By Debra A. Cooper, RN, MSN, MBA/HCM, CIC, CPHRM, Coverys Senior Risk Specialist

The following blog post is part one of a three-part series, "Zika: Keep Your Patients and Practice Safe". Be sure to also read part two about what to tell your patients, and part three about how to reduce risk to healthcare workers and stay abreast of the latest Zika news.

Since recent Zika outbreaks have become known, everyone in the healthcare arena has heard much about the virus, its transmission, and its widely variable impact on patients. But hearing about it and doing something about it are two different things. And to halt or slow the outbreak, we must do something. 

Because the clinical symptoms of Zika virus disease are easily overlooked, clinicians and healthcare facilities need to place the potential of a person having Zika virus disease in the forefront of planning and preparations. Putting Zika on the radar in a deliberate and proactive way is the best way to ensure that the patient can be appropriately treated and managed, precautions can be implemented, and potential adverse outcomes associated with Zika infection can be mitigated. 

Where to start? By increasing the index of suspicion when assessing patients and developing a method to screen and identify patients who may have the virus or who may have been exposed to the illness, appropriate interventions and precautions can be implemented.

Office Readiness: Five Tips for Recognizing and Responding to Zika
  1. Go ahead … think zebras. When making a diagnosis, physicians and other healthcare practitioners know that “common things happen commonly.” They know that a headache is usually just a headache and that a rash is often just a contact reaction to an allergen. But when it comes to Zika virus, the tell-tale signs aren’t always that telling, so it’s important that clinicians be connecting the dots. 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 a Zika infection or who has recently visited an outbreak region, consider testing for the virus. Symptoms to look for include a smooth skin rash or redness that is covered with elevated bumps (usually starting on the face and then spreading elsewhere), a fever of 100.4° F or higher, joint pain, muscle pain, conjunctivitis, headache, pain behind the eyes, or vomiting. Also, remember that many Zika patients are asymptomatic, so it’s crucial to screen for risk factors, as outlined below.
  2. Triage with Zika in mind. Screening questions should be a top priority to help you increase the index of suspicion for Zika infection. There are a number of questions that can be asked of patients to determine if they are at risk of having the illness or not. The risk factors for getting infected may be easily converted into a short triage questionnaire. Consider asking the following questions during triage:
    1. 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. The newest maps should include two areas in Florida.)
    2. Have you recently had sexual contact (protected or unprotected) with a person who has 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.)
    3. Have you recently had sexual contact (protected or unprotected) with a person who has recently been diagnosed with Zika virus?
  3. Leave nothing unsaid. Because the incubation period for Zika is approximately two days, you should consider providing – orally and in writing – an inclusive list of signs/symptoms that could be associated with Zika infection that your patients may have experienced. These include the clinical symptoms addressed in Tip #1 above, as well as chills, loss of appetite, sweating, and lethargy. 
  4. Get prepared now for the possibility of diagnostic testing. As of the time of this writing (August 2016), there were four major diagnostic tests available. However, availability of these tests varies widely from state to state and region to region. It’s crucial that clinicians proactively contact their local or state health department now, if they have not already done so, to get specific information about what specimens to collect (e.g., urine, blood), any special requirements for collection or storage of specimens, and where and how the specimens should be sent for testing.
  5. Know how to serve the patient’s health as well as the public’s health. If the results of Zika testing is positive, the infection must be reported to your local health department. In the case of an infected patient who is a pregnant female (for whom an infection could result in microcephaly or other severe brain defects for her baby), a clinician should be aware that the CDC has established the US Zika Pregnancy Registry. A 24/7 consultation service for health officials and healthcare providers caring for pregnant women is available at 770-488-7100. 

Want to know more about how to prepare and respond to Zika? Be sure to read parts two and three of this three-part series on Zika virus.

No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.