After reading this article, you will be able to:
- Describe the characteristics of H1N1
- Explain what issues can be assumed during a pandemic
- Discuss preparedness and response guidelines
This article explores problematic Joint Commission standards with expert advice from the newsletter Briefings on the Joint Commission's advisors. This month, Elizabeth Di Giacomo-Geffers, RN, MPH, CSHA, a healthcare consultant in Trabuco Canyon, CA, and former Joint Commission surveyor, discusses pending changes to Joint Commission standards.
It seems like potential pandemics require an animal in the title-especially if the word "flu" is involved. But influenza pandemics are no laughing matter, and with swine flu still on everyone's mind, facilities need to ask: Are we ready for the next pandemic?
What is novel influenza A (H1N1)?
Novel influenza A (aka H1N1, swine influenza, swine flu, hog flu, or pig flu) is an infection of a host animal by any of a specific type of microorganisms called swine influenza virus. The swine flu moniker stems from media labeling of a swine-origin A/H1N1 pandemic virus, similar to the way avian flu was caused by the HPAI (high pathogenic avian influenza) H5N1 strain that is endemic to wild bird species in several countries.
The 2009 swine flu outbreak in humans stems from a new strain of influenza A virus subtype H1N1 (origin unknown). According to the World Organization for Animal Health, this strain has not been isolated to pigs and causes the normal symptom of influenza in humans.
The U.S. Department of Health and Human Services (HHS) has released a number of guidelines for facilities to help them prepare for a pandemic. (Read more about HHS' pandemic flu plans here.)
HHS warns that, when a pandemic virus strain emerges, between 25%-30% of the population could develop the disease. Certain things can be assumed during a pandemic, according to HHS:
- Pandemic flu susceptibility will be universal.
- Illnesses will be highest among school-aged children-in the 40% range-and decline with age.
- Of those infected, half will seek outpatient care.
- The number of hospitalizations and deaths is difficult to predict. Based on the virulence of the virus, the estimates range widely.
But where is The Joint Commission addressing swine flu in its standards? The short answer: in many standards. The long answer: the Infection Control (IC) chapter (of course), as well as Environment of Care (EC) and, because of its pandemic nature, the Emergency Management (EM) chapter. Specifically:
- Infection control: IC.01.01.01, IC.01.02.01, IC.01.05.01 (EP 1), IC.01.06.01, IC.02.01.01 (EPs 2 and 3), IC.02.02.01, IC.02.03.01 (EP 1), and IC.02.04.01. These standards address the influx of infectious patients to the facility; required precautions for taking care of infectious patients; established protocols for dealing with infectious patients; prevention of transmission of infectious diseases; reducing risk of transference through equipment, devices, and supplies; and requirements for an infection prevention and control plan.
- Environment of care: EC.02.05.01 (EPs 6 and 9-11). This standard addresses how the hospital addresses risks associated with its utility system. The specific EPs address ventilation systems and the control of airborne contaminants, procedures for responding to interruptions of utility systems, procedures for shutting off malfunctioning systems, and the hospital's plans for emergency clinical interventions during said interruptions.
- Emergency management: EM.02.02.13 (EPs 1-9) and EM.02.02.15 (also EPs 1-9). The former addresses disaster privileging for licensed independent practitioners (LIP), whereas the latter deals with assigning disaster responsibilities to non-LIPs. It may be useful for hospitals to look at Provision of Care (PC) standard PC.02.01.15, which deals with diagnostic testing.
On May 19, the California Department of Public Health (CDPH) issued guidance for the prevention of swine flu in acute care settings. Those guidelines include:
- Notification of the infection preventionist. Hospitals should determine notification policies for admitted patients who may be swine flu carriers. Infection preventionists should be notified immediately when a suspected infection case is admitted to the hospital or the emergency department or if there has been a potential exposure in an outpatient clinic.
- All cases or probable cases in California facilities must be reported within one working day to the local health department as well as to the CDPH Licensing and Certification District Office.
- Currently, neither the Centers for Disease Control and Prevention (CDC) nor CDPH recommendations call for actively screening visitors for symptoms of H1N1. However, the CDPH has suggested possible methods of screening and prevention that include discouraging ill persons from visitation, an exposure questionnaire asking about fever and other symptoms as visitors enter the facility, and even actively screening visitors for fever or other symptoms.
The basics also apply, such as posting visual alerts for people to report symptoms, offering tissues and masks to symptomatic visitors, and making sure proper waste disposal containers are available, as well as appropriate hand hygiene supplies.
As always, additional precautions are a good idea when dealing with visitors to patients in isolation. Limiting access to visitors specific to the patient's emotional well-being and care, protective equipment for visitors, and appropriate hand hygiene precautions all apply.
Read more about the guidelines here.
The CDC has issued guidance for discharging patients with H1N1 influenza. The local department of health should be notified within 24 hours prior to discharging a patient with the virus or if a patient leaves the hospital against medical advice. Read more about these guidelines.
Patients in an acute care facility who are confirmed or probable cases of H1N1 should not be transferred to long-term healthcare facilities until seven days after the onset of the illness or their acute symptoms have been resolved, according to the CDPH. If the long-term healthcare facility is capable of handling the appropriate infection control steps, transferring the patient is acceptable.
The following reports can help facilities deal with the H1N1 situation:
1. U.S. Department of Health and Human Services (HHS). 2009. "HHS pandemic influenza plan." Available from www.hhs.gov/pandemicflu/plan/.
2. California Department of Public Health (CDPH). 2009. "California Department of Public Health novel influenza A (H1N1) virus (swine flu) infection control recommendations in an outpatient setting." Available from www.cdph.ca.gov/HealthInfo/discond/Documents/CDPH-AFL-Update-Infection-Control-H1N1-Influenza-Outpatient-Settings.pdf.
3. Centers for Disease Control and Prevention. 2009. Interim guidance for novel H1N1 flu (swine flu): Taking care of a sick person in your home." Available from www.cdc.gov/h1n1flu/guidance_homecare.htm.