Preparing for a Pandemic

When it comes to treating contagious and easily transmissible diseases-particularly at pandemic levels-healthcare providers are the first line of defense. But are they ready?

As the flu season approaches, it is a good time to review infection control procedures within a healthcare organization, especially related to protocols, isolation, and personal protective equipment (PPE).

Federal guidelines exist, but how well healthcare providers understand and enact those guidelines is sometimes underestimated.

“Any hospital or healthcare organization needs to make sure that what they are doing is completely consistent with the gold standards published by the Occupational Health and Safety Administration (OHSA) and the Centers for Disease Control and Prevention (CDC),” says Tener Goodwin Veenema, PhD, MPH, RN, FAAN, and international expert on disaster preparedness and containment of outbreaks and a professor at Johns Hopkins University.

“The key is how do we made sure that we create an infection control program and have personal protection equipment (PPE) plan that is consistent with national guidelines and positions us to keep our patients, staff, and visitors safe.”

Having a basic and clear policy based on national standards is a good start, she says, but it’s not enough. Healthcare organizations need to make sure they are structured in a way that allows them to have real-time surveillance of disease activity and respond quickly when necessary.

“Healthcare organizations that are forward-thinking to seasonal flu and pandemic levels must begin to think, do we have a robust infection control program where there is adequate surveillance, detection, and oversight of the implementation of infection control standards and the use of PPE,” she explains. “One of those key components is daily surveillance with situational awareness reports to all relevant healthcare and administrative staff so that everyone is aware of where we stand in terms of spread and outbreak.”

David Avalos, MSN, RN, AOCNS, CIC, a member of the Association for Professionals in Infection Control and Epidemiology (APIC) and an infection preventionist at CaroMont Regional Medical Center in Gastonia, NC, says when considering infection control programs, it’s also important to consider travel and not just focus on what is going on in your area.

“We implemented a travel screen and posted a map of global hot spots to identify patients who may have traveled to countries with pandemic outbreaks,” Avalos says. “We realized that not everyone was following the same procedures, and there is a need to standardize the process between inpatient, emergency department, urgent care, and community practices.”

Having systems like these in place help administrators and front-line caregivers make the best decisions on how to triage patients and control spread of infection, Goodwin Veenema says.

When considering PPE programs in particular, healthcare organizations must be sure to review their policies and supply levels.

“For seasonal flu, we are concerned with airborne transmission and droplets. We need respiratory protection for all healthcare providers,” she says, noting that healthcare facilities must recognize that protection is needed for other staff that may come in contact with patients, including security, housekeeping, and nutrition services staff. “Is there enough PPE to cover everyone who could potentially need it? Keep in mind that the flu and certain epidemics and pandemics would come in waves.”

This means that healthcare facilities have to be prepared to have enough of the right types of PPE to last for several weeks or even months, she says. The next challenge, Goodwin Veenema says, is making sure that staff are using PPE correctly.

“Donning and doffing is critically important,” she says, adding that caregivers are often exposed from self-contamination from improperly removing PPE.

Some big mistakes when it comes to PPE include placing N95 respirators on patients instead of surgical masks, reusing isolation gowns and not understanding that they are one-time use items, Avalos explains. Don’t assume caregivers know the policy or understand how to use PPE, he adds.

“I had an issue with a physician using the same gloves and disinfecting the gloves between use. Do not assume they understand all the information provided. We tend to provide a lot of information, but do not assess their level of understanding,” he adds.

Education about PPE for support staff is just as important as having adequate standards and supplies. Healthcare facilities must stress the need for caregivers to protect themselves at all times, but especially in times of an outbreak.

“Remember to create a program where we are really stressing personal preparedness and personal safety,” Goodwin Veenema says. “Encourage all healthcare providers and anyone who works within the hospital to make sure they have a flu shot annually, and to remember that the number one best strategy for infection control is adequate handwashing.”

When it comes to less common or highly contagious disease outbreaks, like Ebola and measles, facilities have to quickly move from standard infection control measures to a higher level of protection.

“With Ebola and measles, we implement incident command,” Avalos explains. “There is a 2:1 ratio-two nurses to one patient-for Ebola patients. We stabilize the patient and prepare him or her to transfer to a treatment facility. With Ebola and measles, we limit healthcare workers’ exposure by minimizing amount of staff involved in patient care.”

Other policies that stress employee safety and health are important, too, he says. Caregivers-particularly nurses-should know the differences between seasonal and pandemic influenza, because they are usually the first line of contact for patients. They also need to be supported in maintaining their own health and have the flexibility to stay home and care for themselves when they become sick themselves, she says.

“Talk with the nursing leadership and make sure everyone understands the infection control program and what their role is,” she says. “We as nurses are all so committed to our patients and our families and try to render high-quality care in any situation. But should there be a pandemic influenza outbreak, all healthcare systems would be challenged to the fullest extent due to the volume of patients needing care. Nurse safety and taking care of ourselves and our colleagues is going to be critically important.”