The DHHS Pandemic Influenza Preparedness Plan

Abstract & Commentary

Synopsis: The Department of Health and Human Services (HHS) has placed a draft influenza preparedness and response plan on its web site. This detailed document provides useful advice about health care system guidance on staffing, infection control, and strategies to limit transmission of infection within health care institutions.

Source: www.hhs.gov/nvpo/pandemicplan.
Accessed January 18, 2005.

The unexpected shortfall in influenza vaccine this year, a result of manufacturing difficulties at Chiron, may lead to a potentially significant increase in the number of influenza cases seen in the United States. Although no pandemic strain has been identified, the Influenza Preparedness and Response Plan, currently posted on the HHS web site, provides much useful information to assist with program planning within health care systems.

In the United States, annual influenza epidemics are associated with an average of 36,000 excess deaths and more than 100,000 excess hospitalizations. Given the lack of vaccine, we can expect greater numbers this year. In addition to an increased number of patients presenting with influenza, we can anticipate higher rates of work absenteeism, as health care workers either become ill themselves or need to stay home to care for ill family members. Planning at the institutional level will need to consider not only bed availability alone, but shortages in human resources as potentially limiting factors.

Influenza has a typical incubation period of 2 days with a range of 1-4 days. Viral shedding (the period in which a person may be infectious, which may begin before symptoms start) typically can last 5-7 days, longer in young children and in immunocompromised individuals. Approximately 50% of persons infected with influenza do not develop symptoms, but still may shed virus. Droplet precautions are thought to be adequate to prevent spread in a setting with an appropriate number of air exchanges.

Specific recommendations include establishing influenza triage in waiting areas for persons with respiratory illness, early discharge of patients whenever feasible, potentially canceling elective admissions and surgeries, and implementing plans to enhance hospital infection control. Other options involve converting urgent care areas into temporary triage facilities for patients with respiratory illness, or setting up alternate sites for those at high risk of complications from influenza, such as immunocompromised patients. Strategies to increase bed availability include eliminating direct admissions, requiring all patients to present to the emergency room for evaluation of need for hospitalization, increasing home health care agency support to facilitate earlier discharge, and creating a patient discharge holding area or discharge lounge to free up bed space.

Suggested mechanisms to minimize influenza transmission in health care settings include placing patients in a private room or co-boarding them with other influenza cases, use of negative pressure rooms if feasible, designation of specific wards to house influenza patients, minimization of transport of patients outside the room, limiting the number of health care workers caring for influenza patients, and limiting the number of visitors to influenza patients’ rooms.

Comment by James E. McFeely, MD

It behooves all of us in the critical care community to pre-plan for an increase in respiratory illness this winter. While a pandemic is unlikely, there almost certainly will be an increase in consumption of hospital resources related to the lack of influenza vaccine. The posted HHS guidelines provide a very useful start for the planning process, which will require coordination among the emergency room, intensive care units, and hospital infection control policies. Investing time now in such planning will pay dividends later, either this year if needed or in the future should another airborne infectious outbreak materialize.

James E. McFeely, MD, Medical Director Critical Care Units, Alta Bates Summit Medical Center, Berkeley, CA, is Associate Editor for Critical Care Alert.