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This is an excerpt from a member-only article. To read the article in its entirety, please login or subscribe.

Plan for infectious pandemics now

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March 1, 2016

Hospitals show how they are planning for Ebola and other diseases while it's relatively quiet

Plan for infectious pandemics now

Hospitals show how they are planning for Ebola and other diseases while it's relatively quiet

It's hard to believe it, but it's been just over a year since Ebola showed you exactly how ready you aren't.

Yes, it was October 2014 when Thomas Eric Duncan, a Liberian national who was visiting family in Dallas, became the first confirmed United States case of Ebola when he checked into Texas Health Presbyterian Hospital with symptoms. He later died; two nurses that had been caring for Duncan at the hospital also came down with symptoms, but were treated and recovered. Also that October, a New York City doctor who had been treating patients in Guinea tested positive for the virus and was later cured at Bellevue Hospital.

The cases, the first ever in American hospitals, set off a near panic in the United States as the CDC released a new set of guidelines and videos to help healthcare workers learn better how to work with PPE and keep their cool when dealing with one of the most infectious diseases on the planet.

It's been pretty quiet since then, and in an infection control feat of immense proportions, world health authorities in January declared Africa Ebola-free after announcing 42 days without a new case of the disease. That's impressive considering the African nations of Liberia, Sierra Leone, and Guinea were ground zero in the outbreak, which claimed more than 11,000 lives.

Despite that bit of good news, officials at the World Health Organization caution that another flare-up could be just a matter of time, and as we in the U.S. saw, it only takes one case to make a lot of people anxious and put healthcare workers at risk. Of course, Ebola is not the only disease to worry about; there are many equally if not more dangerous diseases lurking out there that pose a risk to the population. The smarter?and more proactive?hospital safety professionals are already thinking of ways to get their staff better trained and bolster their hospital's defenses should the next pandemic come through their doors.

"Everyone has plans, and you need to know when to throw them out," says John Ward, director of safety and materials management for Einstein Healthcare Network in Philadelphia, one of the hospitals that dealt with a mass-casualty Amtrak train accident in the city last May. With hundreds potentially exposed to dangerous chemicals, officials initially feared a major incident, and as a result, they reinforced their pandemic protocols following the event. "It was time to revamp your plans. We spent a lot of time deciding how to handle that walk-in patient."

Ward and other hospital safety officials who have spent a lot of time revamping their pandemic plans shared some of their advice:

  • Ready your SWAT team. Chances are you don't even know who would respond if someone walked into your ED with symptoms of Ebola, and that's not good. The folks at Einstein formed what they call a SIDRT (Special Infectious Disease Response Team) that would be first on the scene as soon as symptoms are identified. The team consists of seven ER physicians, 22 critical care nurses, four respiratory therapy assistants, and a radiological team, all ready to swing into action with their specialized skills. An Ebola response plan has been mapped out that involves blocking off certain areas of the hospital, designating certain rooms as off-limits, and preparing pre-stocked carts that can be wheeled into place at a moment's notice.

"Our plan was to be able to take care of one person for a week," says Ward. "It's been nothing but training, and they are very motivated."

  • Buy more PPE than you think you'll ever need, and find someplace for it. What if you don't have enough respirators available for your entire team? What if the only full-body suits your hospital owns are in a closet or trailer somewhere off-site? You don't want to come to these realizations in the middle of a pandemic. By now, you should have purchased at least the minimum amount of PPE your staff will need to wear when dealing with very infectious organisms. Ebola is so infectious that contact with a small drop of blood can transmit the disease. That's why the CDC recommends full-body coverage, tape over seams, powered air-purifying respirators, and about 35 different steps for putting the PPE on and taking it off (donning and doffing). Many hospitals also have begun stocking the equipment in easy-to-access cabinets outside patient safety rooms.
  • Train your staff to work in PPE. You also don't want to wait for a pandemic to realize that your staff has no idea how to use the PPE they've never trained in before. It sounds silly, but that was one of the major complaints to come out of the Ebola case in Dallas. Many of the nurses and patient care staff indicated that they had never seen a full-body suit or even tried one on. The PPE required for highly infectious diseases is bulky, hot, and difficult to work in for long periods of time. It requires working with spotters who look for signs that the users are dehydrated and tired, and therefore need to be rotated out for a break. The CDC teamed with a crew of specialists at Johns Hopkins Hospital in Baltimore to produce a series of videos on how to use and work with the specialized PPE. Check out the videos at www.cdc.gov/vhf/ebola/hcp/ppe-training.
  • Be ready to lock down, and know what that means. In the event of a pandemic, you're going to have to control your perimeter. And that means locking the place down?not an easy task. After all, the hospital is a place where people are supposed to be able to come for help. But you may be dealing with mass hysteria, media coverage, concerned family members, and keeping your staff healthy, and your security staff will be the ones front and center handling the lockdown and the anxious crowd.

"A lockdown means no one is coming in or out of the hospital, and it was close to change of shift and we wanted to keep as much staff as possible here," says Wesley Light, manager of emergency preparedness at Temple University Hospital in Philadelphia, another facility that received patients after the train crash.

Now is the time to hammer out some protocols: In all likelihood you have lockdown procedures in place, but when is the last time you reviewed and practiced them? At what point do you shut all the doors and let no one else inside? Do you have the proper facility locks and barricades in place? Are there protocols in place to limit facility access to only a few entrance points so that you can control the movement of potentially infectious people through your doors?

  • Be ready to change the plan in action. A plan should be designed to change as circumstances warrant, and a major pandemic will challenge your hospital in ways you never thought possible. "Things are not always going to happen the way we wanted them to," says Joe Aurrichio, BS, CHFM, assistant director of plant operations for Virginia Commonwealth University Healthcare System (VCU). Aurrichio and his staff were tested in October 2014 when a patient suspected of having Ebola was admitted to VCU with a two-hour warning. Plans went into place to isolate the patient and close down an entire wing of the hospital as planned, but when a nurse call button failed inside the patient's treatment room in the hot zone, no one knew what to do, and no plant operations or maintenance people had been trained in proper PPE. On the fly, four rooms were cleared, and engineers had to train a nurse on how to fix and replace the button herself. There is a reason that emergency management experts tell you to run drills and practice for the unexpected; never be afraid to throw a proverbial wrench into your training, no matter how far-fetched the scenario may seem.
  • Know how you'll handle patients in isolation. Most hospitals have plans in place to handle patients who need to be held in negative isolation rooms, but in the event of a major pandemic there will be pressure?if only from a public relations standpoint?to completely isolate patients who pose a serious infection risk to others. How will you handle closing off an entire wing of your facility, and devoting a number of staff to supporting that isolated wing?

"Family and friends had to be sequestered in an area not far from ER at a safe distance," says John N. Kastanis, FACHE, president and CEO of Temple University Hospital, about his facility's response to the Philly train crash. "A lot of family and friends were going from ER to ER around the city, and we had some pretty irate family members who insisted on barging in to the ER. We did have to attend to the patient medical needs first."

In other words, prepare to deal with people who want answers and don't want to be told no. You will also need to deal with the media, and with a large amount of waste. At VCU, one Ebola patient generated about 1,000 pounds of waste a day, including toothbrushes and disposable underwear?and that kind of infectious waste can't be thrown in the trash. Decide now where that trash will go and make plans with a vendor who will be capable of disposing of it properly.

  • Prepare to take care of your staff. This might be the most important part of your pandemic preparations. The resources and 24/7 attention will put a major drain on your staff, and you need a plan in place to take care of them. When Pope Francis visited Philadelphia in September 2015, an entire three-square-mile area was closed off, forcing hospitals to create plans that revolved around keeping entire shifts of workers fed and housed so they could get to work. Some employees couldn't go home for an entire weekend.

The Pope's visit was a positive event. Now throw a major pandemic into the mix. Your workers will likely be scared, stressed, tired, and in some cases, working against their spouses' wishes. During the VCU Ebola scare, some nurses were told by their husbands not to come home if they took care of the patient. You will need to identify a place where staff will not only be fed and rested, but also entertained and counseled if needed. A separate lounge with a television, some books, and a resting area is a good idea.



This is an excerpt from a member-only article. To read the article in its entirety, please login or subscribe.

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