Here is an unsettling update: As of January 15, 2008, a total of 350 confirmed human cases of avian influenza have been reported from 14 different countries, and 217 of these victims have died.1 The World Health Organization is closely monitoring the threat to global health posed by avian influenza.1 As convincingly demonstrated during the 2005 outbreak of severe acute respiratory syndrome (SARS) in China and Canada, nurses and other frontline healthcare workers will be at high risk of exposure, illness, and even death should the avian flu virus acquire easy human-to-human transmissability. Protecting these individuals from illness or from infecting their own families and their patients will be a high prioritiy.2

Critical unresolved issues, such as which types of personal protective equipment (PPE) are effective, and whether or not such equipment will be available when needed were addressed in a recent report by the Institute of Medicine.2 PPE for healthcare workers includes respiratory and dermal protection as well as protection of mucous membranes and the eyes. One of the most important yet misunderstood items of PPE is the respirator. An effective respirator covers at least the nose and mouth and protects the wearer from inhaling hazardous airborne particles. Respirators operate either by filtering inhaled air or by supplying breathable air to the wearer.2 Because air-purifying respirators must be tightly sealed to the wearer's face, they must be fit-tested annually. Standard surgical or procedural masks do not offer adequate protection against influenza.

The time to think about issues related to work and influenza is now, not when we are already in the throes of a pandemic.3 Another consideration for nurses is their ethical obligation as healthcare professionals during a national crisis. A good place to start is by reading "Ethics: What Would You Do? Ethics and Infection Control" at the Online Journal of Issues in Nursing4 and the American Nurses Association "Code of Ethics for Nurses."5

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