability status of influenza occurrence by the Australian
Influenza Surveillance Report and Activity Updates.
Methodology, data collection and analysis method
Research methodology
Research methodology is an important part of research and helps to highlight the
process that will be used for the process of data collection and data analysis. The research

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methodology is popularly explained with the help of research design (Mayer, 2015).
According to Saunders et al. (2015) research design is like research onion and each layer of
the onion signifies each layer of the research. The first part of the research opinion is research
philosophy and deals with the development of knowledge in particular field. There are
different types of research philosophy like positivism, realism, interpretivism and
pragmatism. In this research, the researcher will make use of the interpretivism research
philosophy. This research philosophy is suitable for qualitative research and helps to explore
lived experience of the people and thus it will be helpful in the establishment of evidence-
based practice (Mayer, 2015). Research approach is the second layer of the research onion
(Saunders et al., 2105). There are two type of research approach, inductive and deductive
approach. In this research, the researcher will make use of the deductive research approach as
it concentrates n the identification of the theories and testing the theory by the use of data.
Here the theory of personal protective equipment and use of vaccination of the healthcare
professionals will be validated. The research strategy will be survey style with qualitative
method of data analysis. The time horizon will be cross-sectional research as the interview
will be taken at single point of time unlike longitudinal research that takes data at several
point of time (Mayer, 2015). For the selection of the prospective candidates for the interview,
purposive (non-probability) sampling procedure will be used.

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Figure: Research onion
(Source: Saunders et al., 2105)
Data collection
The process of collection of data will be done based on the qualitative face-to-face
interview that will be conducted over 20 nurses selected from five different hospital unit of
Australia. The interview will last for 30 minutes and will consist of 10 questions and the
entire interview session will be recorded with the help of didgital audio recorder (Ranney et
al., 2015).
Data analysis
The recorded interview will be decoded in the written transcript format by a
professional transcriptionist. The analysis of the data will be done in a qualitative format.
Qualitative research helps in understanding of the human condition under different contexts

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and during the perceived situations. Under qualitative research several methods of data
analysis are used however, here the researcher will make use of the content analysis of the
data. Content analysis helps to reduce gamut data of the interview in a consider format and
thus helping to evaluate the significant themes arising from the interview (Bengtsson, 2016).
The process of context analysis that will be used in this research is highlighted below in the
diagram.
Figure: Process of content analysis
(Source: Bengtsson, 2016)

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Validity of the research
Initial framing of the open-ended questions will be done based on the gaps indentified
in the review of literature. After framing of the interview questions, the list will be verified by
a team a nurse manager. Based on their feedbacks on the level of complexicity of the
interview questions, modifications will be done and this will help to uplift the overall validity
of the research
Ethical, cultural and religious considerations
The main ethical considerations that will be considered in the research include privacy
and confidentiality of the participants of the interview. It is the duty of the research to
conduct the research as per the Data Protection Act and privacy and confidentiality issue falls
under the norms highlighted in the Data Protection Act. In order to ensure privacy and
confidentiality of the participants’ information, the name and other identification details will
not be disclosed in the study. All the identification related information will be kept secured
and will not be disclosed under any circumstances (Widodo, 2014). The written transcript
that will be generated from the audio files will be reviewed by the respective participants
before those are finally used in the study. The informed consent that promotes autonomy of
the participants also falls under the Data Protection Act. The informed consent will highlight
the purpose of the interview and the scope of the research. It will also highlight that none of
them are compelled to take part n the interview and are free to leave the interview session at
any point of time without any prior notice. The prospective participants who will give the
consent will be selected for the interview process. Before approaching the nurses, permission
will be taken from respective healthcare organisation. The interview questionnaire will be
culturally competent and will not contain any question that will harm the sentiments of the
participants (Widodo, 2014).

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Personal protective equipment guideline
The personal protective equipment that might be applicable while conducting the
interview within the hospital settings include face masks, aprons, head caps and hand
sanitizer. The use of the personal protective equipments within the hospital premise will help
to prevent the transmission of the infection from and to the nursing professionals and thus
reducing the chances of the spread of the hospital acquired infection.
Writing safe work procedure guidelines
The analysis of the interview response will help in the generation of the evidence-
based practice for the prevention of the HAIs. This evidence-based will then be used for
framing of the Safe Work Procedures (SWP) under the hospital settings. The following steps
will followed for designing of the SWP:
Figure: Steps for SWP
(Source: Government of Western Australia, 2019)

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Conclusion
Thus from the above discussion, it can be concluded that research proposal will be
directed towards elucidating the best practice approach for the prevention of the hospital
acquired infection with the help of qualitative study. The interview will be conducted over
the nursing professionals selected form five different hospitals in Australia and content
analysis of the interview will be done.

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Part 2
Training of the nurses in relation to prevention and early treatment of influenza
The healthcare associated infections are preventable and at the same time result in
increased morbidity and mortality in hospital patients. The perceived barriers in preventing
infection for the nursing professionals who are working as registered nurses in the nursing
homes include language and culture, lack of proper knowledge and training, increased in the
strength of the part-time staffs in the nursing home units, increase in the workload of the
nursing professionals and rate of poor accountability (Travers et al., 2015). The main strategy
that can be used for overcome these barrier will include training and knowledge enhancement
of the nursing professional in order to improve the gap in practice. Proper training will help
to improve nursing skills, critical thinking skills behind the use of the protective measures for
the prevention of the hospital acquired influenza or the detection of the early signs of
influenza. A trained nursing professional will also help to increase the level of accountability
of the nurses in the infection control measures (Travers et al., 2015).
Successful interdisciplinary liaison program can be helpful for training the nursing
professionals in the domain of the healthcare acquired (HCA) infection like the influenza
infection or flu under the hospital settings (Sopirala et al., 2014). In order to establish this
training based approach Sopirala et al. (2014) conducted a training session between January
2006 to March 2008 and the intervention period was observed between the tenure of April
2008 to September 2009. Within these training sessions, the registered nursing professionals
are trained to be liaisons (link nurse) for the prevention of infection with clearly defined goals
that are aligned with the ongoing monthly education about infection control program. After
the analysis of the intervention measures it was found that link nurse program helps in
effective reduction of the cases of the hospital acquired infection. The goal-defined metrics

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with ongoing re-education for the nursing professional by the IP personnel help to increase
the knowledge and thereby helping to improve quality control of the healthcare associated
infection (Sopirala et al., 2014).
Liaw, Siau, Zhou and Lau (2014) proper for the interprofessionals simulation-based
education program for promoting training in the hospital acquired influenza control and skills
of the identification of the early signs of influenza. The interprofessional simulation-based
education program mainly promotes effective working relationship among the nursing
professionals and the doctors for fostering positive perceptions and effective collaborative
attitudes between the two healthcare professionals. interprofessional simulation-based
education program facilitate effective communication among the doctors and the nurses and
thereby helping to promote effective sharing of the important information related to infection
control and identification of the early signs of infection (Liaw, Siau, Zhou & Lau, 2014). The
sharing of the information between the doctors and the nurses help to increase the level of
theoretical knowledge about the medium of the disease transmission in case of influenza and
effective measures can be useful in giving protection against the hospital-acquired infection.
A nurse who is have knowledge about the detailed disease progression and the pathology of
the influenza virus is found to be more skilled to identify the early signs of the influenza
infection and thereby helping to implement early interventions and effective management of
the disease. Moreover, this training approach also helps to increase effective collaboration
with the nure and the doctors and thus helping to improve the overall outcome of care and
increase the provision for the multidisciplinary team support (Liaw, Siau, Zhou & Lau,
2014).
Application on nursing practice
Application of the infection control measures must be directed towards the effective
training of the nursing professionals in order to refine their skills and educating them about

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the infection control practice. Since nurses are the main healthcare professionals who spent
majority of the time with the patients, training and education of the nurses about infection
control is the first step towards the prevention of nosocomial infection (Brusaferro et al.,
2015).
Healthcare associated influenza infection mainly occurs under any healthcare settings
and more common when the influenza virus is also circulating within the community. Thus
influenza effective prevention measures must be implemented under all healthcare settings.
Nursing professionals are required to implement the supplemental measures in order to
control the seasonal outbreak of influenza under the healthcare settings like long-term
facilities or hospitals. The first preventive measure that must be implemented under the
nursing practice is the proper use of the hand hygiene (CDC, 2019). Farhoudi et al. (2016)
stated that use of WHO’s five step of the hand hygiene protocol helps to reduce the chances
of spreading of the nosocomial infection. Training of the nursing professionals will be done
under the simulation based training where both the nurses and the doctors will be trained and
educated in unison about the basic principles of hand hygiene. This will be followed by the
education and training in the domain of use of the personal protective equipment while
handling a patient who is suffering from influenza or other infectious disease. The main
personal protective equipment that will be important for the protection against influenza virus
include face mask covering both the nose and the mouth along with the hand gloves, apron
and head cap. Education will be given regarding how the personal protective equipment will
be used in a sterile form followed by the process of sterile cleaning of the aprons. Hand
gloves and face masks must be disposed safety and then destroyed eventually. The mode of
education will include manual representation of the use of the personal protective equipment.
The liaison program will be used in order to educate the nurse the all respiratory secretions

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and other bodily fluids and diarrheal stools carry the infectious pathogen. However, the
presence of the influenza virus is very uncommon in stool or blood.
Figure: WHO’s Five Steps of Hand Hygiene
(Source: WHO, 2019)
The application of the liaison program will be effective in educating the nurse about
the importance of undertaking seasonal injection of the influenza vaccination in order to
prevent the nosocomial inflectional from the grass root level. According to the Centre of
Disease Control and Prevention (CDC) (2019), prevention of the transmission of the
influenza virus and other infectious agents within the premises of the healthcare set up
demands a multifaceted approach. The spread of the influenza virus can easily occur among
the patients, their family members who come as visitors and health care professionals who
care of the patients directly. A healthcare professional might get infected with the influenza
virus quite easily from a person who resides within their household or community. Thus the

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core of the prevention strategy will include effective administration of the influenza vaccine
(World Health Organization, 2016). Liaison approach or the use of the effective
communication skills will be used in order to make the nursing professionals to understand
the importance of the vaccination for the comprehensive prevention of influenza under te
hospital settings or under their community health settings. Effective communication approach
will be used for educating the nurses about the implementation of the proper respiratory
hygiene and cough etiquette under the hospital settings. Signs and code of actions will be
enlisted in the notice boards of the hospitals stating management of ill healthcare
professionals and how early signs of influenza can be identified. The adherence of the
infection control measures will be enlisted in a colourful poster format over the bed side of
each patients along with the information about the aerosol generating procedures so that the
nurses can get an easy access of the information when in need and abide by the disease
control protocol stringently. Liaison approach will be used for giving education about proper
implementation of environmental and engineering infection control (Tacconelli et al., 2014).
Education of the people
The education of the people about the mode of transmission of the influenza and how
the transmission can be prevented must be done nursing community health nursing settings
by community health nurse of an infection control nurse. The education mode must be done
in the form of either power-point presentation or the by the use of posters and interactive
sessions (CDC, 2019). The study conducted by Zingg et al. (2015) stated that use of colourful
images and audio-visual graphics are useful medium for promoting health-education and
disease awareness among the mass. The mode of communication must be guided by simple
language with the minimal use of the medical or scientific terms so that it becomes easier for
the service users to understand the basic layout of the disease transmission. The education of
the people in the domain to control and spread of the influenza or under the hospital settings

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must begin basic introduction of influenza, mode of transmission of influenza and
fundamental elements for the prevention of influenza.
Basic introduction about influenza: Influenza is a community-based infection that is
transmitted either under the community based settings or under the healthcare settings. Mode
of transmission of influenza: Influenza is mainly transmitted from one person to another
through large particle respiratory droplet transmission (that is when infected people cough or
sneeze near a vulnerable person). The transmission via large-particle droplets mainly occurs
under close contacts between the recipient and the source this is because droplets are large
and mainly travel short distances (6 feet or less) through air (CDC, 2019). Thus, under this
context, the patients will be warned that they must never come in close contact with an
individual who is suffering from influenza. If a family member is infected with influenza, he
or she must be kept in isolation in a separate room and the infected persons’ bed sheets.
Pillow covers must be cleaned regularly with disinfectant. Moreover, the nurse will also
educate the mass about the basic norms of self-hygiene like covering the mouth and nose
while sneezing in order to prevent the spread of the infected water droplets (Baek, et al.,
2014).
The transmission of the disease also occurs via indirect contact transmission like
through influenza contaminated hands. Under this concept, the education will be given about
the importance of the hand hygiene in order to control the spread of the viral infection. Since
nurses themselves perform the five basic rules of the hand hygiene under the healthcare
settings they are the best to educate the community based population about the process of
execution of proper hand hygiene by the use of disinfectant (Baek, et al., 2014). Airborne
transmission of influenza is another detrimental mode of transmission that makes this viral
disease even more contagious and difficult to manger thus education will be given about

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cleaning of the vents of ACs for the prevention of the air borne transmission (Baek, et al.,
2014).
Conclusion
Thus from the above discussion, it can be concluded that for the effective control of
the influenza, the viral disease that spread via direct contact or by the transmission of the
viral pathogen in the air can be done by the effective education of both the nursing
professionals and the healthcare service users. The education of the nursing professionals
must be done under the healthcare settings by the sue of the liaison approach and by the use
of multimodal technique where both the nurses and the doctors will be educated in unison
and this in turn will help to promote effective partnership of the healthcare professionals. The
education of the service users will be done under community health setup by the community
health nursing professionals.

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