Hospitals to share supplies, staff
Every year is a mini-drill for pandemic influenza. Hospitals vaccinate thousands of health care workers against seasonal flu, set priorities amid shortages or delays in vaccine supply, and put renewed emphasis on hand hygiene and respiratory etiquette.
But if (or when) pandemic influenza strikes, traditional flu planning won’t be good enough. Hospitals will need a unified approach to prevent transmission, respond to the ill and worried well, and to protect health care workers.
“We’re strongly encouraging the facilities to communicate with each other, even to start thinking about how they would share resources — not just supplies, but also staffing,” says Deborah Levy, PhD, MPH, lead, health care preparedness in the Division of Health Care Quality Promotion at the Centers for Disease Control and Prevention in Atlanta.
Harborview Medical Center in Seattle is one example of a hospital that is working with its neighbors (and competitors) to prepare for a possible pandemic with better communication and regional coordination.
“It is imperative that health care organizations organize together to plan for any kind of pandemic or disaster situation,” says Chris Martin, BSN, RN, administrative director of emergency services and chair of the disaster committee. “We all are going to need each other.”
In a worst-case scenario, extrapolated from U.S. government estimates, a pandemic could hit King County (Seattle) with 11,000 deaths, more than 50,000 people needing hospitalization, and 1.2 million people sick.
“We would be so far above and beyond what our capacity is, there is no way we could meet that need,” she says.
There are no simple answers to such dire circumstances. But by joining together, King County hospitals are preparing as best they can. The hospitals plan to share supplies and equipment, such as antiviral medications or ventilators. They are pooling grant money they receive from the Health Resources and Services Administration to respond to disasters. They may even share staff, Martin says.
“We are hoping to hire a regional resource center person, to work with hospitals and [other health care] entities to really be able to put together the plans and policies we need to share these resources,” she says. “It makes more sense for us to pool our money rather than for each hospital to make their [separate] decisions about what they want to purchase.”
The hospital is working with distributors to keep the regional stockpile, so it can be rotated and will not become out of date — and it could be easily distributed in time of need. Harborview is the disaster control hospital for King County, which means that it would coordinate the routing of patients to area hospitals so none are overloaded.
Meanwhile, the regional emergency preparedness committee meets every month and conducts periodic tabletop drills. Kathy Maher, RN, MSN, manager of employee health services, is part of the emergency preparedness committee. She provides input on employee needs, from protective equipment to disaster preparedness education.
Here are some of the issues that hospitals must consider in their pandemic influenza planning.
• Priorities for vaccination.
Although the CDC has recommended priority tiering of vaccine, each hospital needs to define specifically who would be the first to receive the vaccine, notes Maher. At Harborview, the top priority would encompass first responders, emergency department personnel, and the public safety personnel who control entry to the emergency department. Respiratory therapists and housekeepers and facility engineers who would maintain the rooms of pandemic influenza patients also would receive the first vaccines.
Direct care providers in the units caring for hospitalized flu patients, including nurses, physicians, hospital assistants, and lab personnel, would be top priority as well.
Martin notes that ambulatory care clinics play a key role in the Harborview plans. Ill patients may show up at the clinics rather than the hospital. And those clinics may provide some surge capacity if hospitals become overwhelmed, she says.
• Administration of antivirals.
According to the Harborview pandemic influenza plan, which is available on-line (http://depts.washington.edu/ictrain/influenza/influenza.htm), employees who are exposed to avian influenza will receive seven to 10 days of prophylaxis with oseltamivir.
Hospitals also should be aware that administration of vaccine or antivirals to the general public may need to take place at health care facilities rather than the public health department, advises Levy. The antivirals need to be administered within 24 to 48 hours of onset of symptoms, and public health departments may not be able to cope with an onslaught of ill patients, she says.
Hospitals also will need security to protect the supplies of antivirals and vaccine, she notes. “Definitely there are issues around pandemic flu that require a different sort of planning,” she says.
• Support services for employees.
Imagine a scenario in which schools are closed and large gatherings of people are prohibited to prevent spread of disease. Now you have key employees with child care issues. Don’t expect to simply bring those children into the hospital, even if you have a child care center, says Levy.
After all, if area day care centers and schools are closed, so is yours.
Meanwhile, employees may need emotional support as they cope with difficult circumstances. For example, if the need surpasses the number of ventilators available, employees will need to decide which patients receive that life-saving treatment.
Harborview asks its employees to develop a personal disaster plan that would include pandemic influenza. The hospital also emphasizes communication and has chaplains and social workers available to discuss issues with employees.
• Respiratory protection.
Harborview has 185 powered air-purifying respirators (PAPRs), which are the primary protection used by employees caring for tuberculosis patients. However, in the case of pandemic influenza, PAPRs may create some disinfecting issues that don’t exist with tuberculosis (which is not spread by fomites).
So, Harborview plans to stockpile about 1,000 N95 filtering facepiece respirators. Some top-priority employees, such as those in the emergency room, will receive initial and annual fit-testing. The hospital also will have a plan to conduct fit-testing on an as-needed basis, says Maher.
Current CDC guidelines call for droplet precautions unless the patient is undergoing an aerosol-generating procedure. But a pandemic could be prolonged, and respiratory protection guidelines could change.
“This is something that would extend for several waves, maybe for six to eight weeks,” says Levy. Planning for pandemic influenza will require a different approach than for sudden disasters, such as an earthquake, hurricane, or bomb attack.