bioterroism readiness plan, health care facilities

Youll be happy to know that our government currently has in place a bioterroism readiness plan for health care facilities.  The plan was finalized in April 1999.  Hospitals and clinics my have the first opportunity to recognize and initiate a response to a bioterrorism-related attack.  Because of this, the plan encourages all healthcare facilities to utilize infection control policies to enable them to rapidly implement prevention and control measures in response to a suspected outbreak.  One of the problems with a bioterrorism attack is that we may not know an attack has occurred until the initial exposure has passed, due to the incubation time of some of the potential infectious agents.  The governments bioterrorism readiness plan reports that agents of bioterrorism are generally not transmitted from person to person and re-aerosolization of such agents is unlikely.  The plan acknowledges the possible psychological responses to a bioterrorism event, including horror, anger, and panic, unrealistic concerns about infection, fear of contagion, paranoia, social isolation, or demoralization. The plan makes recommendations on how to respond to these problems.  One of the components of a healthy psychological response is education.  Below is a discussion of some of the possible infectious agents and the resulting symptoms: Anthrax occurs most frequently in sheep, goats, and cattle, which acquire infectious spores through ingestion of contaminated soil.  Humans can become infected via inhalation, direct skin contact, or via the gastro-intestinal (GI) system.  Pulmonary (lung) infection initiates with flu-like symptoms and is treatable in the early phase.  If treatment is initiated after the onset of more serious respiratory symptoms, mortality remains high despite antibiotic treatment.  Skin infection manifests itself first with localized itching, followed by lesions that ultimately turn black.  The skin infection is usually non-fatal if treated with antibiotics.  GI infection involves abdominal pain, nausea, vomiting and fever following the ingestion of contaminated food, usually meat. The condition is usually fatal in the later stages.  Transmission of anthrax infections from person to person is unlikely.  The most poisonous toxin known causes botulism.  Food born botulism is the most common form of disease in adults.  Infected people will have no fever, but suffer drooping eyelids, weakened jaw clench, and difficulty swallowing or speaking.  Blurred vision, paralysis (first of arms, then respiratory muscles, then legs) and respiratory dysfunction may follow. Botulism is not contagious and the Department of Defense has developed a vaccine for botulism.  The plague is usually transmitted by fleas, but would most likely be applied airborne in a terrorist attack.  Symptoms include fever, cough, chest pain, and blood in sputum.  The disease can be transmitted person-to-person via coughing.  The plague is treated with antibiotics.  The bioterroism readiness plan advises the stockpiling of antibiotics needed to fight the disease.  Smallpox is a virus that has essentially been eradicated from the common population.  No one has had smallpox for 20 years.  It poses a bioterrorism threat due to its potential to cause severe morbidity in a non-immune population and because it can be transmitted via the airborne route.  A single case of smallpox is considered a public health emergency.  Smallpox resembles influenza at the onset. Infected patients develop fever, body-aches, and a rash on the face and extremities (including palms and soles) which ultimately scabs over in 1-2 weeks.  The rash pattern differs from chicken pox in its location and course.  Small pox is highly contagious, but people are only infectious at the onset of the rash and remain infectious until their scabs separate (approximately 3 weeks).  Tulameria is caused by one of the most infections pathogenic bacteria known. It requires only inoculation or inhalation of as few as 10 microorganisms to cause the disease.  In the United States, the disease has occurred sporadically or in small clusters.  Symptoms are similar to the flu, and the disease is easily treated with common antibiotics.  What can you do about a possible bioterrorism attack?  Pragmatically, there really isnt anything you can do personally to protect yourself from a bioterrorism attack.  Once an attack becomes evident, you should follow the directions of your government.  Should you or any of your friends, family or co-workers develop any of the above symptoms, it might be prudent to see a physician as soon as possible.  You might want to pay closer attention than usual to flu-like symptoms.  Remember, a bioterrorist attack will not become evident until an unusually high number of individuals seek medical treatment at their health care facility.  This horrifying threat is not new (the governments plan was finalized in April of 1999).  Whether you knew it or not, weve been facing this threat for quite some time and it has not stopped us from living our lives in the past.  We should continue to live our lives and enjoy our freedoms now as best we can.  The Bioterrorism Readiness Plan: A Template for Healthcare Facilities was prepared by The Association for Professionals in Infection Control and Epidemiology (APIC) and the Centers for Disease Control and Prevention (CDC).  The document is available at www.cdc.gov.  The Law Office of Steven C. Schurr

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