OSHA: Get ready now for flu and potential pandemics
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December 1, 2018
Now that winter's here, we’re in the prime season for the spread of the flu, common colds, and yes, the possibility of a pandemic striking.
Surprise flu epidemics and other pandemics are significantly less likely because for the most part, health officials can see them coming. Still, this is a good time for healthcare workers and safety professionals to prepare—before sick patients start walking through the hospital doors.
According to OSHA, many scientists believe that since no pandemic has occurred since 1968, it is only a matter of time before another one occurs. It is difficult to predict when the next influenza pandemic will occur or how severe it will be.
However, world health officials actively monitor worldwide flu strains for mass outbreaks. OSHA says that the World Health Organization (WHO) maintains a global surveillance system of circulating influenza strains and a Global Influenza Preparedness Plan.
“Once a new influenza virus develops the capacity for efficient and sustained human-to-human transmission in the general population (Phase 6), the WHO declares that an influenza pandemic is in progress (this is known as the ‘Pandemic Period’),” according to information on the OSHA.gov website. “In the event of a pandemic, the U.S. Department of Health and Human Services (HHS)/Centers for Disease Control and Prevention (CDC) will coordinate support and intelligence with U.S. public health departments regarding the pandemic situation in the U.S. and in foreign countries.”
The best emergency plans begin with a hazard assessment, and in the case of medical clinics, it’s always a good idea to know what you’re likely to be faced with.
“Healthcare employers and employees should work together to develop an institutional safety climate that encourages compliance with recommended infection control practices,” says OSHA. “Healthcare administrators should emphasize those aspects of infection control already identified as ‘weak links’ in the chain of infectious precautions—adherence to hand hygiene, consistent and proper use of PPE, and influenza vaccination of healthcare workers.”
Where are you located? Are in you in a city or in a lightly populated area? Do you have a large population of very young or very old people, who may be more susceptible to germs and illnesses? Are you located near a major hospital, or are you the only healthcare facility located in the area? If the latter, you are more likely to be on your own in the event that a pandemic hits your area. Is your facility located in a warm climate, or in a cold area where winter illnesses are more common? Lastly, what’s the financial situation in your neighborhood? The median income level—as well as access to quality healthcare and insurance—could give you a good indicator of who is likely to walk through your doors. You should already know all these factors, but a good emergency management plan always reevaluates them on a regular basis.
It’s time to get your front office staff used to talking on the phone. Many infection control experts say in the event of a major outbreak, one of the best ways to control the spread of the illness is to keep people out of your facility in the first place.
- Consider instituting a policy that requires appointments to be made over the phone.
By doing this, patients stay at home, where they are most comfortable and can avoid the stress of coming into the clinic. It also keeps your staff and other patients from being exposed to potentially dangerous germs. While a policy like this might sound impersonal, it actually gives you a chance to give quicker, more individual attention to those who really need it. If your facility can’t handle a particularly urgent case, you can divert the patient straight to the nearest hospital. Or, if a clinic visit is more appropriate, by asking the right questions and knowing who is incoming, your staff can schedule the patient for early in the morning or late in the day—perhaps as the last patient of the day to avoid exposing a busy waiting room.
- Upgrade intake procedures.
For those patients who do walk through your doors, you’ll want to know where to send them and where to make them wait, especially if their illness is potentially very contagious.
Ask them lots of questions about where they have traveled recently or whom they have been in contact with. This can help your staff decide who should be isolated from the rest of the clinic population—especially those with respiratory infections such as tuberculosis or MERS (Middle East respiratory syndrome)—until they can be properly evaluated. These patients should be moved to an isolation room in a negative-pressure environment and seen as soon as possible by a physician who can make an informed decision about how care should proceed.
“If possible, and when practical, use of an airborne infection isolation room may be considered when conducting aerosol-generating procedures,” OSHA says. “Airborne infection isolation rooms receive numerous air changes per hour and are under negative pressure, so that the direction of the air flow is from the outside adjacent space (e.g., the corridor) into the room. The air in an airborne infection isolation room is preferably exhausted to the outside but may be recirculated provided that the return air is filtered through a high-efficiency particulate air (HEPA) filter.”
Also, OSHA says it’s a good idea to identify appropriate paths, separated from the main traffic routes as much as possible, for entry and movement of pandemic influenza patients in the facility, and determine how these pathways will be controlled (e.g., dedicated pandemic influenza corridors and elevators).
You can institute all the policies in the world, but if your staff doesn’t know how to implement them when it’s game time, the plan will fall apart. Hospitals are required by the government to regularly conduct emergency drills designed to test staff readiness in case a surge of patients comes in the door. Clinics, on the other hand, are not subject to the same scrutiny, and therefore it’s more likely that your frontline staff have never been tested on these abilities.
After you’ve held an in-service training explaining intake and triage procedures, design a small drill using volunteer patients who come into your facility exhibiting the same symptoms. Have your frontline staff practice calming them down, asking the right questions, and isolating them from the rest of the waiting room. The first sign of a pandemic is not the first time you want your employees to practice emergency intake procedures.
Wash your hands. Proper hand washing could be the most important way to stop harmful bugs from spreading around your facility, but for some reason we keep getting told we do it wrong. Take it from the WHO, which has a six-step hand washing technique it says is better at cleaning one’s hands than the CDC’s three-step process. The WHO’s method states that after applying soap or sanitizer to one’s hands:
- Rub your palms together
- Rub each palm front to back over the back of the other hand, interlacing fingers
- Twist your palms with fingers interlaced and rub between fingers
- Interlock your fingers (thumbs should be on opposite sides) and twist again, this time with backs of fingers against palms
- Clasp your left thumb in your right hand and move thumb in circular motion— then switch thumbs
- Press your right fingers together and rub them in a circular motion on your left palm, then switch
Gone are the days of simply putting on gloves and a face mask to take care of a patient. PPE comes in all shapes and sizes, and in some cases it is very difficult to work in. Yet PPE is the front line of defense for your workers, so if you haven’t already, it’s time to do some training on donning and doffing proper protection, as well as working with colleagues in full protective gear. Anxiety and stress levels—not to mention the temperature—will rise when workers are wearing PPE, so by practicing now they will be used to it when the real thing occurs.
Make sure you have plenty of supplies, too. Some facilities have begun to install supply cabinets outside patient treatment rooms reserved specifically for PPE—your workers should never have to spend time looking for the equipment that could save their lives.
While most healthcare workers won’t debate the effectiveness of a flu shot, many states still reject the idea of mandatory flu shots for reasons ranging from religion to personal freedoms. While we can’t tell you to make the shot mandatory, it’s a good idea to communicate its benefits to your employees, as statistics show that those who get the shot stay healthier with very little risk of side effects. That translates to healthier workers who can come to work—and don’t get patients sick. Most insurance plans offer the shots for free. At the very least, there must be a very strict policy in place preventing patient contact when workers are sick, and in all cases, they must wear face masks when working anywhere around patients with compromised immune systems.
Your staff cannot help patients when staff themselves are not well, and if a pandemic strikes, you want all hands on deck. Encourage your workers to keep healthy by living a healthy lifestyle. They should be washing their hands regularly, eating well, and getting plenty of sleep—and staying home when they are sick.
Should things get really busy, especially during an outbreak of patients, stress levels will rise. Staff should be getting plenty of exercise, downtime, and time to spend with their families and pursuing hobbies. Consider hiring a massage therapist to come in and provide 10-minute chair massages, have a catered lunch brought in during busy times, or just provide a quiet room with a TV, magazines, and snacks where staff can go to relax if they are feeling overwhelmed.
- Shore up your supply lines.
In the event of an outbreak, supplies of everything from bandages to masks to linens will deplete quickly. In the case of Ebola, hospitals that dealt with patients had to dispose of hundreds of pounds of trash daily that included used underwear, towels, and shoes worn by workers and patients. While your clinic is not likely to be treating patients on the level of hospitals, it’s a good idea to contact your vendors and make sure they have a plan to resupply you quickly in the event of an outbreak. At the very least, have a plan in place with any hospitals that you are affiliated with.
- Clean as if everything is dirty.
No matter how good of a job you think your staff or housekeeping crew does, there’s a good chance plenty of surfaces in your patient treatment and waiting rooms could still use a good scrubbing. These surfaces come in contact with sick people every day, and germs such as C. diff are notoriously good at holding on for dear life. Carpets, upholstery, handrails, chair arm rests, restrooms, water dispensers, and magazines are all places where germs lurk. Especially in the winter months, make sure all surfaces are being treated daily with bleach or EPA-approved disinfectant to help prevent the spread of stubborn bacteria and viruses.