Infection Control, Bioterrorism Control
By Susan Harris, RN, BS, CIC, Gretchen Himes, RN, BSN, Denise G. Nesselrodt, RN, MSN, CIC, Lanette L. Rhodes, RN, BS, CIC, and John H. Armstrong, MD
Although the concept of a bioterrorist threat or attack might be a hoax or near miss, due to our close proximity to Washington, D.C., the Winchester Medical Center Infection Control Department began developing a bioterrorism management and response protocol last year.
Our IC chairman and the IC staff began collecting information on bioterrorism. We obtained the CDC/APIC Bioterrorism Template and adapted it to our current IC and safety and security policies and procedures to make the plan hospital specific. Little did we know Sept. 11 would change our lives forever. The IC committee approved the bioterrorism management and response protocol on Sept. 24, 2001.
Winchester Medical Center is located approximately 70 miles west of Washington, D.C. and many residents of the community commute daily into the metropolitan area to work. As soon as anthrax was discovered in the D.C. area, we anticipated that patients with potential exposures would arrive at our ER. On Oct. 9 our first potential exposure patient arrived. We activated our safety and security command center and utilized the newly created bioterrorism algorithm to provide communication to all members of our bioterrorism command center personnel.
The patient was initially placed on a modified strict isolation. Employees utilized a hood system, gowns, and gloves.
We realized employees in the ER would need quick and easy access to the bioterrorism-specific supplies so we expanded our isolation caddy (which had been designed by members of our IC department) by adding fact sheets on bioterrorist diseases, as well as on the handling of linen and trash. Chain-of-custody forms, the hoods, the bioterrorism algorithm, and the PPE information were also added.
When it was determined this patient did not have anthrax, she was taken off isolation and we reviewed and modified the bioterrorism plan on an ongoing basis. We continued to see patients in our ER who had potential exposures and were being tested for anthrax. Through continued communication with the ER staff, information was tracked and relayed to the public health department officials.
On the morning of Oct. 24, 2001 we received a call from our lab that we had a probable confirmed anthrax case. After the initial shock, the IC department jumped into action. We notified our safety and security department and the local public health department. The patient was notified by his MD and within an hour was admitted to the hospital for treatment.
The IC department's role expanded quickly. One responsibility was to ensure proper isolation precautions and personal protective equipment were utilized. Our department served as a liaison to representatives of the local and state public health department and representatives for the CDC. We were available to answer staff's questions. We assisted our marketing and public relations department in developing fact sheets and media releases. We also sent daily MMWR and CDC updated protocols to private physician offices and the ER staff.
All too soon, our IC staff realized we were considered the experts in the fight against bioterrorism. Our ER and safety and security departments were familiar with chemical and radiation exposures, but few staff members were familiar with the diseases associated with bioterrorism. Although the employees and physicians received education on anthrax, the ICPs were available to act as a resource to all the healthcare providers at Winchester Medical Center.
Be aware that the national and local media will be at your hospital, trying to obtain bits and pieces of information regarding the patient, the patient's family, and the care and treatment of the anthrax patient. Maintaining patient confidentiality is of the utmost importance. You will also receive phone calls from the general public with concerns and questions that can be referred to the local health department.
Our anthrax patient has been discharged with a positive outcome, and our healthcare providers can relax and congratulate themselves for the wonderful treatment and care provided during the patient's stay.
Bioterrorism is a new frontier for all IC departments and healthcare providers. It is important that IC departments network and share information on bioterrorism. The news media, the public health departments, and healthcare providers have opinions of how to manage bioterrorism but, when there is a confirmed case at your hospital, these individuals will turn to the IC department for guidance in basic fundamentals in patient care management.
For WMC infection control staff, this is just the beginning of our investigations. We are still ever vigilant looking for the next illness as a result of bioterrorism.