During a pandemic, there is a high likelihood that staff members will not report to work for a variety of reasons. Some may contract the virus, others may have children or family members to care for, and others may require time off because of school closures.
Healthcare worker absenteeism can be detrimental to any facility, but for a small facility with few employees, it can be crippling. Unfortunately, absenteeism is also the toughest to plan for, says Terri Rebmann, PhD, RN, CIC, associate director for curricular affairs and assistant professor at the Institute for Biosecurity at Saint Louis University School of Public Health.
"The main thing is they should be talking about it now and trying to make some kind of plan, knowing there are going to be staff shortages," Rebmann says. "We already saw that before it was even deemed a pandemic, there were staffing shortages."
Rebmann suggests hiring contract workers or even retired healthcare professionals or medical students if the pandemic is bad enough.
Keep in mind that during a pandemic, healthcare workers that exhibit symptoms of influenza should remain at home. Rebmann says a big contributor to the SARS outbreak in 2003 was the fact that sick healthcare workers were still coming to work.
"[Healthcare facilities] need to be looking at their occupational health and sick leave policies to really make sure staff are able to call in sick with no repercussions," Rebmann says.
Plan for a surge of patients
Regardless of whether your facility will be hit hard by seasonal influenza or the H1N1 virus, even small medical facilities should have a detailed plan in place to handle a sudden or prolonged surge of patients.
Rebmann conducted a focus group on the H1N1 outbreaks among infection preventionists at the June Association for Professionals in Infection Control conference. Many of the pediatric facilities reported that their 24/7 hotline worked well to triage patients or provide care without bringing them into the facility.
"That at least reduced the number of people that would show up in the ED, because families would call in, talk to a healthcare provider on the phone, and decide 'yes, it's an emergency; I should go in,' or 'no, it's probably not; I can go see my physician or I can just stay home and not even require treatment,' " says Rebmann.
However, establishing this phone system is often cumbersome for smaller facilities with fewer resources. Directing patients to their local or state health department's phone line, which should be in place for providing guidance or answering questions, may be a better alternative. Other facilities that are part of a system may want to consider pooling their resources and placing one or two nurses on call for the entire system.
Screen patients for symptoms at the door
Many experts say the most important part of reducing the transmission of seasonal influenza and H1N1 is separating sick patients from well patients as soon as they enter the facility. To accomplish this requires two things: screening procedures and isolation precautions.
Rebmann notes that isolation precautions, especially those involving negative pressure, are extremely difficult in the limited space of an outpatient facility. Instead, the facility should plan on designating one or two rooms to place patients with influenza as soon as they enter the facility.
But to separate the sick from the well, you need to have screening measures in place. Screening techniques range from passive screening, such as placing a sign at the facility entrance that directs patients according to their symptoms, to active screening, which might include a brief medical exam.
However, actively screening patients requires resources, which is why many facilities are moving toward enlisting volunteers, student workers, or even security guards to perform basic assessments with the help of a simple checklist.
"We aren't talking about a medical evaluation, obviously," Rebmann says. "That's going to be done by the medical providers."
This article was adapted from one that originally appeared in the September 2009 issue of Medical Environment Update, an HCPro publication.