Hospitals advised to play it safe when it comes to H1N1
Hospitals advised to play it safe when it comes to H1N1
It's uncertain whether a more virulent form will return in the fall
Just when you thought it was "out," it pulls you back in — the H1N1 virus, that is. After dramatic headlines and dire warnings from the World Health Organization (WHO) in the early days of this global outbreak, hospitals and infection control specialists swung into action. Facilities such as Clarian Health in Indianapolis temporarily restricted non-essential patient visitors at its downtown hospitals. In addition, Clarian asked families to limit the number of people accompanying patients to the emergency department; outpatient surgery waiting rooms and procedure areas; and primary care and specialist physician offices.
After those early days, however, things seemed to have settled down. The numbers of new cases appeared to be leveling off, and we were assured that the rising number of total cases was simply due to confirmation of lab results from samples that had previously been submitted.
But as we go to press, a middle school administrator in Queens, NY, has died as part of a new outbreak, and concerns are being reignited. According to WHO, there have been 8,480 confirmed human cases of swine flu in 39 countries, including 72 deaths. The United States has reported 4,714 laboratory-confirmed cases, including four deaths; Mexico has 2,895 cases and 66 deaths; and Canada has 496 cases, with one death. Infection control experts, however, put this into perspective by pointing out that in a typical year about 36,000 people die in the United States from "normal" seasonal flu.
Still, health care professionals are taking no chances, especially because the flu pandemic of 1918 started in a similar, relatively benign fashion, and then returned with a vengeance in the fall of that year. "It looks now like a new but another seasonal flu virus," says Katherine West, BSN, MSED, CIC, infection control consultant at Infection Control/Emerging Concepts in Manassas, VA. "It remains to be seen what will happen come fall and in the southern hemisphere over the next few months. Right now we are in a preparatory mode, not in an emergency response mode."
"I think we got lucky, in that it's not very virulent," adds Colleen Connelly, RN, BSN, emergency preparedness manager, University of Utah Hospital in Salt Lake City. "Still, it's an excellent opportunity for all of us in disaster preparedness and pandemic flu preparedness to test our plans and see where the holes are, and to make appropriate adjustments to be ready for the fall."
Even the Centers for Disease Control and Prevention (CDC) continues to voice caution. "It's uncertain at this time how severe this novel H1N1 outbreak will be in terms of illness and death compared with other influenza viruses," says the CDC on the opening page of a special section on its web site devoted to the outbreak (www.cdc.gov/h1n1flu/).
Because this is a new virus, most people will not have immunity to it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against this novel H1N1 virus. The CDC anticipates that there will be more cases, more hospitalizations, and more deaths associated with this new virus in the coming days and weeks."
One of the challenges for quality managers and other health care professionals is that, because this is a new strain, organizations such as the CDC are adapting as they go. "Things have been changing very quickly on the interim guidelines — like who should be getting anti-viral drugs," notes West. "Stronger attention is being paid to pregnant women; some states are cutting back on testing."
The interim guidelines, found at www.cdc.gov/h1n1flu/guidelines_infection_control.htm, cover key issues such as:
- implementation of respiratory hygiene;
- hygiene/cough etiquette;
- implementation of facility contingency plans;
- interim infection control recommendations;
- patient placement and transport;
- limitation of health care personnel entering the isolation room;
- isolation precautions;
- respiratory protection;
- management of visitors;
- duration of precautions;
- surveillance of health care personnel;
- management of ill health care personnel;
- stewardship of personal protective equipment and antivirals;
- environmental infection control;
- facility access control;
- administration of the current 2008-09 seasonal influenza vaccine.
But interim guidelines "are just interim," cautions West. "I can't stress that enough; before you hop on and spend a lot of money, step back a bit, see what needs to be done now, and what you think may change given the scope of what's going on."
Review your plan
One of the key areas of preparation, West says, involves looking at your current response plan and making sure that all the people affected by the plan are aware of everything they have to do. "For example, a lot of hospitals make plans but do not include the fire rescue people who would be bringing patients to the hospital; they need to be consulted and included," she advises.
In addition, she says, your hospital should not only have its own plan, but it also needs to know what the state plan says and, if it's in a border region, what its neighboring states are doing.
Vigilance over the summer and into the fall is critical, West continues, and quality managers will play an important role. "They have a responsibility to do compliance monitoring and to make sure preparation requirements are being met," says West. "Education and training should be taking place, and they need to make sure that fit testing for respirators has taken place; they are the check and balance people."
West cites one CDC official who warned that people who are now pushing preparation off to the side will be scrambling if and when H1N1 comes back. "People who think we are really prepared are in a dream world," says West. "This is a good reminder to sit up and take notice."
Ron Wince, founder and CEO of the Mesa, AZ-based consulting firm Guidon Performance Solutions Inc., agrees, noting that problems may exist in areas that have not been focused on. "For example, most hospital microbiology labs will not be ready to handle the influx of requests for diagnosis," he notes. "Everyone is talking about patient flow, but they're not thinking of a huge backlog in this area, and lab managers are very nervous."
Quality managers who are familiar with the Toyota Lean methodology really can make a difference here, Wince suggests. "People can really improve their turnaround time and streamline processes using those tools," he offers.
Looking for 'holes'
Connelly and her team have been spending a good deal of time looking for "holes" in their response plan. "We've tried to uncover things we may not have planned for," she explains. "So, for example, I had a lot of stockpiled equipment, including N95 masks but did not have a good plan for distribution so that will get added to the plan. Even though in our community clinics they had those supplies within 48 hours, some of the smaller clinics did not get them until later — and I want to be better at that, pushing them out more effectively."
One thing that did work, she says, was the communication plan. "We also did a significant amount of N95 fit testing, and that will help for the fall if it comes back," she adds
Connelly also is looking at revising the care of hospital employees who may contract the virus. "We're going to work with our ED," she shares. "They did great; they were seeing the staff in fast-track. We were glad to see them do it, but since they treated them like they do all patients, perhaps they did not need to go to the lengths they did. We're looking at different processes, like having employees contact the employee health department, which would activate an employee health team to go either to the ED or a clinic to do the exam and diagnostic tests necessary and thus use the space of another area."
Connelly adds that she and her team took notes during every drill and "looked at what we did, the problems that arose and the things we struggled with. We will go back and revisit those issues and come up with supplements to the plan."
She also sees an important role for quality managers. "Quality folks are fantastic with organization and getting the word [out], so they can help with the communication piece," she notes. "I also think they could be involved in compliance and processes. Our plan, for example, unfolds in phases, with different tasks and actions occurring in each of those phases. If they became familiar with each individual plan, they could help facilitate movement in the appropriate direction. There's so much planning, and so many people came up with the plan and wrote it down, but nobody reads it; they could help by just being familiar with the skeleton framework and guidelines."
[For more information, contact:
Colleen Connelly, RN, BSN, Emergency Preparedness Manager, University of Utah Hospital, Salt Lake City. Phone: (801) 585-3134. Pager: (801) 339-3526.
Katherine West, BSN, MSED, CIC, Infection Control Consultant, Infection Control/Emerging Concepts, Manassas, VA. Phone: (703) 365-8388. E-mail: [email protected].
Ron Wince, CEO, Guidon Performance Solutions, Inc., 2550 N. Thunderbird Circle, Suite 317, Mesa, AZ 85215. Phone: (866) 986-4414. Fax: (480) 357-6326.]
Just when you thought it was "out," it pulls you back in the H1N1 virus, that is. After dramatic headlines and dire warnings from the World Health Organization (WHO) in the early days of this global outbreak, hospitals and infection control specialists swung into action. Facilities such as Clarian Health in Indianapolis temporarily restricted non-essential patient visitors at its downtown hospitals.Subscribe Now for Access
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