Plan for infectious pandemics now

Nurse Leader Insider, February 25, 2016

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It's hard to believe it, but it's been just over a year since Ebola showed you exactly how ready you aren't.

Yes, it was October 2014 when Thomas Eric Duncan, a Liberian national who was visiting family in Dallas, became the first confirmed United States case of Ebola when he checked into Texas Health Presbyterian Hospital with symptoms. He later died; two nurses that had been caring for Duncan at the hospital also came down with symptoms, but were treated and recovered. Also that October, a New York City doctor who had been treating patients in Guinea tested positive for the virus and was later cured at Bellevue Hospital.

The cases, the first ever in American hospitals, set off a near panic in the United States as the CDC released a new set of guidelines and videos to help healthcare workers learn better how to work with PPE and keep their cool when dealing with one of the most infectious diseases on the planet.

The smarter and more proactive hospital safety professionals are already thinking of ways to get their staff better trained and bolster their hospital's defenses should the next pandemic come through their doors.

Ready your SWAT team. Chances are you don't even know who would respond if someone walked into your ED with symptoms of Ebola, and that's not good. The folks at Einstein Healthcare in Philadelphia formed what they call a SIDRT (Special Infectious Disease Response Team) that would be first on the scene as soon as symptoms are identified. The team consists of seven ER physicians, 22 critical care nurses, four respiratory therapy assistants, and a radiological team, all ready to swing into action with their specialized skills. An Ebola response plan has been mapped out that involves blocking off certain areas of the hospital, designating certain rooms as off-limits, and preparing pre-stocked carts that can be wheeled into place at a moment's notice.

Buy more PPE than you think you'll ever need, and find someplace for it. What if you don't have enough respirators available for your entire team? What if the only full-body suits your hospital owns are in a closet or trailer somewhere off-site? You don't want to come to these realizations in the middle of a pandemic. By now, you should have purchased at least the minimum amount of PPE your staff will need to wear when dealing with very infectious organisms. Ebola is so infectious that contact with a small drop of blood can transmit the disease. That's why the CDC recommends full-body coverage, tape over seams, powered air-purifying respirators, and about 35 different steps for putting the PPE on and taking it off (donning and doffing). Many hospitals also have begun stocking the equipment in easy-to-access cabinets outside patient safety rooms.

Train your staff to work in PPE. You also don't want to wait for a pandemic to realize that your staff has no idea how to use the PPE they've never trained in before. It sounds silly, but that was one of the major complaints to come out of the Ebola case in Dallas. Many of the nurses and patient care staff indicated that they had never seen a full-body suit or even tried one on. The PPE required for highly infectious diseases is bulky, hot, and difficult to work in for long periods of time. It requires working with spotters who look for signs that the users are dehydrated and tired, and therefore need to be rotated out for a break.

Be ready to lock down, and know what that means. In the event of a pandemic, you're going to have to control your perimeter. And that means locking the place down, not an easy task. After all, the hospital is a place where people are supposed to be able to come for help. But you may be dealing with mass hysteria, media coverage, concerned family members, and keeping your staff healthy, and your security staff will be the ones front and center handling the lockdown and the anxious crowd.

Prepare to take care of your staff. This might be the most important part of your pandemic preparations. The resources and 24/7 attention will put a major drain on your staff, and you need a plan in place to take care of them. When Pope Francis visited Philadelphia in September 2015, an entire three-square-mile area was closed off, forcing hospitals to create plans that revolved around keeping entire shifts of workers fed and housed so they could get to work. Some employees couldn't go home for an entire weekend.

This is an excerpt from the monthly healthcare safety resource Briefings on Hospital Safety. Subscribers can read the rest of the article here. Non-subscribers can find out more about the journal, its benefits, and how to subscribe by clicking here.

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