Did hospitals do enough to protect HCWs?
Did hospitals do enough to protect HCWs?
Provide training, communication about plan
Think of the outbreak of a novel H1N1 virus this spring as a colossal pandemic preparedness drill - either for a future virus or for a stronger resurgence of the strain later this year. So, how did hospitals do in their mission to protect health care workers, including providing appropriate protective equipment, training, and communication?
The results varied. Some hospitals 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 hospitals did not have a written pandemic plan. Less than half (43%) reported that their hospitals 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.
"This is an industry that continues to operate in a way that is not supportive of worker protection in many areas," says Bill Borwegen, MPH, SEIU's health and safety director. "Six years after the government put out recommendations on pandemic flu, we're showing that a very small percentage of hospitals have a level of preparedness."
Yet hospitals have improved in their ability to collaborate and work in regional cooperation, according to a report on the U.S. Department of Health and Human Services' Hospital Preparedness Program by the Center for Biosecurity at the University of Pittsburgh Medical Center.
"Our conclusion was that hospitals are significantly better prepared now as compared to 2001," says Eric Toner, MD, senior associate at the Center for Bioterrorism. The center interviewed 133 individuals at 97 locations across the country, including every state and territory, he reports.
"The thing we found to be most significant was the degree of collaboration and cooperation among hospitals and between hospitals and public health and emergency management [agencies]," he says." That collaboration is nearly universal, in part because of the guidance from the Hospital Preparedness Program but also because of the new Joint Commission standard that requires increased collaboration among hospitals in a community."
Communication breakdown
The SEIU survey may reflect a failure of hospitals to communicate with staff and to include employees in their training and exercises, says Toner.
"We've seen examples of hospitals that have done tabletop exercises that involve the administrative team, and they think therefore they're prepared. They have a written plan that's been signed off on by the administrative team. But it does nothing to reassure the staff," he says.
"It's essential if you want your staff to show up [during a pandemic] that they be aware of the plan, that they have confidence in the plan, and confidence that you can keep them safe. Health care workers are courageous people who show up and do remarkable things in difficult situations, but they have to have some confidence that they're being protected and they're not being foolish in coming to work," he says.
Review gaps, chances to improve
Even as the cases of novel H1N1 influenza rose in the spring, the Hospital Preparedness Program already had begun to consider an "after action review," looking for gaps or lessons learned.
"There was a strong response [from hospitals to the novel virus]," says Gregg Pane, MD, MPA, director of the program, noting that since 2002, some $3 billion has been spent on stockpiles of protective equipment and antivirals, additional medical equipment, decontamination units, and communications infrastructure. Some hospitals received medications from the national stockpile to combat the novel H1N1 virus.
"Employees should feel [the preparedness] is a lot better than it was and it's getting better," he says.
Hospitals should identify gaps and work to correct them, Pane says. "We require drills and exercises as the core of the program. You can count a real event," he adds. "We expect a lot of our states to include this flu [scenario] as a real drill and [examine] what they learned."
A nurse at a hospital in New York state who had been involved in her facility's pandemic plans offered her perspective to Hospital Employee Health. (She asked that her name and hospital not be identified.) The hospital's pandemic plan was never fully implemented with the current H1N1 situation, she says. Employees were not told to wear N95s when caring for patients with suspected novel H1N1, and they weren't educated about the pandemic plan, she says.
"This is our wake-up call," she says. "I'm hoping that this will be a good test for facilities to realize that they are not really prepared. They think they're prepared on paper, but the actual logistics of having people properly protected and patients properly treated the minute they walk in the door [still need to be addressed]. Hopefully, this will give us the time to review our pandemic plans and improve them."
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It's still a time for pandemic preparedness Stay vigilant, influenza experts caution Although news reports of novel H1N1 moved off the front pages of newspapers and the sense of alarm subsided, the threat of a pandemic remained very real. The virus continued to circulate, and public health authorities watched it closely for signs of mutation. "This is an ongoing public health threat and continued vigilance is needed," says Daniel Jernigan, MD, PhD, deputy director of the influenza division at the Centers for Disease Control and Prevention. "It's important for everyone to be prepared." Based on the experience so far with novel H1N1, here are some issues to keep in mind: Communicate well with employees. Employees need to be kept informed about the threat, such as the number of cases of a novel virus in the community and the hospital, as well as the hospital's preparedness activities. At Scripps Memorial Hospital in La Jolla, CA, hospital leaders conduct rounds in clinical areas during emergency situations, sharing information and addressing concerns, says Linda Good, PhD, RN, COHN-S, manager of employee occupational health services. "That physical presence of leadership is something that is very important to employees," she says. Check on respirator supplies. When supply is limited, respirator manufacturers base their allocation on long-standing contracts with their hospital customers, says David Naylor, retired vice president of sales with Aramsco of Thorofare, NJ, a major distributor of respirators and a company specializing in escalation when demand surges. Naylor suggests periodically confirming that the promised supply is being kept for the hospital. "Make a personal visit to [the distributor's] supply warehouse and see that the additional 30 days you've contracted for him to keep for you [as a stockpile] is actually there, and do that on a regular weekly basis," Naylor advises. "It's written into your contracts in most cases that you hold the right to view safety stock." The Service Employees International Union is suggesting that hospitals purchase half-mask elastomeric respirators for employees with the potential for exposure to H1N1 patents. The respirators can be disinfected and reused. "The facility will save money by buying this higher level of protection [rather than purchasing disposable N95s], says Bill Borwegen, MPH, SEIU health and safety director. Expect the unexpected. Influenza viruses can mutate suddenly, and H1N1 could blend with other circulating strains, including the very virulent avian influenza H5N1. Or another influenza virus or other virus could suddenly emerge. That means you should have sufficient supplies of protective equipment, says Stephen Weber, MD, hospital epidemiologist and medical director of infection control at the University of Chicago Medical Center. "Most parts of the country got a little advanced warning about H1N1," he says." In the future no one knows if they're going to be the next Mexico City [where the novel H1N1 first spread] or Hong Kong [site of the first SARS cases]." |
For some hospitals, however, pandemic plans went into effect as soon as reports arose that a novel flu strain was circulating in Mexico.
Yale-New Haven (CT) Hospital began repeating the fit-testing of employees in high-risk areas, such as the emergency department, and implemented just-in-time refit-testing and retraining in personal protective measures for other employees. The hospital also geared up for active monitoring of employees who had contact with probable or confirmed cases, says Mark Russi, MD, director of occupational health at Yale-New Haven and chair of the Medical Center Occupational Health section of the American College of Occupational and Environmental Medicine.
"We have been in daily communications with all staff via e-mail," says Russi, who also is associate professor of medicine and public health at the Yale University and ACOEM liaison to the Healthcare Infection Control Practices Advisory Committee, a CDC advisory panel. "Those [messages] have emphasized assiduous care to infection control practices. We emphasized and re-emphasized the necessity of not coming to work if you have respiratory symptoms."
Scripps Memorial Hospital in La Jolla, CA, had previously fit-tested about half the hospital's employees, from admitting staff to food service and environmental services workers. In an emergency, even nonclinical staff 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.
Employees also are reassured because of the way the hospital has responded to past emergencies, says Good. For example, when wildfires devastated San Diego County, the hospital provided child and pet care for employees.
"Our hospital has a tradition of disaster preparedness and a culture of safety," she says.
Think of the outbreak of a novel H1N1 virus this spring as a colossal pandemic preparedness drill - either for a future virus or for a stronger resurgence of the strain later this year. So, how did hospitals do in their mission to protect health care workers, including providing appropriate protective equipment, training, and communication?Subscribe Now for Access
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