Partnership's Aggressive Policies Prevent H1N1 Outbreak

Now that H1N1 fears have seemingly subsided, many infection control departments are evaluating their flu prevention programs, looking for deficiencies, while also noting effective policies and procedures.

For a number of facilities, the recent two-headed flu season proved the importance of a well-rounded respiratory infection control program.

Fred Hutchinson Cancer Research Center (FHCRC) and the Seattle Cancer Center Alliance (SCCA) created an aggressive prevention program that resulted in no increase of H1N1 cases in the facility month-to-month, despite a 100-fold increase in H1N1 cases in the Seattle area. The features of the program were published in a recent issue of Blood.

"I think we were really afraid and we didn't know how pathogenic or virulent this strain really was, especially with immunocopromised patients," says Michael Boeckh, MD, infectious disease physician at FHCRC. "There was simply no knowledge, so we took a very conservative approach. We really didn't want to find out later that it was a very bad strain, so we thought we would take the approach of designing a very comprehensive way of keeping the virus out of the system."

FHCRC already had a plan in place that was designed to incorporate a "heightened sense of alertness" beginning in October when most respiratory infections surface, and then that alertness would step down in April if activity had subsided. This allowed FHCRC to unknowingly prepare for the first H1N1 outbreaks, says Corey Casper, MD, a researcher in the FHCRC's Vaccine and Infectious Disease Institute and medical director of the SCCA's IC program.

"So ironically we had heightened our sense of alertness, and we were actually thinking of backing down when H1N1 hit, but rather than backing down we were actually able to scale back up to a higher level of alertness and take our plan off the shelf and very rapidly make it specific to H1N1," Casper says.

One of the major features of FHCRC's H1N1 plan was the screening process. Every person—patient or visitor—who entered the facility would have to answer a list of questions to determine whether they carried flu-like symptoms (see the Tools page on OSHA Healthcare Advisor to download the checklist).

The layout of FHCRC made it particularly conducive to screening patients and visitors as soon as they walked in the door, Casper says. Like most facilities, there is a reception area at the main entrance, but more importantly the blood draw laboratories are located in the same area.

"So many of the patient visits start with blood draw before you get chemotherapy, or before you get your latest prognosis about your cancer, you need a blood draw," Casper says. "So that is really where you start the patient care."

In addition to the screening checklist, the IC department also instituted a policy in which everyone who was screened received a sticker. Everyone at the facility knew that if they saw someone without a sticker, they needed to say something.

A major issue of contention in medical centers is how to handle paid sick time for employees who get H1N1. CDC guidelines recommend that employees with flu-like illnesses stay home for up to seven days depending on the severity of symptoms.

Employees may not have enough sick time or may feel pressured to come back to work before they have fully recovered. The first step in developing an effective sick leave policy is getting administrative buy-in, which could do more harm than good, Casper says.

"The administrators and the executives of a healthcare organization are looking at this as either a tool for risk management or a tool to save money and they're not looking at it as a tool to improve the quality of medical care, which is delivery," Casper says. "And if you're not looking at it from that perspective, then you don't give it the appropriate resources and attention that it needs."

Often the fear is that staff members will take advantage of extra sick time, but Casper says administration was upfront about the issue, and explained that additional sick time should only be used if it was absolutely needed.

"Our administration wanted to do the right thing, and due to the uncertainty of how bad this was going to be, which nobody knew at the time, I think we had a very great buy-in," Boeckh says.