Botulism and Bioterrorism: APRN Practice and Intervention Strategies

This report delves into the public health threat of botulism, examining the causative agents like Clostridium botulinum and its potential use as a bioterrorism agent. It discusses the high toxicity of the botulism toxin, its ease of production, and historical instances of concern. The report highlights the critical role of nurses and other healthcare professionals in the multidisciplinary team, emphasizing the need for training and education to handle crisis situations. It outlines the importance of early assessment, intervention strategies, and the application of standard precautions. Furthermore, it explores the implications for Advanced Practice Registered Nurses (APRNs), including their roles in patient assessment, intervention, and community impact, while also addressing emergency and long-term concerns. The report references various sources to support the claims made and emphasize the importance of preparedness in the face of this significant public health concern.

1Running head: EPIDEMIOLOGY
Epidemiology
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Botulism is a rare but serious illness caused by a toxin that causes severe morbidity
and even mortality. Botulism has drawn attention in the recent past as a potential tool for
bioterrorism that aims to cause mass mortality when applied on a large scale (Jansen et al.,
2014). The present paper discusses botulism and describes the agents of the disease, the ways
in which it might be used for bioterrorism and examples of terrorist events using this
particular agent. Further, the implications for advance practice nurse APRN practice is
highlighted that can be applied for encountering an individual or community affected by this
disease. In addition, emergency and longer-term concerns along with recommended
interventions are also pointed out.
The causative agent of Botulism in the toxin made by Clostridium botulinum and
sometimes Clostridium butyricum and Clostridium baratii bacteria. These bacteria are
present in a number of sources; however, they are not common to cause disease conditions.
Under certain circumstances, the spores of the bacteria grow and secrete toxins that are lethal.
The toxin acts in the body by attacking the nerves, thereby making the muscles weak.
Muscles that are responsible for controlling the mouth, face, throat and eyes are mainly
affected. Botulism also weakens the muscles involved in breathing. As a result, the individual
suffers difficulty in breathing and might eventually die (cdc.gov, 2017).
Botulism and bioterrorism have been linked by a rich pool of literature in the recent
few years as botulism toxin is a potential biological agent for destruction (Jansen et al.,
2014). After the 9/11 attack in the US, the possibility of using biological agents by terrorists
have been in prominence. The toxin had always been on the list of important bioweapon
candidate agents. The reason for this is the high levels of toxicity that it presents. The
bioterrorists find the toxin agent convenient to use since the bacteria can be grown in an easy
manner. In addition, the toxin can be produced in large quantities rapidly. This is why it is a
significant candidate for the bioterrorist's arsenal. As opined by Adler and Franz (2016) the

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agent has received much public attention after investigators found a vial of the bacteria in
Iraq after the demise of Saddam Hussein. In 1991, after the end of the Gulf War, the country
had put forward a claim that they had produced huge quantities of the toxin. If such were the
case, it would have been adequate to kill the entire human population on earth.
Literature points out that nurses have a significant role in the multidisciplinary team
who is supposed to care for a patient receiving treatment for botulism. Nurses are to be
prepared further through training and education so that they can handle situations of crisis in
a more advanced and effective manner. The common response received from study
participants in due course of research is that since nurses are to spend a considerable amount
of time with the patients, they are in a position to assess the patient condition in a better
manner and deliver best interventions. Nurses also play a role in guiding patients with
different forms of exercise that patients can benefit from (Keller et al., 2017). Nurses are
involved in the care process at the initial stages and therefor are able to identify the
impairments of the patient and the issues that are faced by the wider community.
The use of botulinum toxin as a biological weapon mainly occurs by aerosolization,
and through intentional contamination of food and water supplies. Patients are to be managed
through standard precautions (Weant et al., 2014). Health care professionals, including
nurses, are to undertake needs assessment for defining complications that arise due to
botulism. Interventional opportunities would come up on the basis of such assessment. For
having a substantial impact on the community, interventional strategies must be planned and
based on best evidence. These are also to be complementary, comprehensive and reinforcing
(Jansen et al., 2014).

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References
Adler, M., & Franz, D. R. (2016). Toxicity of Botulinum Neurotoxin by Inhalation:
Implications in Bioterrorism. In Aerobiology (pp. 167-185).
Botulism (2017). Cdc.gov. Retrieved 9 November 2017, from https://www.cdc.gov/botulism/
Jansen, H. J., Breeveld, F. J., Stijnis, C., & Grobusch, M. P. (2014). Biological warfare,
bioterrorism, and biocrime. Clinical Microbiology and Infection, 20(6), 488-496.
Keller, J., Cover, K., Snider, A., Buckley, M. L., & Lutmerding, M. R. (2017). Central Ohio’s
Regional Response to the Largest Botulism Outbreak in 30 Years. Prehospital and
Disaster Medicine, 32(S1), S52-S53.
Weant, K. A., Bailey, A. M., Fleishaker, E. L., & Justice, S. B. (2014). Being prepared:
bioterrorism and mass prophylaxis: Part II. Advanced emergency nursing
journal, 36(4), 307-317.