Preparedness of Hospitals in the Republic of Ireland for an Influenza Pandemic, an Infection Control Perspective
Identifieur interne : 000213 ( Pmc/Corpus ); précédent : 000212; suivant : 000214Preparedness of Hospitals in the Republic of Ireland for an Influenza Pandemic, an Infection Control Perspective
Auteurs : Mary Reidy ; Fiona Ryan ; Dervla Hogan ; Sean Lacey ; Claire BuckleySource :
- BMC Public Health [ 1471-2458 ] ; 2015.
Abstract
When an influenza pandemic occurs most of the population is susceptible and attack rates can range as high as 40–50 %. The most important failure in pandemic planning is the lack of standards or guidelines regarding what it means to be ‘prepared’. The aim of this study was to assess the preparedness of acute hospitals in the Republic of Ireland for an influenza pandemic from an infection control perspective.
This was a cross sectional study involving a questionnaire completed by infection control nurses, time period from June – July 2013, (3 weeks) from acute public and private hospitals in the Republic of Ireland. A total of 46 out of 56 hospitals responded to the questionnaire.
From a sample of 46 Irish hospitals, it was found that Irish hospitals are not fully prepared for an influenza pandemic despite the 2009 Influenza A (H1N1) pandemic. In 2013, thirty five per cent of Irish hospitals have participated in an emergency plan or infectious disease exercise and have plans or been involved in local planning efforts to care for patients at non-health care facilities. Sixty per cent of Irish hospitals did not compile or did not know if the hospital had compiled a “lessons learned” from any exercise that were then used to revise emergency response plans. Fifty two per cent of hospitals have sufficient airborne isolation capacity to address routine needs and have an interim emergency plan to address needs during an outbreak. Fifty one percent of hospitals have taken specific measures to stockpile or have reserve medical supplies e.g. masks, ventilators and linen.
This is the first study carried out in the Republic of Ireland investigating the current preparedness for an influenza pandemic from an infection control perspective.
Deficits exist in the provision of emergency planning committees, testing of emergency plans, airborne isolation facilities, stockpiling of personal protective equipment (PPE) and medical supplies and organisational schemes/incentives for healthcare workers to continue to work in a pandemic. While Irish standards are comparable to findings from international studies, the health care service needs to continue to enhance preparedness for an influenza pandemic and implement standard preparedness guidance for all Irish hospitals.
Url:
DOI: 10.1186/s12889-015-2025-6
PubMed: 26335570
PubMed Central: 4557843
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Preparedness of Hospitals in the Republic of Ireland for an Influenza Pandemic, an Infection Control Perspective</title><author><name sortKey="Reidy, Mary" sort="Reidy, Mary" uniqKey="Reidy M" first="Mary" last="Reidy">Mary Reidy</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.460892.1</institution-id><institution-id institution-id-type="ISNI">0000 0004 0389 5639</institution-id><institution>Bon Secours Hospital,</institution></institution-wrap>Tralee, County Kerry Ireland</nlm:aff></affiliation></author><author><name sortKey="Ryan, Fiona" sort="Ryan, Fiona" uniqKey="Ryan F" first="Fiona" last="Ryan">Fiona Ryan</name><affiliation><nlm:aff id="Aff2">Department of Public Health, Cork, Ireland</nlm:aff></affiliation></author><author><name sortKey="Hogan, Dervla" sort="Hogan, Dervla" uniqKey="Hogan D" first="Dervla" last="Hogan">Dervla Hogan</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000000123318773</institution-id><institution-id institution-id-type="GRID">grid.7872.a</institution-id><institution>Department of Epidemiology and Public Health,</institution><institution>University College Cork,</institution></institution-wrap>Cork, Ireland</nlm:aff></affiliation></author><author><name sortKey="Lacey, Sean" sort="Lacey, Sean" uniqKey="Lacey S" first="Sean" last="Lacey">Sean Lacey</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000000123318773</institution-id><institution-id institution-id-type="GRID">grid.7872.a</institution-id><institution>Department of Epidemiology and Public Health,</institution><institution>University College Cork,</institution></institution-wrap>Cork, Ireland</nlm:aff></affiliation></author><author><name sortKey="Buckley, Claire" sort="Buckley, Claire" uniqKey="Buckley C" first="Claire" last="Buckley">Claire Buckley</name><affiliation><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0693 825X</institution-id><institution-id institution-id-type="GRID">grid.47244.31</institution-id><institution>Department of Mathematics,</institution><institution>Cork Institute of Technology,</institution></institution-wrap>Cork, Ireland</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26335570</idno><idno type="pmc">4557843</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557843</idno><idno type="RBID">PMC:4557843</idno><idno type="doi">10.1186/s12889-015-2025-6</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000213</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000213</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Preparedness of Hospitals in the Republic of Ireland for an Influenza Pandemic, an Infection Control Perspective</title><author><name sortKey="Reidy, Mary" sort="Reidy, Mary" uniqKey="Reidy M" first="Mary" last="Reidy">Mary Reidy</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.460892.1</institution-id><institution-id institution-id-type="ISNI">0000 0004 0389 5639</institution-id><institution>Bon Secours Hospital,</institution></institution-wrap>Tralee, County Kerry Ireland</nlm:aff></affiliation></author><author><name sortKey="Ryan, Fiona" sort="Ryan, Fiona" uniqKey="Ryan F" first="Fiona" last="Ryan">Fiona Ryan</name><affiliation><nlm:aff id="Aff2">Department of Public Health, Cork, Ireland</nlm:aff></affiliation></author><author><name sortKey="Hogan, Dervla" sort="Hogan, Dervla" uniqKey="Hogan D" first="Dervla" last="Hogan">Dervla Hogan</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000000123318773</institution-id><institution-id institution-id-type="GRID">grid.7872.a</institution-id><institution>Department of Epidemiology and Public Health,</institution><institution>University College Cork,</institution></institution-wrap>Cork, Ireland</nlm:aff></affiliation></author><author><name sortKey="Lacey, Sean" sort="Lacey, Sean" uniqKey="Lacey S" first="Sean" last="Lacey">Sean Lacey</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000000123318773</institution-id><institution-id institution-id-type="GRID">grid.7872.a</institution-id><institution>Department of Epidemiology and Public Health,</institution><institution>University College Cork,</institution></institution-wrap>Cork, Ireland</nlm:aff></affiliation></author><author><name sortKey="Buckley, Claire" sort="Buckley, Claire" uniqKey="Buckley C" first="Claire" last="Buckley">Claire Buckley</name><affiliation><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0693 825X</institution-id><institution-id institution-id-type="GRID">grid.47244.31</institution-id><institution>Department of Mathematics,</institution><institution>Cork Institute of Technology,</institution></institution-wrap>Cork, Ireland</nlm:aff></affiliation></author></analytic><series><title level="j">BMC Public Health</title><idno type="eISSN">1471-2458</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>When an influenza pandemic occurs most of the population is susceptible and attack rates can range as high as 40–50 %. The most important failure in pandemic planning is the lack of standards or guidelines regarding what it means to be ‘prepared’. The aim of this study was to assess the preparedness of acute hospitals in the Republic of Ireland for an influenza pandemic from an infection control perspective.</p></sec><sec><title>Methods</title><p>This was a cross sectional study involving a questionnaire completed by infection control nurses, time period from June – July 2013, (3 weeks) from acute public and private hospitals in the Republic of Ireland. A total of 46 out of 56 hospitals responded to the questionnaire.</p></sec><sec><title>Results</title><p>From a sample of 46 Irish hospitals, it was found that Irish hospitals are not fully prepared for an influenza pandemic despite the 2009 Influenza A (H1N1) pandemic. In 2013, thirty five per cent of Irish hospitals have participated in an emergency plan or infectious disease exercise and have plans or been involved in local planning efforts to care for patients at non-health care facilities. Sixty per cent of Irish hospitals did not compile or did not know if the hospital had compiled a “lessons learned” from any exercise that were then used to revise emergency response plans. Fifty two per cent of hospitals have sufficient airborne isolation capacity to address routine needs and have an interim emergency plan to address needs during an outbreak. Fifty one percent of hospitals have taken specific measures to stockpile or have reserve medical supplies e.g. masks, ventilators and linen.</p></sec><sec><title>Conclusions</title><p>This is the first study carried out in the Republic of Ireland investigating the current preparedness for an influenza pandemic from an infection control perspective.</p><p>Deficits exist in the provision of emergency planning committees, testing of emergency plans, airborne isolation facilities, stockpiling of personal protective equipment (PPE) and medical supplies and organisational schemes/incentives for healthcare workers to continue to work in a pandemic. While Irish standards are comparable to findings from international studies, the health care service needs to continue to enhance preparedness for an influenza pandemic and implement standard preparedness guidance for all Irish hospitals.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Fiore, Ae" uniqKey="Fiore A">AE Fiore</name></author><author><name sortKey="Uyeki, Tm" uniqKey="Uyeki T">TM Uyeki</name></author><author><name sortKey="Broder, K" uniqKey="Broder K">K Broder</name></author><author><name sortKey="Finelli, L" uniqKey="Finelli L">L Finelli</name></author><author><name sortKey="Euler, Gl" uniqKey="Euler G">GL Euler</name></author><author><name sortKey="Singleton, Ja" uniqKey="Singleton J">JA Singleton</name></author><author><name sortKey="Iskander, Jk" uniqKey="Iskander J">JK Iskander</name></author><author><name sortKey="Wortley, Pm" uniqKey="Wortley P">PM Wortley</name></author><author><name sortKey="Shay, Dk" uniqKey="Shay D">DK Shay</name></author><author><name sortKey="Bresee, Js" uniqKey="Bresee J">JS Bresee</name></author><author><name sortKey="Cox, Nj" uniqKey="Cox N">NJ Cox</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Schoenbaum, Sc" uniqKey="Schoenbaum S">SC Schoenbaum</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Rebmann, T" uniqKey="Rebmann T">T Rebmann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rebmann, T" uniqKey="Rebmann T">T Rebmann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Amaratunga, Ca" uniqKey="Amaratunga C">CA Amaratunga</name></author><author><name sortKey="O Sullivan, Tl" uniqKey="O Sullivan T">TL O’ Sullivan</name></author><author><name sortKey="Philips, Kp" uniqKey="Philips K">KP Philips</name></author><author><name sortKey="Lemyre, L" uniqKey="Lemyre L">L Lemyre</name></author><author><name sortKey="Oconnor, E" uniqKey="Oconnor E">E OConnor</name></author><author><name sortKey="Dow, D" uniqKey="Dow D">D Dow</name></author><author><name sortKey="Corneil, W" uniqKey="Corneil W">W Corneil</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hui, Z" uniqKey="Hui Z">Z Hui</name></author><author><name sortKey="Jian Shi, H" uniqKey="Jian Shi H">H Jian-Shi</name></author><author><name sortKey="Xiong, H" uniqKey="Xiong H">H Xiong</name></author><author><name sortKey="Peng, L" uniqKey="Peng L">L Peng</name></author><author><name sortKey="Da Long, Q" uniqKey="Da Long Q">Q Da-Long</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rebmann, T" uniqKey="Rebmann T">T Rebmann</name></author><author><name sortKey="English, J" uniqKey="English J">J English</name></author><author><name sortKey="Carrico, R" uniqKey="Carrico R">R Carrico</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Li, X" uniqKey="Li X">X Li</name></author><author><name sortKey="Jianshi, H" uniqKey="Jianshi H">H Jianshi</name></author><author><name sortKey="Zhang, H" uniqKey="Zhang H">H Zhang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zoutman, De" uniqKey="Zoutman D">DE Zoutman</name></author><author><name sortKey="Ford, Bd" uniqKey="Ford B">BD Ford</name></author><author><name sortKey="Melinyshyn, M" uniqKey="Melinyshyn M">M Melinyshyn</name></author><author><name sortKey="Schwartz, B" uniqKey="Schwartz B">B Schwartz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rebmann, T" uniqKey="Rebmann T">T Rebmann</name></author><author><name sortKey="Wilson, R" uniqKey="Wilson R">R Wilson</name></author><author><name sortKey="Lapointe, S" uniqKey="Lapointe S">S LaPointe</name></author><author><name sortKey="Russell, B" uniqKey="Russell B">B Russell</name></author><author><name sortKey="Moroz, D" uniqKey="Moroz D">D Moroz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rebmann, T" uniqKey="Rebmann T">T Rebmann</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Irvin, Cb" uniqKey="Irvin C">CB Irvin</name></author><author><name sortKey="Cindrich, L" uniqKey="Cindrich L">L Cindrich</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Public Health</journal-id><journal-id journal-id-type="iso-abbrev">BMC Public Health</journal-id><journal-title-group><journal-title>BMC Public Health</journal-title></journal-title-group><issn pub-type="epub">1471-2458</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26335570</article-id><article-id pub-id-type="pmc">4557843</article-id><article-id pub-id-type="publisher-id">2025</article-id><article-id pub-id-type="doi">10.1186/s12889-015-2025-6</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Preparedness of Hospitals in the Republic of Ireland for an Influenza Pandemic, an Infection Control Perspective</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Reidy</surname><given-names>Mary</given-names></name><address><email>maryreidy@bonsecours.ie</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Ryan</surname><given-names>Fiona</given-names></name><address><email>FionaM.Ryan@hse.ie</email></address><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Hogan</surname><given-names>Dervla</given-names></name><address><email>Dervla.Hogan@ucc.ie</email></address><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Lacey</surname><given-names>Sean</given-names></name><address><email>Claire.Buckley@ucc.ie</email></address><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Buckley</surname><given-names>Claire</given-names></name><xref ref-type="aff" rid="Aff4">4</xref></contrib><aff id="Aff1"><label>1</label><institution-wrap><institution-id institution-id-type="GRID">grid.460892.1</institution-id><institution-id institution-id-type="ISNI">0000 0004 0389 5639</institution-id><institution>Bon Secours Hospital,</institution></institution-wrap>Tralee, County Kerry Ireland</aff><aff id="Aff2"><label>2</label>Department of Public Health, Cork, Ireland</aff><aff id="Aff3"><label>3</label><institution-wrap><institution-id institution-id-type="ISNI">0000000123318773</institution-id><institution-id institution-id-type="GRID">grid.7872.a</institution-id><institution>Department of Epidemiology and Public Health,</institution><institution>University College Cork,</institution></institution-wrap>Cork, Ireland</aff><aff id="Aff4"><label>4</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0693 825X</institution-id><institution-id institution-id-type="GRID">grid.47244.31</institution-id><institution>Department of Mathematics,</institution><institution>Cork Institute of Technology,</institution></institution-wrap>Cork, Ireland</aff></contrib-group><pub-date pub-type="epub"><day>3</day><month>9</month><year>2015</year></pub-date><pub-date pub-type="pmc-release"><day>3</day><month>9</month><year>2015</year></pub-date><pub-date pub-type="collection"><year>2015</year></pub-date><volume>15</volume><elocation-id>847</elocation-id><history><date date-type="received"><day>2</day><month>10</month><year>2014</year></date><date date-type="accepted"><day>6</day><month>7</month><year>2015</year></date></history><permissions><copyright-statement>© Reidy et al. 2015</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold> This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>When an influenza pandemic occurs most of the population is susceptible and attack rates can range as high as 40–50 %. The most important failure in pandemic planning is the lack of standards or guidelines regarding what it means to be ‘prepared’. The aim of this study was to assess the preparedness of acute hospitals in the Republic of Ireland for an influenza pandemic from an infection control perspective.</p></sec><sec><title>Methods</title><p>This was a cross sectional study involving a questionnaire completed by infection control nurses, time period from June – July 2013, (3 weeks) from acute public and private hospitals in the Republic of Ireland. A total of 46 out of 56 hospitals responded to the questionnaire.</p></sec><sec><title>Results</title><p>From a sample of 46 Irish hospitals, it was found that Irish hospitals are not fully prepared for an influenza pandemic despite the 2009 Influenza A (H1N1) pandemic. In 2013, thirty five per cent of Irish hospitals have participated in an emergency plan or infectious disease exercise and have plans or been involved in local planning efforts to care for patients at non-health care facilities. Sixty per cent of Irish hospitals did not compile or did not know if the hospital had compiled a “lessons learned” from any exercise that were then used to revise emergency response plans. Fifty two per cent of hospitals have sufficient airborne isolation capacity to address routine needs and have an interim emergency plan to address needs during an outbreak. Fifty one percent of hospitals have taken specific measures to stockpile or have reserve medical supplies e.g. masks, ventilators and linen.</p></sec><sec><title>Conclusions</title><p>This is the first study carried out in the Republic of Ireland investigating the current preparedness for an influenza pandemic from an infection control perspective.</p><p>Deficits exist in the provision of emergency planning committees, testing of emergency plans, airborne isolation facilities, stockpiling of personal protective equipment (PPE) and medical supplies and organisational schemes/incentives for healthcare workers to continue to work in a pandemic. While Irish standards are comparable to findings from international studies, the health care service needs to continue to enhance preparedness for an influenza pandemic and implement standard preparedness guidance for all Irish hospitals.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Influenza</kwd><kwd>Pandemic</kwd><kwd>Infection control</kwd><kwd>Infection control nurse</kwd><kwd>Personal protective equipment</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2015</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec id="Sec1" sec-type="introduction"><title>Background</title><p>The historical degree of antigenic natural process and occurrence of the 2009 pandemic influenza A (H1N1) virus strains shows that mutations in the future cannot be foreseen [<xref ref-type="bibr" rid="CR1">1</xref>]. Due to the growth in global transport and urbanization, epidemics caused by a new influenza virus are likely to spread rapidly around the world [<xref ref-type="bibr" rid="CR2">2</xref>]. Influenza pandemics occur sporadically and most of the population is susceptible so that attack rates can range as high as 40–50 % of the population [<xref ref-type="bibr" rid="CR3">3</xref>].</p><p>The objective of pandemic planning is to assist countries to be prepared to recognise and manage an influenza pandemic. Planning can minimise the spread of the pandemic virus, decrease cases, hospitalisations and deaths, preserve essential services and mitigate the economic and social aftermaths of a pandemic [<xref ref-type="bibr" rid="CR4">4</xref>].</p><p>Hospital emergency management plans are a vital element of hospital preparedness for magnitude casualties and need to tackle all key risks including biologic threats such as bioterrorism, emerging infectious diseases, outbreaks and pandemics [<xref ref-type="bibr" rid="CR5">5</xref>]. The key failure in pandemic planning is the lack of standards or guidelines regarding what it means to be ‘prepared’ [<xref ref-type="bibr" rid="CR6">6</xref>].</p><p>International studies reported similar findings to each other regarding infectious disease disaster preparedness. Hospitals had inadequate interaction and accounting procedures, poor healthcare worker training programs and inadequate stockpiled personal protective equipment and other medical equipment e.g. ventilators [<xref ref-type="bibr" rid="CR5">5</xref>–<xref ref-type="bibr" rid="CR8">8</xref>]. These studies highlighted deficient 24 h infection control resources, lack of preparedness for an increase in the need for negative-pressure facilities and failure of healthcare workers (HCWs) to participate in hospital pandemic preparedness drills which involved an infectious disease scenario along with lack of prioritization strategies for distribution of restricted doses of antiviral medications [<xref ref-type="bibr" rid="CR5">5</xref>, <xref ref-type="bibr" rid="CR9">9</xref>–<xref ref-type="bibr" rid="CR11">11</xref>]. Hospitals require more preparedness for infectious disease outbreaks and hospitals have not focused on testing their plans despite the evidence that preparedness is key during a pandemic [<xref ref-type="bibr" rid="CR5">5</xref>, <xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR13">13</xref>]. Smaller hospitals (≤99 beds) are less prepared than larger hospitals with regards to surge capacity [<xref ref-type="bibr" rid="CR14">14</xref>]. The consistent recommendations from these studies are that hospitals need to continue to prepare and test their preparedness for an influenza pandemic. In comparison to similar studies, these authors used different audit tools in order to assess the level of preparedness for an influenza pandemic (no audit tool the same). There is no checklist currently in Ireland for Irish hospitals to assess how prepared they are for an influenza pandemic, not included in the Irish guidance for an influenza pandemic. The Centre of Diseases Control and Prevention (CDC) has a check list which assists hospitals to assess their preparedness which is not included in the Irish pandemics preparedness as a tool to assist hospitals.</p><p>The aim of this study was to assess the preparedness of acute hospitals in the Republic of Ireland for an influenza pandemic from an infection control perspective.</p></sec><sec id="Sec2" sec-type="materials|methods"><title>Methods</title><p>This is a cross-sectional study using a questionnaire completed by infection control nurses. The participant information sheet and a letter outlining the study requesting permission to carry out the research was sent to the Chief Executive Officer (CEO)/Manager of each hospital. An e-mail was sent to the infection prevention control nurse (IPCN) of each hospital outlining the study and objectives of same, inclusion and exclusion criteria were applied as follows: Acute public and private hospitals in the Republic of Ireland were included. Nursing Homes and Psychiatric hospitals were excluded. The list of acute public and private hospitals was compiled from the Health Service Executive web site and the Health Protective Surveillance Centre surveillance scientist who collates data for the National Clostridium Difficile Associated Disease surveillance in the Republic of Ireland.</p><sec id="Sec3"><title>Questionnaire Design/Data Collection Method</title><p>There is no checklist currently in Ireland for Irish hospitals to assess how prepared they are for an influenza pandemic, not included in the Irish guidance for an influenza pandemic. The Centre for Disease Control provides a checklist in order for hospitals to assess their preparedness for an influenza pandemic. International studies were cross sectional studies using questionnaires, no questionnaire was similar. The author adapted the questionnaire by Rebmann (2009b), examining the knowledge of infection control nurses of their hospitals preparedness for an influenza pandemic using a quantitative study design. The researcher used this questionnaire for the study with permission from the author Rebmann. Prior to piloting the questionnaire, it was edited using English terminology rather than Americanized versions. The name of the hospital was sought in order for follow-up phone calls to hospitals to fill in blank answers. This questionnaire was modified and piloted by IPCNs in three hospitals. No modifications were required following their evaluation. The questionnaire included 42 questions to be answered. This questionnaire allowed hospitals to give comments on the best and worst aspects of their hospitals preparedness for an influenza pandemic which was analysed descriptively. Open ended questions were included in the questionnaire; these comments will be reviewed in further research.</p><p>The questionnaire contained 42 questions. The domains evaluated in the questionnaire included the following:<list list-type="order"><list-item><p>Pandemic emergency preparedness</p></list-item><list-item><p>Airborne isolation</p></list-item><list-item><p>Staffing</p></list-item><list-item><p>Vaccines administration to healthcare workers (HCW's)</p></list-item><list-item><p>Stockpile of supplies.</p></list-item></list></p><p>The name of each hospital was sought in order for follow-up phone calls to hospitals to fill in blank answers. The questionnaire contained a number of ‘Yes’, ‘No’ or 'Don't know' style questions and also allowed IPCNs to give comments. Consent was obtained when survey completed by each IPCN and returned to author. Time period to sending out questionnaires and receiving responses was from June – July 2013, (3 weeks) from acute public and private hospitals in the Republic of Ireland. A total of 46 out of 56 hospitals responded to the questionnaire</p><p>The statistical computer package IBM SPSS, Version 22 was used to perform quantitative analysis on the collected data. In order to perform analysis of data, it was necessary to code the response variables i.e., yes = 1, no = 0, don't know = blank. Data cleaning was carried out throughout the data entry process. Analysis of the data was performed through descriptive statistics, such as frequencies for each of the variables. Contingency tables were used to describe the relationship between question responses. A chi-squared test for association was used to determine whether or not any associations observed were statistically significant (p ≤ 0.05). Hospital size categories were selected from arbitrary, no existing hospital classification in use in Ireland. Hospital sizing involved the following:<list list-type="bullet"><list-item><p>Small <100 beds (8 hospitals responded)</p></list-item><list-item><p>Medium 100–199 beds (18 hospitals responded)</p></list-item><list-item><p>Large >199 beds (20 hospitals responded)</p></list-item></list></p><p>Contingency tables were used to describe the relationship between question responses. A chi-squared test for association was used to determine whether or not any associations observed were statistically significant (p ≤ 0.05).</p></sec><sec id="Sec4"><title>Ethics</title><p>Ethical approval was granted by the Clinical Research Committee of the Cork Teaching Hospitals (public hospitals) and the Bon Secours Group Ethics Committee (private hospitals) in Ireland.</p></sec></sec><sec id="Sec5" sec-type="results"><title>Results</title><p>The response rate was 85 %; 46 out of 56 acute public and private hospitals completed the questionnaire. Response rate is broken down further by the following: small sized hospitals <100 beds (8 responses), medium sized hospitals 100–199 beds (18 responses) and large sized hospitals >199 beds (20 responses) see Table <xref rid="Tab1" ref-type="table">1</xref> on the break down of results.</p><sec id="Sec6"><title>1. Pandemic emergency preparedness:</title><p>Eighty five percent (n = 39) of hospitals have an emergency planning committee and of those hospitals that have a committee, seventy nine per cent include in their scope planning for an influenza pandemic (see Table <xref rid="Tab2" ref-type="table">2</xref>). Smaller hospitals were significantly less likely to have an emergency planning committee (p = .045). Sixty seven per cent (n = 31) of emergency planning committees include planning for influenza pandemic (see Table <xref rid="Tab3" ref-type="table">3</xref>). There was no statistical association found between whether or not emergency planning committees include planning for influenza pandemic and hospital size (p = 0.972). The highest result of seventy two per cent (n = 13) accounts for medium sized hospitals, with a similar result of sixty two per cent (n = 5) for small and sixty five per cent (n = 13) for large hospitals.<table-wrap id="Tab1"><label>Table 1</label><caption><p>Break down of results on Preparedness of Hospitals in the Republic of Ireland for an Influenza Pandemic, an Infection Control Perspective</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Pandemic emergency preparedness</th><th>Small hospitals compliance</th><th>Medium hospitals compliance</th><th>Large hospitals</th><th>Total percentage compliance</th><th>Total number of hospitals</th></tr></thead><tbody><tr><td>Existence of emergency planning committee</td><td>50 % (n = 4)</td><td>94 % (n = 17)</td><td>90 % (n = 18)</td><td>85 % (n = 39)</td><td>39</td></tr><tr><td>Hospitals with an emergency planning committee, percentage of committees which included in their scope planning for an influenza pandemic</td><td></td><td></td><td></td><td>79 %</td><td>36</td></tr><tr><td>Percentage of emergency planning committees which include planning for influenza pandemic</td><td>62 % (n = 5)</td><td>72 % (n = 13)</td><td>65 % (n = 13)</td><td>67 %</td><td>31</td></tr><tr><td>Percentage of hospitals which participated in an emergency plan or infectious disease exercise in the past 12 months</td><td>25 % (n = 2)</td><td>40 % (n = 7)</td><td>35 % (n = 16)</td><td>35 %</td><td>16</td></tr><tr><td>Percentage of hospitals which involve community participation when conducting an emergency plan</td><td></td><td></td><td></td><td>15 %</td><td>5</td></tr><tr><td>Percentage of hospitals who compiled lessons learnt from emergency exercises carried out</td><td></td><td></td><td></td><td>40 %</td><td>15</td></tr><tr><td>Percentage of hospitals who educated staff on revisions made to emergency response plans</td><td></td><td></td><td></td><td>36 %</td><td>16</td></tr><tr><td>Percentage of emergency plans which include a surge capacity plan to incorporate additional staffing resources</td><td>12.5 % (n = 1)</td><td>29 % (n = 5)</td><td>37 % (n = 7)</td><td>30 %</td><td>13</td></tr><tr><td>Percentage of hospitals who have plans or been involved in local planning efforts to care for patients at non-health care facilities</td><td></td><td></td><td></td><td>30 %</td><td>14</td></tr><tr><td>Percentage of hospitals who have incentives to encourage HCW’s to continue to come to work in the event of a major infectious disease outbreak/disaster</td><td>25 % (n = 2)</td><td>22 % (n = 4)</td><td>20 % (n = 4)</td><td>22 %</td><td>10</td></tr><tr><td>Airborne isolation</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Percentage of hospitals who have enough airborne isolation capabilities and capacity to meet current needs</td><td>62 % (n = 5)</td><td>50 % (n = 9)</td><td>50 % (n = 10)</td><td>52 %</td><td>24</td></tr><tr><td>Percentage of hospitals who have an interim emergency plan for addressing airborne isolation capacity for an outbreak of prolonged airborne-spread disease to safely house patients on an emergency temporary basis</td><td>12 % (n = 1)</td><td>72 % (n = 13)</td><td>55 % (n = 11)</td><td>54 %</td><td>25</td></tr><tr><td>Percentage of hospitals who have sufficient plans to safely house patients during a major airborne-spread disease outbreak</td><td>12 % (n = 1)</td><td>41 % (n = 7)</td><td>45 % (n = 9)</td><td>38 %</td><td>17</td></tr><tr><td>Staffing</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Percentage of hospitals who have cross trained staff to treat an influx of influenza patients</td><td>12 % (n = 1)</td><td>28 % (n = 5)</td><td>15 % (n = 3)</td><td>26 %</td><td>12</td></tr><tr><td>Percentage of hospitals who have cross-trained staff to provide patient care outside their routine area or speciality</td><td>12 % (n = 1)</td><td>28 % (n = 5)</td><td>15 % (n = 3)</td><td>20 %</td><td>9</td></tr><tr><td>Percentage of hospitals who have developed policies or procedures to provide altered standards of care during a pandemic</td><td></td><td></td><td></td><td>35 %</td><td>16</td></tr><tr><td>Percentage of hospitals who have plans for instituting a ‘working quarantine’ for staff</td><td></td><td></td><td></td><td>20 %</td><td>9</td></tr><tr><td>Vaccine administration</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Percentages of hospitals who have a plan to prioritise hospital workers to receive vaccines in the event of an infectious emergency</td><td></td><td></td><td></td><td>65 %</td><td>30</td></tr><tr><td>Stockpile of supplies</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Percentage of hospital who have taken measures to stockpile linen, gowns, masks and other supplies</td><td>12 % (n = 1)</td><td>72 % (n = 13)</td><td>47 % (n = 9)</td><td>51 %</td><td>23</td></tr><tr><td>Existence of emergency planning committee</td><td>50 % (n = 4)</td><td>94 % (n = 17)</td><td>90 % (n = 18)</td><td>85 % (n = 39)</td><td>39</td></tr><tr><td>Hospitals with an emergency planning committee, percentage of committees which included in their scope planning for an influenza pandemic</td><td></td><td></td><td></td><td>79 %</td><td>36</td></tr><tr><td>Percentage of emergency planning committees which include planning for influenza pandemic</td><td>62 % (n = 5)</td><td>72 % (n = 13)</td><td>65 % (n = 13)</td><td>67 %</td><td>31</td></tr><tr><td>Percentage of hospitals which participated in an emergency plan or infectious disease exercise in the past 12 months</td><td>25 % (n = 2)</td><td>40 % (n = 7)</td><td>35 % (n = 16)</td><td>35 %</td><td>16</td></tr><tr><td>Percentage of hospitals which involve community participation when conducting an emergency plan</td><td></td><td></td><td></td><td>15 %</td><td>5</td></tr><tr><td>Percentage of hospitals who compiled lessons learnt from emergency exercises carried out</td><td></td><td></td><td></td><td>40 %</td><td>15</td></tr><tr><td>Percentage of hospitals who educated staff on revisions made to emergency response plans</td><td></td><td></td><td></td><td>36 %</td><td>16</td></tr><tr><td>Percentage of emergency plans which include a surge capacity plan to incorporate additional staffing resources</td><td>12.5 % (n = 1)</td><td>29 % (n = 5)</td><td>37 % (n = 7)</td><td>30 %</td><td>13</td></tr><tr><td>Percentage of hospitals who have plans or been involved in local planning efforts to care for patients at non-health care facilities</td><td></td><td></td><td></td><td>30 %</td><td>14</td></tr><tr><td>Percentage of hospitals who have incentives to encourage HCW’s to continue to come to work in the event of a major infectious disease outbreak/disaster</td><td>25 % (n = 2)</td><td>22 % (n = 4)</td><td>20 % (n = 4)</td><td>22 %</td><td>10</td></tr><tr><td>Airborne isolation</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Percentage of hospitals who have enough airborne isolation capabilities and capacity to meet current needs</td><td>62 % (n = 5)</td><td>50 % (n = 9)</td><td>50 % (n = 10)</td><td>52 %</td><td>24</td></tr><tr><td>Percentage of hospitals who have an interim emergency plan for addressing airborne isolation capacity for an outbreak of prolonged airborne-spread disease to safely house patients on an emergency temporary basis</td><td>12 % (n = 1)</td><td>72 % (n = 13)</td><td>55 % (n = 11)</td><td>54 %</td><td>25</td></tr><tr><td>Percentage of hospitals who have sufficient plans to safely house patients during a major airborne-spread disease outbreak</td><td>12 % (n = 1)</td><td>41 % (n = 7)</td><td>45 % (n = 9)</td><td>38 %</td><td>17</td></tr><tr><td>Staffing</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Percentage of hospitals who have cross trained staff to treat an influx of influenza patients</td><td>12 % (n = 1)</td><td>28 % (n = 5)</td><td>15 % (n = 3)</td><td>26 %</td><td>12</td></tr><tr><td>Percentage of hospitals who have cross-trained staff to provide patient care outside their routine area or speciality</td><td>12 % (n = 1)</td><td>28 % (n = 5)</td><td>15 % (n = 3)</td><td>20 %</td><td>9</td></tr><tr><td>Percentage of hospitals who have developed policies or procedures to provide altered standards of care during a pandemic</td><td></td><td></td><td></td><td>35 %</td><td>16</td></tr><tr><td>Percentage of hospitals who have plans for instituting a ‘working quarantine’ for staff</td><td></td><td></td><td></td><td>20 %</td><td>9</td></tr><tr><td>Vaccine administration</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Percentages of hospitals who have a plan to prioritise hospital workers to receive vaccines in the event of an infectious emergency</td><td></td><td></td><td></td><td>65 %</td><td>30</td></tr><tr><td>Stockpile of supplies</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Percentage of hospital who have taken measures to stockpile linen, gowns, masks and other supplies</td><td>12 % (n = 1)</td><td>72 % (n = 13)</td><td>47 % (n = 9)</td><td>51 %</td><td>23</td></tr></tbody></table></table-wrap><table-wrap id="Tab2"><label>Table 2</label><caption><p>Contingency table of hospital size with emergency planning committee</p></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="2"></th><th colspan="3">Does the hospital have an emergency planning committee?</th><th>Total</th></tr></thead><tbody><tr><td colspan="2"></td><td>Yes</td><td>No</td><td>Don't know</td><td></td></tr><tr><td rowspan="3">Hospital size</td><td><100</td><td>4 (50.0 %)</td><td>3 (37.5 %)</td><td>1 (12.5 %)</td><td>8 (100.0 %)</td></tr><tr><td>100-199</td><td>17 (94.4 %)</td><td>1 (5.6 %)</td><td>0 (0.0 %)</td><td>18 (100.0 %)</td></tr><tr><td>>199</td><td>18 (90.0 %)</td><td>1 (5.0 %)</td><td>1 (5.0 %)</td><td>20 (100.0 %)</td></tr><tr><td colspan="2">Total</td><td>39 (84.8 %)</td><td>5 (10.9 %)</td><td>2 (4.3 %)</td><td>46 (100.0 %)</td></tr></tbody></table></table-wrap><table-wrap id="Tab3"><label>Table 3</label><caption><p>Contingency table of hospital size with planning for influenza pandemic</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2" colspan="2"></th><th colspan="3">Does emergency planning committees include planning for influenza pandemic?</th><th rowspan="2">Total</th></tr><tr><th>Yes</th><th>No</th><th>Don't know</th></tr></thead><tbody><tr><td rowspan="3">Hospital size</td><td><100</td><td>5 (62.5 %)</td><td>2 (25.0 %)</td><td>1 (12.5 %)</td><td>8 (100.0 %)</td></tr><tr><td>100-199</td><td>13 (72.2 %)</td><td>4 (22.2 %)</td><td>1 (5.6 %)</td><td>18 (100.0 %)</td></tr><tr><td>>199</td><td>13 (65.0 %)</td><td>5 (25.0 %)</td><td>2 (10.0 %)</td><td>20 (100.0 %)</td></tr><tr><td colspan="2">Total</td><td>31 (67.4 %)</td><td>11 (23.9 %)</td><td>4 (8.7 %)</td><td>46 (100.0 %)</td></tr></tbody></table></table-wrap></p><p>Thirty five per cent (n = 16) of hospitals have participated in an emergency plan or infectious disease exercise in the past twelve months (see Table <xref rid="Tab4" ref-type="table">4</xref>). The majority of hospitals (56.5 %) (n = 26) have not participated in an emergency plan or infectious disease exercise in the last 12 months (p < 0.001). A minority (17.6 % (n = 6)) of hospitals involved community participation when conducting an emergency plan (p = 0.037).<table-wrap id="Tab4"><label>Table 4</label><caption><p>Contingency table of hospital participation</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Response</th><th>Participated in an emergency plan or infectious disease exercise in the past 12 months</th><th>Community participation</th><th>Compiled lessons learned</th><th>Educated/trained on revisions</th><th>Emergency plan include a surge capacity plan</th></tr></thead><tbody><tr><td>Yes</td><td>16 (34.8 %)</td><td>6 (17.6 %)</td><td>16 (41.0 %)</td><td>16 (35.6 %)</td><td>13 (29.5 %)</td></tr><tr><td>No</td><td>26 (56.5 %)</td><td>10 (29.4 %)</td><td>15 (38.5 %)</td><td>21 (46.7 %)</td><td>18 (40.9 %)</td></tr><tr><td>Don't know</td><td>4 (8.7 %)</td><td>18 (52.9 %)</td><td>8 (20.5 %)</td><td>8 (17.8 %)</td><td>13 (29.5 %)</td></tr><tr><td>Total</td><td>46 (100.0 %)</td><td>34 (100.0 %)</td><td>39 (100.0 %)</td><td>45 (100.0 %)</td><td>44 (100.0 %)</td></tr><tr><td>p-value</td><td><0.001</td><td>0.037</td><td>0.232</td><td>0.057</td><td>0.567</td></tr></tbody></table></table-wrap></p><p>Fifteen per cent (n = 5) of hospitals involved community participation when conducting an emergency plan. Forty per cent (n = 15) of hospitals compiled lessons learned from emergency exercises carried out. Thirty six per cent (n = 16) of hospitals educated staff on revisions made to emergency response plans. Thirty per cent (n = 13) of emergency plans included a surge capacity plan to incorporate additional staffing resources.</p><p>Only thirty per cent (n = 14) of hospitals have plans or been involved in local planning efforts to care for patients at non-health care facilities (p = 0.001, see Table <xref rid="Tab5" ref-type="table">5</xref>). While twenty two per cent (n = 10) of hospitals have incentives to encourage HCWs to continue to come to work in the event of a major infectious disease outbreak/disaster (p < 0.001).<table-wrap id="Tab5"><label>Table 5</label><caption><p>Contingency table of hospitals involved in local planning and staff incentives</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Response</th><th>Established plans or been involved in local planning efforts to care for a patients at non-health care facilities</th><th>Incentives to encourage HCWs to continue to come to work in the event of a major infectious disease outbreak/disaster</th></tr></thead><tbody><tr><td>Yes</td><td>14 (30.4 %)</td><td>10 (21.7 %)</td></tr><tr><td>No</td><td>26 (56.5 %)</td><td>30 (65.2 %)</td></tr><tr><td>Don't know</td><td>6 (13.0 %)</td><td>6 (13.0 %)</td></tr><tr><td>Total</td><td>46 (100.0 %)</td><td>46 (100.0 %)</td></tr><tr><td>p-value</td><td>0.001</td><td><0.001</td></tr></tbody></table></table-wrap></p></sec><sec id="Sec7"><title>2. Airborne isolation capabilities</title><p>From Table <xref rid="Tab6" ref-type="table">6</xref>, fifty two per cent (n = 24) of hospitals have enough airborne isolation capabilities and capacity (in terms of rooms or areas) to meet their current routine needs.<table-wrap id="Tab6"><label>Table 6</label><caption><p>Contingency table of hospitals having sufficient and preparation for isolation</p></caption><table frame="hsides" rules="groups"><thead><tr><th></th><th>Enough airborne isolation capabilities and capacity</th><th>Interim emergency plan for addressing airborne isolation capacity</th></tr></thead><tbody><tr><td>Yes</td><td>24 (52.2 %)</td><td>25 (54.3 %)</td></tr><tr><td>No</td><td>22 (47.8 %)</td><td>14 (30.4 %)</td></tr><tr><td>Don't know</td><td>0 (0.0 %)</td><td>7 (15.2 %)</td></tr><tr><td>Total</td><td>46 (100.0 %)</td><td>46 (100.0 %)</td></tr><tr><td>p-value</td><td>0.883</td><td>0.005</td></tr></tbody></table></table-wrap></p><p>Fifty four per cent (n = 25) of hospitals have an interim emergency plan for addressing airborne isolation capacity for an outbreak of prolonged airborne-spread disease to safely house patients on an emergency temporary basis. From Table <xref rid="Tab7" ref-type="table">7</xref>, twelve and a half per cent (n = 1) of smaller hospitals and fifty five per cent (n = 11) of larger sized hospitals have an interim emergency plan compared to seventy two percent (n = 13) of medium sized hospitals.<table-wrap id="Tab7"><label>Table 7</label><caption><p>Contingency table of hospital size and interim emergency airborne isolation capacity</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2" colspan="2"></th><th colspan="3">Interim emergency plan for addressing airborne isolation capacity</th><th rowspan="2">Total</th></tr><tr><th>Yes</th><th>No</th><th>Don't know</th></tr></thead><tbody><tr><td rowspan="3">Hospital size</td><td><100</td><td>1 (12.5 %)</td><td>5 (62.5 %)</td><td>2 (25.0 %)</td><td>8 (100.0 %)</td></tr><tr><td>100-199</td><td>13 (72.2 %)</td><td>4 (22.2 %)</td><td>1 (5.6 %)</td><td>18 (100.0 %)</td></tr><tr><td>>199</td><td>11 (55.0 %)</td><td>5 (25.0 %)</td><td>4 (20.0 %)</td><td>20 (100.0 %)</td></tr><tr><td colspan="2">Total</td><td>25 (54.3 %)</td><td>14 (30.4 %)</td><td>7 (15.2 %)</td><td>46 (100.0 %)</td></tr></tbody></table></table-wrap></p><p>Thirty eight per cent (n = 17) of hospitals have sufficient plans to safely house patients during a major airborne-spread disease outbreak (Table <xref rid="Tab8" ref-type="table">8</xref>, p = 0.074).<table-wrap id="Tab8"><label>Table 8</label><caption><p>Contingency table to house patients during major airborne disease outbreak</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Sufficient plans to safely house patients during a major airborne-spread disease outbreak</th><th>Frequency</th><th>Percent</th></tr></thead><tbody><tr><td>Yes</td><td>17</td><td char="." align="char">37.8</td></tr><tr><td>No</td><td>20</td><td char="." align="char">44.4</td></tr><tr><td>Don't know</td><td>8</td><td char="." align="char">17.8</td></tr><tr><td>Total</td><td>45</td><td char="." align="char">100.0</td></tr></tbody></table></table-wrap></p></sec><sec id="Sec8"><title>3. Staffing</title><p>Low levels of cross-training (twenty six percent, (n = 12)) to treat an influx of influenza patients was reported overall (see Table <xref rid="Tab9" ref-type="table">9</xref>, p < 0.001).<table-wrap id="Tab9"><label>Table 9</label><caption><p>Contingency table re staffing preparedness</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Response</th><th>Cross-training to treat an influx of influenza patients</th><th>Cross-trained staff to provide patient care outside their routine area</th><th>Plans for having designated staff limited to treat either influenza or non-influenza patients</th><th>Developed policies/procedures</th><th>Plans for instituting "working quarantine" for staff</th></tr></thead><tbody><tr><td>Yes</td><td>12 (26.1 %)</td><td>9 (19.6 %)</td><td>23 (50.0 %)</td><td>16 (34.8 %)</td><td>10 (21.7 %)</td></tr><tr><td>No</td><td>30 (65.2 %)</td><td>31 (67.4 %)</td><td>16 (34.8 %)</td><td>24 (52.2 %)</td><td>27 (57.7 %)</td></tr><tr><td>Don't know</td><td>4 (8.7 %)</td><td>6 (13.0 %)</td><td>7 (15.2 %)</td><td>6 (13.0 %)</td><td>9 (19.6 %)</td></tr><tr><td>Total</td><td>46 (100.0 %)</td><td>46 (100.0 %)</td><td>46 (100.0 %)</td><td>46 (100.0 %)</td><td>46 (100.0 %)</td></tr><tr><td>p-value</td><td><0.001</td><td><0.001</td><td>0.015</td><td>0.005</td><td>0.001</td></tr></tbody></table></table-wrap></p><p>Twenty per cent of (n = 9) hospitals have cross-trained staff to provide patient care outside their routine area or speciality (Table <xref rid="Tab9" ref-type="table">9</xref>, p < 0.001). Fifty per cent (n = 25) of hospitals have plans during a pandemic influenza outbreak to have designated staff limited to treat either influenza or non-influenza patients (Table <xref rid="Tab9" ref-type="table">9</xref>, p = 0.015). Thirty five per cent (n = 13) of hospitals have developed policies or procedures to provide altered standards of care during a pandemic (Table <xref rid="Tab9" ref-type="table">9</xref>, p = 0.005).</p><p>Twenty per cent (n = 16) of hospitals have plans for instituting a “working quarantine” for staff (Table <xref rid="Tab9" ref-type="table">9</xref>, p < 0.001). All hospitals surveyed had an infection control nurse and the average number of nurses by weighted time equivalent per hospital was 1.78. Seventy six per cent of hospitals have an infection control professional available for immediate (within fifteen minutes) verbal consultation.</p></sec><sec id="Sec9"><title>4. Vaccine administration</title><p>Sixty five per cent (n = 30) of hospitals have a plan to prioritise hospital workers to receive vaccines in the event of an infectious emergency (Table <xref rid="Tab10" ref-type="table">10</xref>, p < 0.001).<table-wrap id="Tab10"><label>Table 10</label><caption><p>Contingency table vaccines and healthcare workers</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Response</th><th>Prioritise hospital workers to receive vaccines in the event of an infectious emergency</th><th>Included HCWs family members to be part of the hospitals prioritisation plan</th></tr></thead><tbody><tr><td>Yes</td><td>30 (65.2 %)</td><td>2 (5.7 %)</td></tr><tr><td>No</td><td>7 (15.2 %)</td><td>27 (77.1 %)</td></tr><tr><td>Don't know</td><td>9 (19.6 %)</td><td>6 (17.1 %)</td></tr><tr><td>Total</td><td>46 (100.0 %)</td><td>35 (100.0 %)</td></tr><tr><td>p-value</td><td><0.001</td><td><0.001</td></tr></tbody></table></table-wrap><table-wrap id="Tab11"><label>Table 11</label><caption><p>Contingency table of hospital size with measures of stockpile</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2" colspan="2"></th><th colspan="3">Measures to stockpile</th><th rowspan="2">Total</th></tr><tr><th>Yes</th><th>No</th><th>Don't know</th></tr></thead><tbody><tr><td rowspan="3">Hospital size</td><td><100</td><td>1 (12.5 %)</td><td>5 (62.5 %)</td><td>2 (25.0 %)</td><td>8 (100.0 %)</td></tr><tr><td>100-199</td><td>13 (72.2 %)</td><td>5 (27.8 %)</td><td>0 (0.0 %)</td><td>18 (100.0 %)</td></tr><tr><td>>199</td><td>9 (47.4 %)</td><td>9 (47.4 %)</td><td>1 (5.3 %)</td><td>19 (100.0 %)</td></tr><tr><td colspan="2">Total</td><td>23 (51.1 %)</td><td>19 (42.2 %)</td><td>3 (6.7 %)</td><td>45 (100.0 %)</td></tr></tbody></table></table-wrap></p><p>Only two hospitals included HCWs family members to be part of the hospitals prioritisation plan for receiving vaccine or anti-infective therapy in the event of an infectious disease emergency Table <xref rid="Tab10" ref-type="table">10</xref>, p <0.001).</p><sec id="Sec10"><title>5. Stockpile of supplies</title><p>Fifty one per cent (n = 23) of hospitals have taken measures to stockpile linen, gowns, masks and other supplies, (see Table <xref rid="Tab11" ref-type="table">11</xref>).</p></sec></sec></sec><sec id="Sec11" sec-type="discussion"><title>Discussion</title><p>The main findings from this study showed hospitals are not fully prepared from an infection control perspective for an influenza pandemic.</p><sec id="Sec12"><title>1. Pandemic emergency preparedness</title><p>Our results revealed 85 % of Irish hospitals had an emergency planning committee and 67 % of such committees included planning for an influenza pandemic. There is a statistically significant association between hospital size and the existence of an emergency planning committee i.e. 50 % of smaller hospitals (<100 beds) have emergency planning committees compared to >90 % of medium and larger hospitals surveyed. Chinese findings were similar [<xref ref-type="bibr" rid="CR12">12</xref>] where 85 % of hospitals had an emergency planning committee while 79 % included in their scope planning for an influenza pandemic in comparison to findings from a Chinese study which demonstrated a higher result of 93 %.</p><p>One third of Irish hospitals had participated in an emergency plan or infectious disease exercise in the last year in comparison to Canadian findings [<xref ref-type="bibr" rid="CR13">13</xref>] which showed a higher result of 84.5 % of hospitals had tested their plans while Chinese studies [<xref ref-type="bibr" rid="CR12">12</xref>] demonstrated 55 % of hospitals had evaluated and reviewed their emergency plan at least once and a similar result of 84 % of carrying out an infectious disease scenario in the previous year [<xref ref-type="bibr" rid="CR14">14</xref>].</p><p>Irish hospitals demonstrated a low level of including community participation of 15 % in comparison to a rate of 86.5 % from America findings [<xref ref-type="bibr" rid="CR14">14</xref>].</p><p>Noteworthy that only 60 % of respondents did not compile or did not know if the hospital had compiled a “lessons learned” from any exercise that were then used to revise emergency response plans while 85 % of American hospitals had compiled lessons learned from the exercise that was used to revise their emergency plan [<xref ref-type="bibr" rid="CR14">14</xref>]. Hospital emergency plans should be updated regularly based on lessons learned from exercises [<xref ref-type="bibr" rid="CR8">8</xref>].</p></sec><sec id="Sec13"><title>2. Airborne isolation Capabilities</title><p>Over half of Irish hospitals had enough airborne isolation capabilities and capacity to meet the current routine needs (one per 150 acute inpatient beds, or one per 75 acute inpatient beds for regional or tertiary hospitals SARI 2009) compared to 85 % of American hospitals reported that their hospital has sufficient numbers of negative-pressure rooms to accommodate their current isolation needs [<xref ref-type="bibr" rid="CR14">14</xref>]. Only 55 % of Irish hospitals have an interim emergency plan to address needs during an outbreak.</p><p>Significantly, only 38 % of Irish hospitals have sufficient plans to safely house patients during a major airborne disease outbreak and 54 % had an interim emergency plan for addressing airborne isolation capacity for an outbreak of prolonged airborne -spread disease to safely house patients on an emergency temporary basis [<xref ref-type="bibr" rid="CR14">14</xref>].</p></sec><sec id="Sec14"><title>3. Staffing</title><p>Only 26 % of Irish hospitals have cross-trained staff to be able to treat an influx of influenza patients while 22 % have cross-trained staff to provide patient care outside their routine area or speciality compared to a similar study of 24.6 % showing similar results [<xref ref-type="bibr" rid="CR14">14</xref>].</p></sec><sec id="Sec15"><title>4. Vaccines</title><p>Sixty-five percent of Irish hospitals have a plan to prioritise hospital workers to receive vaccines in the event of an infectious emergency. In regards to international studies there is no comparison to vaccines. This low reported percentage may be due to IPCNs not having the information as occupational health nurses would normally be responsible for vaccines.</p></sec><sec id="Sec16"><title>5. Stockpile of supplies</title><p>The emergency plan should include protocols for stockpiling or obtaining additional staff, medical and laboratory equipment supplies [<xref ref-type="bibr" rid="CR14">14</xref>] whilst stockpiling a sufficient amount of PPE could be a large financial burden on each hospital; this must occur before pandemics escalate due to the inevitable shortage of PPE [<xref ref-type="bibr" rid="CR15">15</xref>]. There is a statistically significant association between hospital size and taking measures to stockpile or have reserve medical supplies (p = 0.026). The Health Service holds a stockpile of supplies which is given to hospitals during a pandemic. Medium sized hospitals are better prepared than smaller and larger sized hospitals.</p><p>Less than half of hospitals have stockpiled or worked with the HSE to establish a stockpile of FFP2/FFP3 respirators (average of 6 days) compared to 67 % of American hospitals stockpiling N95 respirators [<xref ref-type="bibr" rid="CR14">14</xref>].</p><p>One third of hospitals have stockpiled surgical masks (average of 5.1 days supply) compared to 46 % of American findings [<xref ref-type="bibr" rid="CR14">14</xref>].</p><p>One fifth of hospitals have stockpiled or worked with the state to establish a stockpile of linen (average of 2.4 days supply of linen) compared to a demonstration of a higher rate of half of US hospitals indicated they had enough linen for <5 days [<xref ref-type="bibr" rid="CR14">14</xref>].</p><p>Overall these findings are evidence for the need for greater prioritisation of pandemic preparedness stockpiling.</p></sec><sec id="Sec17"><title>Strengths of study</title><p>Forty six hospitals out of a total of 56 acute public and private hospitals in the Republic of Ireland completed the questionnaire yielding a response rate of 82 %. This was a good response rate in comparison to the literature review studies; ranging from 20 % [<xref ref-type="bibr" rid="CR14">14</xref>] – 88.2 % [<xref ref-type="bibr" rid="CR13">13</xref>].</p></sec><sec id="Sec18"><title>Limitations</title><p>There may have been responder bias as IPCNs completed the survey, may have focussed on strengths. Standardised validated questionnaire was not used however, previously used questionnaires were adapted and piloted prior to use. Information was limited by IPCN's as some had the information themselves due to being a member of the emergency committee, some IPCN's went to lead persons to gain answers to the questionnaire while others did not have all the information. Ten hospitals did not respond, all private hospitals responded. No reason given for not responding. Analysis was not done in regards to levels of preparedness by private and public hospitals. The question was not posed if hospitals were using a checklist in order to assess their preparedness e.g. Centre for Disease Control guidance.</p></sec></sec><sec id="Sec19" sec-type="conclusion"><title>Conclusion</title><p>This is the first study in the Republic of Ireland investigating preparedness of Irish acute hospitals for an influenza pandemic from an infection control perspective, acute hospitals in the Republic of Ireland have deficits regarding emergency planning committees, testing of emergency plans, airborne isolation facilities and incentives to encourage HCW’s to come to work in line with the literature. The Republic of Ireland needs to address gaps in influenza pandemic preparedness.</p><sec id="Sec20"><title>Recommendations</title><p>Hospitals should prepare and regularly test their preparedness for an influenza pandemic using the standardised recognised tools.</p><p>There should be national agreement on the use of a standardised internationally recognised tool to be used in all acute hospitals for this purpose.</p><p>The overarching recommendation is the need for a strategic approach to pandemic preparedness and elements of this research could be used to inform health policy in the Republic of Ireland.</p></sec></sec></body><back><glossary><title>Abbreviations</title><def-list><def-item><term>APIC</term><def><p>Association for Professionals in Infection Control and Epidemiology</p></def></def-item><def-item><term>CDC</term><def><p>Centre for Disease Control</p></def></def-item><def-item><term>CI</term><def><p>Confidence Interval</p></def></def-item><def-item><term>DH</term><def><p>Department Health</p></def></def-item><def-item><term>DOH</term><def><p>Department of Health</p></def></def-item><def-item><term>GAR</term><def><p>Global Assessment Report</p></def></def-item><def-item><term>HCP</term><def><p>Health Care Professionals</p></def></def-item><def-item><term>HCW</term><def><p>Health Care Worker</p></def></def-item><def-item><term>HSE</term><def><p>Health Service Executive</p></def></def-item><def-item><term>IC</term><def><p>Infection Control</p></def></def-item><def-item><term>ICP</term><def><p>Infection Control Preventionist</p></def></def-item><def-item><term>ICN</term><def><p>Infection Control Nurse</p></def></def-item><def-item><term>IPCN</term><def><p>Infection Prevention and Control Nurse</p></def></def-item><def-item><term>IP</term><def><p>Infection Prevention</p></def></def-item><def-item><term>PHE</term><def><p>Public Health Emergency</p></def></def-item><def-item><term>PPE</term><def><p>Personal Protective Equipment</p></def></def-item><def-item><term>SARS</term><def><p>Severe Acute Respiratory Syndrome</p></def></def-item><def-item><term>SPSS</term><def><p>Statistical Package for the Social Sciences</p></def></def-item><def-item><term>US</term><def><p>United States</p></def></def-item><def-item><term>WHO</term><def><p>World Health Organisation</p></def></def-item></def-list></glossary><fn-group><fn><p><bold>Competing interests</bold></p><p>The authors declare that they have no completing interests.</p></fn><fn><p><bold>Authors’ contributions</bold></p><p>MR carried out the study. FR participated in the design of the study and coordination and helped to draft the manuscript. CMB reviewed the analysis and edited the manuscript. DH participated in the design of the study and assisted in drafting and editing the manuscript. SL participated in the statistical element of the study. IJP designed the study, reviewed the analyses and revised the paper. 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