1. Todd, Betsy MPH, RN, CIC

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At the annual meeting of the Association for Professionals in Infection Control and Epidemiology, held in Tampa, Florida, in June, the most talked-about sessions addressed influenza-related issues and disaster planning.

Figure. Gregory A. P... - Click to enlarge in new windowFigure. Gregory A. Poland, director of the Mayo Vaccine Research Group, presented a strong argument for mandatory influenza immunization for health care workers.

Gregory A. Poland, director of the Mayo Vaccine Research Group, presented a rigorous case for mandatory influenza immunization for health care workers. He said that studies show vaccination of health care workers decreases overall patient mortality; asymptomatic transmission of influenza virus, combined with sick employees who continue to work, contributes to the spread of the disease in clinical settings; and nurses are the least vaccinated of any health care worker group, despite having the closest contact with patients.


Raymond Yung Wai-Hung, head of the Infection Control Branch of the Centre for Health Protection in Hong Kong's Department of Health, used their experiences with severe acute respiratory syndrome to illustrate how a "culture of infection prevention" can foster preparedness as we monitor the spread of avian influenza. He emphasized the need for concrete emergency planning, clear lines of command and control, strong surveillance, worker education and training, better "surge capacity," and effective and transparent communication with the public. He also stressed the importance of extended support for recovered patients, including health care workers, after an epidemic.


Richard E. Dixon, a consultant to the Centers for Disease Control and Prevention (CDC), spoke about how local, national, and international planning for a pandemic threat differ in focus. His ideas for hospital-level preparedness planning included


* deciding how responsibilities will be divided among neighboring facilities.


* planning and testing staffing plans (which might include retirees) on critical units, taking into account various likely degrees of absenteeism.


* storing or making advance arrangements for an inventory of critical supplies that can last through two to four weeks of interrupted deliveries.


* identifying staff who can work from home during a pandemic, as well as what they will need in order to function effectively.


* determining how best to triage "a tidal wave" of sick and worried people in the ED and ambulatory areas.


* educating the community on preparedness plans now, before an event, in order to "get all the craziness and paranoia out [and dealt with] before the emergency."



Many participants found "Managing Disasters: The Katrina Experience" to be the most heart-stopping session of the conference. Michele Pearson, an epidemiologist with the CDC's Division of Healthcare Quality and Promotion, was instrumental in organizing the Greater New Orleans Public Health Support Team (GNOPHST) in the immediate aftermath of the disaster. She discussed how the local office of public health (OPH) struggled to function with its building flooded; without vehicles; without cellular, Blackberry, or computer communications; with most of its tracking files lost; and with an 80% drop statewide in public health laboratory capacity. About 65% of OPH staff were themselves victims of the hurricane-their homes were lost, they had no food or additional clothing, and loved ones were missing. Beginning on September 7 (nine days after the hurricane), the GNOPHST created a "daily dashboard" to bring some order to the chaos. The dashboard provided a "comprehensive snapshot" of such things as surveillance activities; diseases detected; environmental issues; and the numbers of hospital admissions, available beds, and open pharmacies.


Joanne Maffei, an infectious disease physician at the Louisiana State University Health Sciences Center and head of infection control at Charity Hospital, graphically described the problems faced in her hospital during the five days before patients could be evacuated from the barely functioning facility. She stressed the need for creative avenues of communication. The staff made use of special bulletin boards, thrice-daily "town hall meetings," police and ham radios and walkie-talkies, and megaphones. They found frequent communication between the leadership team and the front line staff to be essential.


Deoine Reed, infection control manager at Ochsner Health System in New Orleans, learned to plan for staff needs as well as patients' needs. Ochsner set up a toll-free number for the staff's families and learned that payroll employees needed to be included on any list of "essential" personnel. Dr. Reed left the conference attendees with these questions:


* Does your hospital have a disaster plan?


* Does everyone, or only the leadership, understand it?


* Has the plan been tested? (If so, test it again.)


* Can your facility survive for an extended period without help from federal or state agencies?


* What happens after your disaster plan, when staff may have to adjust to long term changes in hospital operations and many may experience posttraumatic stress?