Hospitals in the Valley tread cautiously, optimistically toward H1N1 flu treatment

By William K. Alcorn | October 3, 2009 at 12:08a.m.

Health-care workers will be among the first to be vaccinated.

Area hospitals are gearing up for the worst, while hoping their extraordinary preparations for the H1N1 (swine-flu) virus are not needed.

So far, so good, said Patricia Patterson, Humility of Mary Health Partners clinical infection-control manager.

“Ninety-five percent of the flu we’re seeing now is H1N1, and most cases have been fairly mild, less severe than the usual seasonal flu, which arrives later in the fall,” Patterson said.

But all that could change quickly.

Flu viruses can quickly mutate and become more virulent and deadly, she said.

Public health officials expect the H1N1 vaccine to arrive in late October or early November. What is not known is in what quantities it will be available, they say.

In the meantime, hospitals continue to prepare. The first step is to keep their own employees healthy so they can take care of patients.

Forum Health and HMHP offered seasonal flu vaccine to their employees.

And, since health-care workers are among those slated to receive the H1N1 vaccine in the first round, they will probably be lining up for shots again within weeks.

Hospitals have also devised policies and procedures to handle a surge of sick flu patients.

When someone comes in to the emergency department with flu symptoms, they are given a respiratory hygiene bag containing tissues and a surgical mask and sent to a waiting area separate from other ER patients, said Kathy Aven, infection preventionist at Northside Medical Center in Youngstown.

The hospitals contacted have negative air-flow rooms (the air does not circulate in the rest of the hospital) in their emergency rooms and main patient areas.

Flu patients are put in private rooms, and those taking care of them wear N-95 masks, made especially to keep out airborne viruses and bacteria.

Health care workers wear the N-95 mask to protect themselves. Patients wear surgery masks that protect others from them.

The problem, Patterson said, is that the N-95 are in short supply, with a six- to seven-week wait for orders.

The officials say they are prepared for a large influx of patients.

Communication is the key, Aven said.

“We would depend on the public health department to help coordinate efforts. We would notify it of our situation and find out what is going on elsewhere,” she said.

HMHP has a plan for pandemic-flu disaster, including how to handle a patient surge and how to manage a large number of ill health-care workers, said Patterson.

Patients would go into triage, and if it is determined they are ill enough to be admitted, a nasal swab would be taken for a test that determines quickly whether it is influenza Type A or B. If it tests positive for Type A., of which H1N1 is a strain, then the swab would be sent to the Ohio Department of Health for definitive testing.

In the meantime, treatment would begin right away as if it were H1N1. At this point, 95 percent of the flu we are seeing is H1N1, Patterson said.

Forum Health Trumbull Memorial Hospital in Warren has infectious disease and emergency management committees, which have developed policies and guidelines based on Centers for Disease Control and Prevention recommendations, said Linda Heater, who worked with Shelly Snitzer on the hospital’s infection control program.

“No matter what kinds of patients come in, or if there is a surge of patients, we have guidelines and policies to take care of them and also protect other patients and the staff,” Heater said.

Ideally flu patients are in private rooms, but it could become necessary to put more than one person in a room, she said.

The hospital’s first line of defense is registration and the emergency room. If patients have flu-like symptoms, they are offered a mask and asked to sit in a waiting area separate from other patients, Heater said.

To help hospitals out, not all people with the flu need to come to the hospital. The CDC does not recommend going to the hospital if you just have a cough and a cold, Heater said.

However, “we do want people to come to the hospital if they are short of breath, have poor color, or are pregnant with a temperature, or children who are listless and have breathing problems,” said Aven.

Hospitals are also prepared to help one another.

They have memorandums of understanding with other hospitals and vendors that spell out how they would get supplies.

Also, if there is a large surge of flu patients, elective procedures would be canceled and patients sent home to make way for the flu victims, officials said.

As part of its disaster preparedness, Salem Community Hospital has an extensive plan that defines the steps staff would take to reallocate space and personnel to meet the needs of current patients and those from the emerging event. It addresses how patients would be triaged and tracked through the hospital system. The plan also lists the types and amounts of emergency equipment and supplies on-hand to treat an influx of patients, said Michele Hoffmeister, director of public relations.

Salem Community Hospital also maintains relationships with other area hospitals and health-care providers to give mutual aid, and also has a plan to support staff members with dependent care and other needs who may be working extended hours, she said.

alcorn@vindy.com