Hospitals given leeway in forming smallpox teams

Number of workers immunized could vary widely

Hospitals will have considerable leeway to make their own decisions about who and how many health care workers will be immunized for smallpox if the government moves ahead as expected and offers the vaccine to medical personnel.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP), recently recommended that about 510,000 key hospital workers should receive the vaccine nationally. The number is derived from estimating about 100 immunized for each of the nation’s 5,100 acute-care hospitals. However, the recommendation was made with the full expectation that the numbers of workers volunteering for vaccination could vary considerably from hospital to hospital.

"We intend that there be some flexibility," says John Modlin, MD, ACIP chairman. "It may very well be that it’s far better to leave the decision, in terms of the actual number of health care workers in any one hospital, up to not only the local public health authorities, but the people who are ultimately making the decisions in those hospitals themselves. They know their staff far better than we do."

ACIP recommended that the teams include health care workers who provide in-room medical care for the first few smallpox patients requiring hospital admission and those who would evaluate and manage patients who present to the emergency department (ED) with suspected smallpox. For the first seven to 10 days after patients with smallpox have been identified, this team would be hospital-based and provide care 24 hours a day, using eight- to 12-hour shifts. Nonessen-tial workers should be restricted from entering the rooms of patients with smallpox. ACIP recommends that smallpox hospital teams include:

  • ED staff, including both physicians and nurses
  • Intensive care unit staff, including physicians, nurses, and in hospitals that care for infants and children, this encompass pediatricians, pediatric intensivists, and pediatric ED physicians and nurses
  • General medical unit staff, including physicians, internists, pediatricians, obstetricians, and family physicians in institutions where these individuals are the essential providers of primary medical care
  • Medical house staff (i.e., selected medical, pediatric, obstetric, and family physicians)
  • Medical subspecialists, including infectious disease specialists, also may involve the creation of regional teams of subspecialists (e.g., local medical consultants with smallpox experience, dermatologists, ophthalmologists, pathologists, surgeons, anesthesiologists in facilities where intensivists are not trained in anesthesia) to deliver consultative services
  • Infection control professionals
  • Respiratory therapists
  • Radiology technicians
  • Security personnel
  • Housekeeping staff (e.g., those staff involved in maintaining the health care environment and decreasing the risk of fomite transmission).

Clinical laboratory workers are not included in the initial phase of pre-attack smallpox vaccination because the quantity of virus likely to be in clinical specimens of blood and body fluids is low. Consistent adherence to standard precautions and CDC protocols will prevent exposure to virus in clinical specimens. Although it is not recommended that emergency medical technicians (EMTs), as a group, be vaccinated in this first phase, individual hospitals may identify and include hospital-based EMTs (i.e., personnel who would be dispatched to transport patients with suspected smallpox) on their smallpox care teams, ACIP recommended.