Stories of survival: Getting help with H1N1

EH comes to the fore as pandemic spread

(Editor's note: At most hospitals, Employee Health runs a lean operation with minimal support staff. As H1N1 influenza cases surged and patients filled the emergency departments, employee health departments struggled to cope with their own tsunami of work: Vaccinations, fit-testing, screening employees for influenza-like illness, monitoring symptoms. Hospital administrators also gained a new appreciation for the role of employee health professionals. Here are some stories from the front lines.)

I am certain we were all singing the Beatles song "HELP! I need somebody . . ." as we dealt with the H1N1 influenza pandemic. Pre-flu, most of us were staffed slim, crazy busy, and simply did not have enough hours in our days to do what was needed. Along came this "new" flu, and we were over our heads. HELP!!!

Help came to me in the form of a true blessing . . . another RN!!! In late August, my vice president promised that if I would assist him on the hospital Pandemic Flu Command Center, he would make sure another nurse was hired to "help you with this mess" (his words). I love that administrator!

The understanding was that Employee Health would be able to hire an RN for three to six months to assist with both influenza vaccine campaigns and all the other "flu business."

Having been the only nurse ever in our facility's Employee Health office, I was amazed that I did get another nurse — especially in these trying financial times. But she did arrive. Again, I was blessed. My new co-worker came with several years' experience working at our local health department. In fact, she works with me four days a week and continues to work at the health department one day weekly.

As we worked through this flu pandemic, we not only survived; we thrived. We gave thousands of vaccines, screened hundreds of ill employees, and most of all provided support and "care" to all on our front lines. We were in our emergency department one evening administering H1N1 vaccine and saw firsthand just how hard and swiftly staff were working. Yet, many took the time to thank us for looking out for them. We learned the next day that our ED set an all-time 24-hour record the day we were there!

I learned many valuable things from my new colleague. Her health department background provided a wealth of information and her fresh eyes and new perspective inspired me often. She helped me update consent forms and protocols and encouraged me to write down many procedures that were previously informal.

Best of all, the hospital has continued to retain her on an as-needed basis, and she has been working 16 hours a week. It is reassuring to know that when I need her, she'll be there. Meanwhile, as the H1N1 pandemic recedes (we hope!), what I learned and experienced continues to sustain and inspire me. Now, if I could just get caught up on my sleep and housework . . . .

— Kim Stanchfield, RN, COHN-S, Employee Health Nurse Specialist, Rockingham Memorial Hospital in Harrisonburg, VA, and Editor, Journal of the Association of Occupational Health Professionals in Healthcare (AOHP). A version of this appeared in the AOHP Journal.

A time for teamwork

Dealing with novel H1N1 was a big challenge, but it was also a great learning experience in working "smarter" and in the importance of teamwork. As the outbreak unfolded, we knew we could not do it all ourselves. (We have a staff of four medical assistants, one RN, and three nurse practitioners.) So we hired a nurse as a temporary employee for three months to coordinate seasonal and H1N1 immunization for the more than 20,000 employees in the health system. We also hired a nurse who had work restrictions for a nonwork-related injury who could not be accommodated on her unit. She assisted with the immunization clinics and mask fit-testing.

This year, mandatory vaccination was discussed, but it was decided we would do a "full-court press" and see how successful we could be with a voluntary program, focusing on easy access for all shifts, education and nonstop publicity. We enlisted nurses on the inpatient units to be vaccinators for all the employees of the unit, and the outpatient services vaccinated their own employees as well. When the lineup for shots looked like the opening of the "Black Friday" sales, we enlisted the help of our physicians (who learned to give a good shot even though they don't teach that skill in medical school).

We worked hard, but we felt rewarded by the gratitude of employees who felt we were there for them at all times for all aspects of occupational health. Before the pandemic, many employees may have considered Occupational Health just a place for TB tests. We received recognition and the acknowledgment that we could accomplish many things with minimal staff. We were an integral part of the hospital's response to the pandemic, not only with vaccinations but by evaluating staff for prophylaxis, illness and treatment and return to work after illness evaluations.

The pandemic was a learning experience for other staff as well. Our Surgical Intensive Care Unit, where extracorporeal membrane oxygenation (ECMO) for patients with acute respiratory distress syndrome (ARDS) is performed, became a referral center for patients in Southeast Michigan with H1N1 who needed that treatment. The nurses in the SICU often spent their entire work shift (12 hours) in the patient's room. Wearing an N95 for all that time was not only uncomfortable, but we did experience a shortage of N95 respirators. The nurses, who had previously resisted using powered air-purifying respirators (PAPRs) for patient care, quickly switched to PAPRs when they realized that they were more comfortable over a long shift and that they could communicate with patients using the respirators. The nursing staff worked tirelessly during May and June when the majority of patients in the SICU were in pandemic precautions. (The UMHS experience with ECMO for H1N1 patients was published in the CDC's Morbidity and Mortality Weekly Report (MMWR) in July 2009.)

— Christine Pionk, RN, MS, Nurse Practitioner, Occupational Health Services, University of Michigan Health System, Ann Arbor.

Counting on Employee Health

Initially, Employee Health was not involved in the H1N1 task force of the six-hospital system, but the response team soon realized that we needed to be included in planning and in the regular conference calls. For example, Employee Health was central to the distribution of H1N1 vaccine to health care workers. The system was able to secure vaccine — even before our original shipment arrived — and the six hospitals shared their resources to prioritize employees with direct contact with suspected or confirmed H1N1 patients.

In addition to Employee Health, our multidisciplinary team included representatives from each hospital in emergency preparedness, infection control, materials management, and pharmacy. Employee Health took the lead in fit-testing and worked with infection control to monitor employee symptoms and return to work. In addition, input was provided regarding supply needs.

This was really the first time that we had to pull together and work as a system across all the hospitals. It was an opportunity for everybody to pull together for the benefit of employees and patients. If there's another event, whether it's influenza or something else, we now know what worked and what didn't work, and which stakeholders need to be involved in the discussion.

— MaryAnn Gruden, MSN, CRNP, NP-C, COHN-S/CM, Employee Health Coordinator, Western Pennsylvania Hospital, Pittsburgh, and AOHP Community Liaison.

On the frontlines of flu

New York state was at the forefront of the response to the novel H1N1 virus. After all, we were dealing with the first cases in the United States. In April 2009, about 150 students from St. Francis Preparatory School in the New York City borough of Queens came down with flu-like symptoms after a trip to Mexico. Many of these were later confirmed to be cases of novel H1N1.

Then, on Aug. 30, as we were preparing an early start to our seasonal flu vaccinations, we received a mandate from the New York Department of Health and Mental Hygiene: All health care workers must receive seasonal and H1N1 vaccines unless they have medical contraindications.

But what about the logistics? We needed new forms to document vaccination (seasonal on one side, H1N1 on the other). We didn't have a software program to track the vaccinations of some 15,000 employees. And we were only three weeks from the start of our program. We were responsible for three adult acute care hospitals, a children's hospital, a home care network, and off-site medical clinics.

We scrambled to develop a system, working with Human Resources and Information Technology. The pharmacy staff stepped up and offered to help with vaccinations. So did nurse managers and infectious disease physicians and fellows, and we used the services of nursing student assistants (under supervision).

We didn't receive H1N1 vaccine until mid- to late-October. At about that time, the health department suspended the mandate because of vaccine supply difficulties. Still, we vaccinated 75% of our employees against the seasonal flu, a higher rate than ever before.

If the mandate is reinstated, we'll be ready. We also learned that when we're in a pinch, our administration will give us the resources we need.

— Al Carbuto, MS, RN, FNP-BC, COHN-S, Nurse Practitioner, Occupational Health Service/Jack Weiler Hospital Division, Montefiore Medical Center, Bronx, NY.