Journal Review

Antivirals hoarded, duties dropped as H1N1 hit

'Considerable opportunity for improvement remains'

Lautenbach E, Saint S, Henderson D, et al. Initial response of health care institutions to emergence of H1N1 influenza: Experiences, obstacles, and perceived future needs. Clin Infect Dis 2010; 50:Epub ahead of print.

Although generally institutions were well prepared for the H1N1 crisis, respondents to this survey said they had to neglect other medical duties, were aware of antiviral hoarding by colleagues and overall favored mandatory vaccination of health care workers, the authors of this timely report conclude. In this survey of members for the Society for Healthcare Epidemiology of America (SHEA), the researchers report that the majority of respondents felt that their institutions were well prepared for the H1N1 crisis and were provided with adequate resources.

"However, the time commitment required to respond to this crisis was considerable, with attention to other critical infection prevention activities suffering as a result," the authors noted. "Personal stockpiling of antiviral agents was common, and many institutions implemented initiatives designed to curtail such practices."

Revising plans on the basis of the H1N1 experience was one of the most common initiatives noted by respondents as an urgent need in the coming months. Future work also should assess beliefs and obstacles in responding to H1N1 among other health care professionals responding to the crisis (e.g., emergency department clinicians, nurses, etc). Accessibility to antimicrobial agents in the event of a pandemic is a critical component of preparedness plans. "In this light, it is concerning that one-third of respondents reported shortages of antiviral medications," the authors note. "That personal stockpiling was reported by many respondents is perhaps not surprising, given past data showing this practice was also widespread during heightened fears of an avian influenza pandemic. Efforts to discourage the prescribing of antivirals for personal stockpiling should be emphasized. Indeed, approximately one-half of the respondents' institutions initiated such efforts."

On April 15, 2009, novel swine-origin influenza A (H1N1) was identified from specimens of two epidemiologically unrelated patients. Over the next two months, H1N1 spread to more than 70 countries. On June 11, 2009, the World Health Organization raised the worldwide pandemic alert level to Phase 6, indicating that a global pandemic was under way. The ability to respond quickly in the face of an emerging infectious disease is critical for global patient safety efforts. Indeed, the capacity to collaborate across institutions and countries has proved critical in the success of recent pandemics, such as SARS.

An invitation to complete an internet-based survey was sent electronically to all SHEA members on May 26, 2009, with a repeat electronic survey reminder sent one week later. There were 323 survey respondents, which represent 25.9% of the total SHEA membership. Of note, 169 (52.3%) respondents reported that prior to the current H1N1 crisis, their hospital was well prepared for a potentially pandemic situation. After reflecting on their institution's experience and response to the H1N1 crisis, 195 (60.4%) respondents reported that at the time of the survey, their hospitals were well prepared for a potential pandemic. Furthermore, the majority of respondents reported that senior administrators provided both adequate political support (85.1%) and adequate resources (80.2%). Despite the perceived adequate levels of support, 32.7% of respondents reported that during the busiest week of the H1N1 flu crisis, they spent more than 60% of their time taking care of issues related to H1N1. On a related note, 50.9% of respondents reported that during the H1N1 flu crisis, other important infection prevention-related activities were neglected. Ninety-nine (30.7%) respondents reported a shortage of antiviral medication during the H1N1 crisis. Furthermore, 126 (39%) respondents agreed that personal stockpiling of antiviral medications occurred during the H1N1 crisis at their own institution. With regard to vaccination, 251 (77.7%) respondents felt that health care workers should be mandated to receive flu shots.