Infection Control Today - 01/2002: Infection Control, BioterrorismControl

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

Althoughthe concept of a bioterrorist threat or attack might be a hoax or near miss, dueto our close proximity to Washington, D.C., the Winchester Medical CenterInfection Control Department began developing a bioterrorism management andresponse 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 ICand safety and security policies and procedures to make the plan hospitalspecific. Little did we know Sept. 11 would change our lives forever. The ICcommittee approved the bioterrorism management and response protocol on Sept.24, 2001.

Winchester Medical Center is located approximately 70 miles west ofWashington, D.C. and many residents of the community commute daily into themetropolitan 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. OnOct. 9 our first potential exposure patient arrived. We activated our safety andsecurity command center and utilized the newly created bioterrorism algorithm toprovide communication to all members of our bioterrorism command centerpersonnel.

The patient was initially placed on a modified strict isolation. Employeesutilized a hood system, gowns, and gloves.

We realized employees in the ER would need quick and easy access to thebioterrorism-specific supplies so we expanded our isolation caddy (which hadbeen designed by members of our IC department) by adding fact sheets onbioterrorist diseases, as well as on the handling of linen and trash.Chain-of-custody forms, the hoods, the bioterrorism algorithm, and the PPEinformation were also added.

When it was determined this patient did not have anthrax, she was taken offisolation and we reviewed and modified the bioterrorism plan on an ongoingbasis. We continued to see patients in our ER who had potential exposures andwere being tested for anthrax. Through continued communication with the ERstaff, information was tracked and relayed to the public health departmentofficials.

On the morning of Oct. 24, 2001 we received a call from our lab that we had aprobable confirmed anthrax case. After the initial shock, the IC departmentjumped into action. We notified our safety and security department and the localpublic health department. The patient was notified by his MD and within an hourwas admitted to the hospital for treatment.

The IC department's role expanded quickly. One responsibility was to ensureproper isolation precautions and personal protective equipment were utilized.Our department served as a liaison to representatives of the local and statepublic health department and representatives for the CDC. We were available toanswer staff's questions. We assisted our marketing and public relationsdepartment in developing fact sheets and media releases. We also sent daily MMWRand CDC updated protocols to private physician offices and the ER staff.

All too soon, our IC staff realized we were considered the experts in thefight against bioterrorism. Our ER and safety and security departments werefamiliar with chemical and radiation exposures, but few staff members werefamiliar with the diseases associated with bioterrorism. Although the employeesand physicians received education on anthrax, the ICPs were available to act asa resource to all the healthcare providers at Winchester Medical Center.

Be aware that the national and local media will be at your hospital, tryingto obtain bits and pieces of information regarding the patient, the patient'sfamily, and the care and treatment of the anthrax patient. Maintaining patientconfidentiality is of the utmost importance. You will also receive phone callsfrom the general public with concerns and questions that can be referred to thelocal health department.

Our anthrax patient has been discharged with a positive outcome, and ourhealthcare providers can relax and congratulate themselves for the wonderfultreatment and care provided during the patient's stay.

Bioterrorism is a new frontier for all IC departments and healthcareproviders. It is important that IC departments network and share information onbioterrorism. The news media, the public health departments, and healthcareproviders have opinions of how to manage bioterrorism but, when there is aconfirmed case at your hospital, these individuals will turn to the ICdepartment for guidance in basic fundamentals in patient care management.

For WMC infection control staff, this is just the beginning of ourinvestigations. We are still ever vigilant looking for the next illness as aresult of bioterrorism.