Nurse Survey Shows Deficiencies in Hospital Swine Flu Readiness

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many hospitals are not ready for h1n1: nurse survey shows deficiencies in hospital swine flu readiness

data from 190 healthcare facilities in nine states from california to maine

a patient health and safety survey of 190 american hospitals from coast to coast compiled by registered nurses in nine different states finds that a disturbing number of our nation's healthcare facilities are not prepared for the coming h1n1/swine flu pandemic, according to results released today by the california nurses association/national nurses organizing committee.

the data reflects a survey conducted over the past four weeks by rns in hospitals in arizona, california, florida, illinois, maine, minnesota, nevada, pennsylvania, and texas. and it comes just a day after release of a report from the president's council of advisors on science and technology predicting nearly 2 million americans could be hospitalized due to swine flu infections this winter, and as many as 90,000 could die, nearly triple the deaths that occur in a normal flu season.

what the rns reported are wide gaps in safety gear, infection control training, and post-exposure procedures. . . ]

among key findings:

at more than one-fourth of the hospitals, nurses cite inadequate isolation of swine flu patients, increasing the risk of infection to others.

nurses at 15 percent of hospitals do not have access to the proper respirator masks, exposing nurses and patients to infection; at up to 40 percent of the hospitals, nurses are expected to re-use masks, in violation of centers for disease control guidelines.

at 18 percent of the hospitals, rns report that nurses have become infected; one sacramento, calif. rn has already died.

. . .

findings of the survey include:

half the hospitals have seen infected patients. at 18 percent, rns have been infected, nurses say.

nurses at 15 percent of hospitals report that they do not have access or only some have access to the appropriate n95 respirator masks, and at 19 percent of the hospitals all or some masks were not "fitted," to ensure their effectiveness against the virus

more than one in five, 22 percent of the facilities, do not have enough masks, say nurses.

at almost 40 percent of those which do have sufficient masks, all or some of the masks are expected to be reused, say nurses. that puts nurses and patients at risk of infection and violates cdc guidelines which say all healthcare personnel who enter rooms of patients in isolation for h1n1 should wear a fit-tested disposable n95 mask, and that the masks should not be reused.

nurses at 26 percent of hospitals report that infected patients are not being properly isolated, in appropriately ventilated rooms, raising the possibility of the infection spreading to others in the facility. at nearly a third of the facilities, proper infection controls are not being followed.

nurses at fewer than half of facilities (49 percent) report that they have been adequately trained on h1n1 issues, including identification of infected patients, and procedures for caring for these patients.

nurses at only 35 percent of facilities report that they are guaranteed adequate sick leave if they become ill while caring for a patient, penalizing them for appropriately staying home while infectious.

these numbers are borne out by the controversies that have been reported at hospitals across the country. . .

http://www.calnurses.org/media-center/press-releases/2009/august/many-hospitals-are-not-ready-for-h1n1-nurse-survey-shows-deficiencies-in-hospital-swine-flu-readiness.html

credits rnboston

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Specializes in cardiac, ortho, med surg, oncology.

I know that makes me feel better about working during this pandemic. Not. My hospital already struggles to identify and properly isolate MRSA and VRE patients. Can't imagine how they will deal with H1N1 patients. Not to mention that there has been NO discussion at all about how we will deal with infected patients as the influenza surges and from what I have read the surge is just around the corner....

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Specializes in EMS, ER, GI, PCU/Telemetry.

i haven't heard anything about my hospital screening during admission in the ER or any precautions as far as swine flu is concerned. we only have 2 negative pressure rooms on my floor which are usually occupied by patients with TB, i am wondering if the pt's with the H1N1 need to be in the negative pressure rooms.

i have always refused to reuse an N95 respirator mask, but we do have lots of them.... it's just identifying the patients that scares me.... i am wondering about the vaccine, when will it be ready, and are health care professionals first in line to get it?

my OBGYN told me yesterday that a pregnant nurse from our sister hospital was given a patient with the H1N1 virus, accepted the assignment, and is now testing positive for the swine flu.

i'd clock out and leave before i ever took a patient with the swine flu or the symptoms of. my job is not worth my baby or my life.

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Specializes in Too many to list.
i haven't heard anything about my hospital screening during admission in the ER or any precautions as far as swine flu is concerned. we only have 2 negative pressure rooms on my floor which are usually occupied by patients with TB, i am wondering if the pt's with the H1N1 need to be in the negative pressure rooms.

i have always refused to reuse an N95 respirator mask, but we do have lots of them.... it's just identifying the patients that scares me.... i am wondering about the vaccine, when will it be ready, and are health care professionals first in line to get it?

my OBGYN told me yesterday that a pregnant nurse from our sister hospital was given a patient with the H1N1 virus, accepted the assignment, and is now testing positive for the swine flu.

i'd clock out and leave before i ever took a patient with the swine flu or the symptoms of. my job is not worth my baby or my life.

HCW and pregnant women are in the priority group to be vaccinated by mid-October. The trick is not to get infected before then.

If you suspect that a pt has swine flu, and you are pregnant, switch assignments. Most other HCW will not let you take any pt that could possibly have flu. And, even though many hospitals are saying it is safe to use surgical masks except for procedures such as neb tx, or bronchoscopy or when CPAP/BiPap is in use for these patients, I would wear the N95 around anyone that was coughing, had GI s/s, conjunctivitis, tonsilitis or showed any s/s of ILI. Remember also that many positive confirmed cases will not be febrile. Wear eye protection also as it is suspected that the virus can get to the respiratory tract via the lacrimal duct.

Most of these patients are not going to be in negative pressure rooms I would guess, considering that the number of cases will probably outstrip the number of the available rooms at some point. Your ER should be screening for ILI but some cases will slip thru or will not develop s/s until they are already admitted to the floors.

Of course, you are at risk in the community as well. Avoid crowds. Maybe let someone else do the shopping for you, as shopping carts are not disinfected before you use them. It is going to be difficult to avoid the flu because it is already present in the community, and the numbers of infected people will start to rise exponentially very soon since the schools are opening.

Any pregnant woman that believes that she has been infected or definitely exposed should contact her OB-Gyn about whether or not she should be on Tamiflu prophylaxsis or tx. Not all ER docs or primary docs are going to give out Tamiflu, but the OB-Gyn may feel it is warranted. It may not be necessary if your s/s are mild, but your OB-Gyn should know about your illness if you do get the flu.

Good luck, and be careful.

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Indigo, I think I found one reason why hospitals are struggling. You said Pregnant women and HCWs are priority. At our regional tabletop exercise Tuesday, we were told pregnant women and children under 18.

We were also told that there is simply not enough Tamiflu to go around for the general public and it will only be given to very high risk people or those whose symptoms are very severe in the first 36 hours after exposure.

We did preregister for the vaccine, though. It might get here before the surge.

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Specializes in Too many to list.

http://news.yahoo.com/s/time/20090822/hl_time/08599191770700

Personally, I think kids should be vaxed first, and here is why:

Last month, the Centers for Disease Control and Prevention (CDC) identified the groups that should get the very first doses, and the list did not contain many surprises: pregnant women, children between 6 months and 4 years of age, anyone in a household who has contact with kids younger than 6 months old, health-care workers who have direct patient contact and all kids ages 5 to 18 who have underlying medical problems.

...a new study in the Aug. 20 issue of Science suggests that in this case, the usual practice might not be the best. Rather than inoculating the people likeliest to die from H1N1/09, we may want instead to inoculate the people likeliest to spread it. After all, even the most at-risk among us can't get sick with a virus we never come in contact with. "If you can stop transmission, you can protect the people who are vulnerable," says Jan Medlock, a mathematician at Clemson University and one of the authors of the Science paper.

Medlock and co-author Alison Galvani of Yale University School of Medicine studied mortality data and data of infectious contacts from the influenza pandemics of 1918 and 1957... In their calculations, the most effective policy was to aim first for inoculating children ages 5 to 19 and adults ages 30 to 39. That's because school-age children are such a powerful nexus of flu infection: they get sick, infect one another in the close and less-than-hygienic hothouse of school and then bring the virus back home to their parents. The parents, in turn, can then infect others in the community. Knock these links out of the transmission chain, and the spread of the virus slows down considerably

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Specializes in Too many to list.

http://www.washingtontimes.com/news/2009/aug/18/us-cuts-doses-of-flu-vaccine/

We are at the fall back position now. On August 18, we got this bad news:

Citing delays in manufacturing and packaging the vaccines, the Department of Health and Human Services said only 45 million doses of the new H1N1 vaccine would be on hand in mid-October, instead of the 120 million previously forecast.

How does this affect who gets the vaccine first? Well, it has to do with priority vs target groups:

Target Groups

http://afludiary.blogspot.com/2009/08/brother-can-you-spare-shot.html

On July 29th at the ACIP meeting (see The ACIP Committee Recommendations) we learned of plans to target roughly 159 million `higher risk’ Americans with a vaccination program this fall, and the hopes that all Americans who want a shot will be offered one in the months that follow.

These target groups assumed that adequate quantities of vaccine would be available in October, and are made up of:

Pregnant women (4 Million)

Household contacts and caregivers of children under 6 mos (who cannot receive a vaccination themselves) (5 Million)

Health Care Workers & Medical Service Personnel (14 million)

Children and adolescents aged 6mos –24yrs (102 Million)

Persons aged 25-64 years of age with certain Medical Conditions (34 million)

Priority Groups

While it was it was hoped that it would not be needed, as a fallback position - in the event of a major shortfall of vaccine – ACIP identified a smaller `subgroup’ who could receive prioritization for the vaccine.

This priority group consists of roughly 42 million people.

Pregnant women (4 million)

Household contacts of Infants

Health Care Workers With Direct Patient Contact (9 Million)

Children aged 6mos – 4 yrs (18 million)

Children under 19 with chronic medical conditions (6 Million)

No doubt there are now discussions ongoing about what to do about this expected vaccine shortfall.

Whether to concentrate on this smaller subgroup? Or to go ahead with the larger 159 million-person priority group as originally planned?

UPDATE: It appears, based on reporting from ABC News this morning, that the decision is leaning towards going with this 42 million person cohort.

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