H1N1 Flu Pandemic Was a Real-World Test of Preparedness

Terri Rebmann, PhD, RN, CIC, from the Institute of Biosecurity, Division of Environmental and Occupational Health at Saint Louis University, says that the 2009 H1N1 influenza pandemic provided a "real-world test" of hospital disaster plans, and that institutions must address ongoing challenges such as "inconsistent use of isolation precautions; changing and conflicting guidelines; lack of available supplies, including N95 respirators and medications; and overwhelming amounts of information that required sifting." She emphasizes in Infection Control & Hospital Epidemiology that further research is needed regarding pandemic planning.

Rebmann says that, "A major gap in pandemic planning is the lack of standards or guidelines regarding what it means to be 'prepared,' and that examples of infection prevention issues for hospital disaster plans include "having a plan appendix that addresses the unique aspects of infectious disease disasters; having occupational health policies and procedures, such as protocols for occupational exposures; having surveillance and triage protocols for identification of potentially contagious individuals; having sufficient laboratory coverage and supplies; having rapid turnaround in laboratory diagnostic procedures; and having 24/7 coverage for employee exposures. Hospital disaster planners should use published recommendations to assess their disaster plan and to develop policies and procedures that will decrease infection transmission during disasters."

Rebmann points to studies prioer to the 2009 H1N1 influenza pandemic that have endeavored to document the preparedness levels in hospitals, and reports that hospitals "lack adequate communication and reporting procedures, lack adequate healthcare worker training programs, and lack stockpiled personal protective equipment and other necessary medical equipment, such as ventilators. Other identified deficiencies include a lack of around-the-clock infection prevention coverage, little to no capacity for a surge in the need for negative-pressure facilities and/or for healthcare workers, failure to participate in hospital preparedness drills that involve an infectious disease scenario, and no prioritization plan for allocation of limited doses of antiviral medications."

The H1N1 global outbreak presented numerous challenges, Rebmann says, but adds that the most widely reported challenge in responding to the 2009 H1N1 influenza pandemic was "the lack of available supplies, including N95 respirators and medications. Although some hospitals reported having sufficient supplies of N95 respirators, many more indicated that they did not. Many hospitals reported difficulty in obtaining a variety of supplies from vendors or other regional healthcare systems during the pandemic, including reports that existing mutual aid agreements were not honored. Some hospitals also reported that the wrong types or sizes of N95 respirators were received, resulting in the inability to use the supplies or necessitating fit-testing for the new brand of respirator. Both APIC and SHEA members reported that stocks of antiviral medications became depleted; APIC members emphasized the need for more pediatric doses of antivirals. Consequently, hospitals needed to enact prioritization plans for allocating the limited resources."

Rebmann adds, "More research needs to be conducted in the area of pandemic preparedness. Future research areas for study include the quantification of exactly how much surge capacity should be developed for varioussized healthcare facilities and communities: how many beds, supplies (e.g., personal protective equipment, ventilators, and medications), and isolation rooms or areas are needed for a surge in patients. Studies are needed to determine how many, if any, negative-pressure rooms or areas should be available in ambulatory settings for triaging and/or screening potentially contagious individuals. More work also needs to be done in the development of crisis standards of care."

Reference: Rebmann T. Pandemic Preparedness: Implementation of Infection Prevention Emergency Plans. Infect Control Hosp Epidemiol 2010;31:S63S65