Fear's over. Now what?

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Fear's over. Now what?
Fear's over. Now what?

When the World Health Organization officially declared the H1N1 pandemic over, Deb Burdsall wondered if the long-term care industry had dodged a major bullet. Although the outbreak was not as severe or widespread as originally forecast, it made her think about what might have been.

“The main consideration that has worried me is long-term care's place at the table, and where long-term care communities fit into the national emergency preparedness plans,” said Burdsall, corporate infection preventionist for Lutheran Life Communities in Arlington Heights, IL, and an active member of the Association of Practitioners in Infection Control and Epidemiology. “We care for very vulnerable individuals who live and interact together.

“There is a resource dependency in long-term care that requires outside agencies such as government and manufacturers, as well as long-term care providers, to act in the best interest of our elders and others in our care.”

Her concerns focus specifically on vaccine allocations and supplies of personal protective equipment such as N-95 personal respirators. As it turned out, the transmission of H1N1 was similar to seasonal influenza, not requiring the use of N-95 respirators, and the heightened alert overall served a constructive purpose, Burdsall said.

“H1N1 was a great opportunity to look at how respiratory outbreaks are identified, communicated, managed and controlled,” she said. “People always want clear direction in times of crisis. The H1N1 threat helped clarify where we needed to improve communication and modify the approach toward identifying and controlling illness,” she said.

Hudson Garrett, Ph.D., medical science liaison for Orangeburg, NY-based Professional Disposables International, agrees that “long-term care had many challenges when confronted with this massive pandemic.”

He echoes Burdsall's assertion that “the struggle centered around the appropriate use of personal protective equipment as well as securing adequate supplies of PPE for healthcare providers and visitors.”

The pandemic threat did yield some positive developments, however, such as the increased use of protective facial masks and enhanced hand hygiene efforts on behalf of both visitors and residents. Still, Garrett cautions long-term care facilities about complacency on this front.

“Some of these changes have remained, but most facilities have reduced their vigilance surrounding hand hygiene and environmental cleaning after the government officially declared the threat over,” he said. “This leaves us vulnerable to additional pandemics, so efforts to keep residents, visitors, and healthcare providers' hands clean must remain.”

‘Dry run' for future?

Fortunately, the H1N1 threat did not become as widespread as originally feared; yet the industry should use the experience to redouble its efforts for the future, said Sally Ann Friedman, spokeswoman for Oakland, CA-based Clorox's Away From Home Division.

“As a manufacturer of products that help prevent the spread of viruses like H1N1, we saw so many people take the flu more seriously during the pandemic,” she said. “However, the reality is an average of 200,000 people are hospitalized from the flu every year,” she said. “It is important to help prevent the spread of the flu every year–not just during pandemics.”

Friedman credits public agencies such as WHO and the Centers for Disease Control and Prevention for “working tirelessly to provide up-to-the-minute information on the spread of H1N1 and making sure the public did not panic.”

Moreover, the agencies emphasized prevention steps such as the importance of flu vaccinations and provided clarity on the difference between the seasonal flu vaccine and the H1N1 vaccine, she said.

Judson Boothe, marketing director for medical supplies at Roswell, GA-based Kimberly-Clark Health Care, is also calling for long-term care providers to continue working against future pandemic threats.

“Even though the H1N1 pandemic has been officially declared over, it is important to remain vigilant,” he said, noting his company is working with healthcare facilities to help them prepare for the next unknown pandemic.

“We are actively engaging our customers with programs that encourage a more proactive approach,” he continued. “The best time to prepare for a pandemic is during a non-pandemic time. We are working now to help facilities replenish their stockpiles so that they are better prepared for the next pandemic event.”

Report card time

If the performance of key players during the H1N1 emergency were translated into grades, both Garrett and Burdsall would issue above-average marks. Garrett gave a “B” grade to both providers and agencies while Burdsall gave her facility an “A” for its efforts.

“Most providers were aware of the signs and symptoms of H1N1 and during the crisis it was critical to appropriately use both antiviral and antimicrobial agents to preserve the medication arsenal as well as to protect residents from complications associated with inappropriate antimicrobial therapy,” Garrett said.

“Both the CDC and WHO executed their pandemic response plans and regularly disseminated information to both the public and healthcare providers.

“One of the major frustrations for healthcare providers, however, was the continually changing guidance that was issued from these agencies, as each week there were changes implemented, creating stress on healthcare providers and facilities to keep up.”

Burdsall said her facility gets the top grade because everyone on the team meshed together well.

“We had amazing support from the CEO and the administrative team, the nursing and direct care staff, as well as all support staff,” she said. “They asked the right questions, did not overreact, worked the problem and got a systematic process in place rapidly with the help of the interdisciplinary teams. Communication was the primary emphasis, along with prompt identification of symptoms, isolation and treatment.”

Embracing the lessons
In reviewing the experience, long-term care providers have several lessons they can take away, Garrett said.

“First, we have to have better mechanisms to distribute stockpile items such as personal protective equipment. During the pandemic, many of these supplies, particularly masks, were not available, which places the safety of healthcare providers and patients at risk,” he said.

“Better education of healthcare providers, residents, and the general public about the safety of vaccines is also critical to the success of a future vaccine awareness program. Businesses, particularly those that manufacture critical medical products, also were forced to develop and execute a pandemic preparedness and response plan, which placed a significant burden on these entities.”

Boothe added: “Reflecting on the many lessons learned during the H1N1 pandemic, I would say that providing much-needed product to protect healthcare workers is paramount. They are under tremendous pressure to provide the highest level of care to those in need. As a manufacturer of PPE, it's our job to make sure they have the tools needed to do their jobs.”

At Burdsall's facility, decision algorithms and procedural checklists are now part of the infection prevention and control policy. Furthermore, daily communication has improved, which helps identify and control any infection trend more quickly, she said.

“As William Hastie said, ‘History informs us of past mistakes from which we can learn without repeating them,'” Burdsall said. “I would say that what we have seen is an example of an informed response.”