Did facilities do enough to protect staff from H1N1?

Provide training, communication about plan

The outbreak of a novel H1N1 virus in the spring was a colossal pandemic preparedness drill for a future virus or for a stronger resurgence of the strain this fall. This "drill" takes on a greater meaning in light of a recent report from the President's Council of Advisors on Science and Technology which estimates that swine flu could infect half the U.S population and cause as many as 90,000 deaths this fall and winter.

So in the spring, how did health care facilities do in their mission to protect staff, including providing appropriate protective equipment (PPE), training, and communication?

The results varied. Some facilities moved swiftly to ensure that their employees were properly fit-tested for respirators and beefed up their stockpiles of protective equipment. Others declined to provide N95 respirators even when it wasn't clear how virulent this strain would be.

Just as the first cases were emerging in Mexico, the Service Employees International Union (SEIU) released the startling results of a survey on pandemic preparedness: About one-third of union leaders at 104 facilities in 14 states said their facilities did not have a written pandemic plan. Less than half (43%) reported that their facilities had provided training to employees on pandemic influenza or communicated to employees about pandemic plans (48%).

In an SEIU "snapshot" survey of nurses who were union leaders at 16 facilities in California, only one said the facility was adequately protecting its staff during the H1N1 outbreak. Some 44% said their facility had not provided worker health and safety training to staff related to H1N1. The surveys were conducted in May.

Scripps Memorial Hospital in La Jolla, CA, had previously fit-tested about half the hospital's employees, including outpatient surgery staff. In an emergency, even nonclinical staff in outpatient surgery might have to help with duties that would increase their risk of exposure, notes Linda Good, PhD, RN, COHN-S, manager of employee occupational health services. "We don't want to ask someone to do something they weren't protected to do," she says.

Members of the outpatient surgery staff are given the same level of protection as inpatient surgery staff in terms of immunizations, PPE, and training, because in a pandemic, "they may be called upon to pitch in," she says.

To avoid the spread of H1N1, it's critically important to screen outpatient surgery patients ahead of time for illness, says Meaghan Reshoft, RN, BSN, MBA, CASC, executive director of surgical services at Northwest Community Hospital & Northwest Community Day Surgery Center in Arlington Heights, IL.

"Make sure you provide instructions that say, if they become ill before the surgery appointment, they should contact their physicians and the ASC for the next step," Reshoft says. "You certainly don't want to perform surgery on someone coming down with the flu."

Also address potentially sick employees, Reshoft advises. Northwest employees can obtain free influenza testing through the hospital employee health department. The hospital and surgery center also have a policy for employees who potentially are acquiring the flu that addresses when they should come back to work. This policy is based on guidance from the CDC, which at press time was expected to be updated in mid-September.

The web sites www.cdc.gov/H1N1 and www.flu.gov have a "wealth of information, including how to prepare your facility and home for a flu pandemic," Reshoft says. "In addition, state and local government web sites may contain information on local area outbreaks and other information specific to the state and community level," she adds. Northwest's web site has links to several sites where staff and patients can obtain more information about H1N1, Reshoft says.

E-cards available to encourage vaccination

The Centers for Disease Control and Prevention (CDC) has launched a social media campaign to encourage information sharing about H1N1 flu. The campaign includes social networks such as Facebook and Twitter, mobile information, online videos, and e-cards.

For more information on the e-cards, go to www2a.cdc.gov/ecards. Click on "all cards," and then select "flu" in the "select category" box. One card, titled "Don't Get the Flu," shows a woman saying, "I can't cover my shift," and is targeted for health care professionals.