SrasV1, Istex, Corpus, bibRecord, 000D09

Planning for the Inevitable: Preparing for Epidemic and Pandemic Respiratory Illness in the Shadow of H1N1 Influenza

Identifieur interne : 000D09 ( Istex/Corpus ); précédent : 000D08; suivant : 000D10

Planning for the Inevitable: Preparing for Epidemic and Pandemic Respiratory Illness in the Shadow of H1N1 Influenza

Auteurs : Elizabeth Lee Daugherty ; Abigail L. Carlson ; Trish M. Perl

Source :

Clinical Infectious Diseases [ 1058-4838 ] ; 2010.

RBID : ISTEX:39A023DE57EEE21D9E4BDA14D2CA3AAB53D28DDD

Abstract

The recent outbreak of novel H1N1 influenza has underscored the importance of hospital preparedness in responding to epidemic and pandemic respiratory illness. Comprehensive planning for the emergence of novel respiratory pathogens should be based on an all-hazards approach, with the input of key stakeholders. A staged, scalable model allows for a flexible response, and the addition of a medical control chief and a situational assessment chief to the incident command system provides the clinical and epidemiologic expertise essential for effective implementation. Strategies for coordinated and efficient communication both within and outside the institution should be clearly outlined. Furthermore, the outbreak of novel H1N1 influenza demonstrated the necessity of (1) additional support roles within the hospital, (2) development of employee databases, and (3) incorporation of disease severity into staged planning. Careful consideration of these issues will allow institutions to better meet the challenges of treating epidemic and pandemic respiratory illness, both now and in the future.

Url:

https://api.istex.fr/ark:/67375/HXZ-30J6LZVP-P/fulltext.pdf

DOI: 10.1086/651272

Links to Exploration step

ISTEX:39A023DE57EEE21D9E4BDA14D2CA3AAB53D28DDD

Le document en format XML

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<subject>Health Care Epidemiology</subject>

</subj-group>

</subj-group>

</article-categories>

<title-group>

<article-title>Planning for the Inevitable: Preparing for Epidemic and Pandemic Respiratory Illness in the Shadow of H1N1 Influenza</article-title>

</title-group>

<contrib-group>

<contrib contrib-type="author" corresp="yes">

<name><surname>Daugherty</surname>

<given-names>Elizabeth Lee</given-names>

</name>

<xref ref-type="aff" rid="aff1">1</xref>

<xref ref-type="corresp" rid="cor1"></xref>

</contrib>

<contrib contrib-type="author">

<name><surname>Carlson</surname>

<given-names>Abigail L.</given-names>

</name>

<xref ref-type="aff" rid="aff2">2</xref>

</contrib>

<contrib contrib-type="author">

<name><surname>Perl</surname>

<given-names>Trish M.</given-names>

</name>

<xref ref-type="aff" rid="aff2">2</xref>

<xref ref-type="aff" rid="aff3">3</xref>

</contrib>

<aff id="aff1"><label>1</label>
<institution>Division of Pulmonary and Critical Care Medicine, Johns Hopkins University</institution>
, <addr-line>Baltimore, Maryland</addr-line>
</aff>

<aff id="aff2"><label>2</label>
<institution>Department of Hospital Epidemiology and Infection Control, Johns Hopkins University</institution>
, <addr-line>Baltimore, Maryland</addr-line>
</aff>

<aff id="aff3"><label>3</label>
<institution>Division of Infectious Diseases, Johns Hopkins University</institution>
, <addr-line>Baltimore, Maryland</addr-line>
</aff>

</contrib-group>

<author-notes>

<corresp id="cor1">Reprints or correspondence: Dr Elizabeth Lee Daugherty, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, Fifth Floor, Baltimore, MD 21205 (<email>edaughe2@jhmi.edu</email>
).</corresp>

</author-notes>

<pub-date pub-type="ppub">

<day>15</day>

<month>4</month>

<year>2010</year>

</pub-date>

<volume>50</volume>

<issue>8</issue>

<fpage>1145</fpage>

<lpage>1154</lpage>

<history>

<date date-type="received">

<day>24</day>

<month>7</month>

<year>2009</year>

</date>

<date date-type="accepted">

<day>7</day>

<month>1</month>

<year>2010</year>

</date>

</history>

<copyright-statement>© 2010 by the Infectious Diseases Society of America</copyright-statement>

<copyright-year>2010</copyright-year>

<abstract>

<p><bold>The recent outbreak of novel H1N1 influenza has underscored the importance of hospital preparedness in responding to epidemic and pandemic respiratory illness. Comprehensive planning for the emergence of novel respiratory pathogens should be based on an all-hazards approach, with the input of key stakeholders. A staged, scalable model allows for a flexible response, and the addition of a medical control chief and a situational assessment chief to the incident command system provides the clinical and epidemiologic expertise essential for effective implementation. Strategies for coordinated and efficient communication both within and outside the institution should be clearly outlined. Furthermore, the outbreak of novel H1N1 influenza demonstrated the necessity of (1) additional support roles within the hospital, (2) development of employee databases, and (3) incorporation of disease severity into staged planning. Careful consideration of these issues will allow institutions to better meet the challenges of treating epidemic and pandemic respiratory illness, both now and in the future.</bold>
</p>

</abstract>

</article-meta>

</front>

<body>

<p>Since 11 September 2001 and the 2003 severe acute respiratory syndrome (SARS) outbreak, the health care and public policy communities have extensively discussed the importance of disaster planning. Significant steps have been taken by national and international health care organizations to prepare for the burden on health systems that such events might pose [<xref rid="R1" ref-type="bibr">1</xref>
]. The 2009 H1N1 influenza outbreak has underscored the importance of preparedness at the hospital level. Some hospitals have effectively integrated the infection prevention and disaster planning lessons learned from SARS and previous influenza pandemics. However, experts continue to worry that other novel respiratory pathogens may spread in an explosive fashion in health care settings, taxing an already stressed infrastructure. Data from the early 2009 H1N1 influenza response confirm that the concern for risk in health care settings is warranted. In one report, the Centers for Disease Control and Prevention noted that 50% of health care personnel with documented H1N1 infections were infected in a health care setting [<xref rid="R2" ref-type="bibr">2</xref>
]. Furthermore, expert estimates regarding the expected volume of patients in a pandemic [<xref rid="R3" ref-type="bibr">3</xref>
], although variable, highlight the need for plans that incorporate measures to (1) provide quality care to affected patients, (2) protect patients and health care personnel from health care-associated infection, and (3) maintain continuity of core operations in the face of epidemic and pandemic respiratory illness (EPRI). Few resources are available, however, to guide hospital EPRI planning efforts, and early experiences in the 2009 H1N1 influenza outbreak highlighted key planning issues that had previously been inadequately addressed. Herein, we offer an approach to hospital EPRI response planning that incorporates lessons learned in the initial response to 2009 H1N1 influenza. We review the all-hazards model for disaster planning, discuss unique issues in EPRI readiness, and offer tools for effective EPRI response.</p>

<sec>

<title>Establishing a Framework: The All-Hazards Approach</title>

<p>Disaster planning best practices dictate that an all-hazards approach provides the strongest basis for a functional institutional response to critical events [<xref rid="R4" ref-type="bibr">4</xref>
]. All-hazards planning is based on the concept that most disaster-response functions are common to all disaster types, and unified planning provides the strongest basis for effective response. As hospital disaster planners develop comprehensive approaches to threats to infrastructure and ongoing clinical operations, all-hazards planning using the Incident Command System (ICS), developed as part of the National Incident Management System [<xref rid="R5" ref-type="bibr">5</xref>
], provides a common framework that is easily interpretable across institutions and departments. An example of an ICS adapted for EPRI to include critical infection control resources is shown in <xref rid="fig1" ref-type="fig">Figure 1</xref>
.</p>

</sec>

<sec>

<title>Modification of the All-Hazards Approach for EPRI Planning</title>

<p>Use of the ICS for EPRI response provides the most effective use of health care epidemiologic data and infectious disease resources. However, EPRI requires planners to explicitly address several problems unique to outbreaks of pathogens that are efficiently transmitted from person to person. An outbreak of a pathogen with the potential for propagation (eg, SARS or novel influenza) requires different mitigation strategies than a single-source bioterrorism event, such as release of anthrax spores. Comprehensive EPRI plans must therefore address the following:</p>

<p>

<list list-type="order">

<list-item>

<p>Screening, surveillance, and tracking of exposed individuals</p>

</list-item>

<list-item>

<p>Controlled hospital access</p>

</list-item>

<list-item>

<p>Prevention strategies</p>

<list list-type="alpha-upper">

<list-item>

<p>Isolation and cohorting</p>

</list-item>

<list-item>

<p>Personal protective equipment use</p>

</list-item>

<list-item>

<p>Vaccination</p>

</list-item>

<list-item>

<p>Antiviral prophylaxis</p>

</list-item>

<list-item>

<p>Modification of environmental controls</p>

</list-item>

</list>

</list-item>

<list-item>

<p>Disease-specific admission criteria, treatment, and triage algorithms</p>

</list-item>

<list-item>

<p>Continuity of limited clinical operations</p>

</list-item>

</list>

</p>

<p><xref rid="fig2" ref-type="fig">Table 1</xref>
 summarizes functions to be addressed, involved departments, and tools for executing effective responses. A comprehensive discussion of admission criteria and continuity of operations planning is beyond the scope of this article.</p>

</sec>

<sec>

<title>EPRI Planning: The Process</title>

<p><bold><italic>Engagement of stakeholders.</italic>
</bold>
 To address unique EPRI issues and promote engagement and support for the alterations in hospital operations that may be necessary in pandemic response, the planning process must involve numerous stakeholders. Our planning efforts centered in the Department of Hospital Epidemiology and Infection Control (HEIC) and the Office of Emergency Management, but core leadership for the planning process will vary by institution. Key clinical departments, including medicine, pediatrics, obstetrics and gynecology, emergency medicine, microbiology, pharmacy, and occupational health, must be integrally involved in the planning process to ensure development of an effective response to a large-scale outbreak. In addition, psychiatry, social work, chaplaincy, and palliative care must be strategically involved because a prolonged EPRI outbreak may require major efforts in family education, grief and stress management, and compassionate care of patients who are too sick to save. Without question, administrative input from human resources, ethics, and legal affairs must be given high priority, as must security and environmental services. EPRI response planning is an iterative process and requires coordination of multiple parties. Some stakeholders, however, may be involved only at major decision points.</p>

<p>The overarching goal of hospital planning is to outline broad objectives and then encourage and empower departments to develop their own plans within key parameters, as dictated by infection prevention principles, ethical standards, and operational pragmatism. In <xref rid="fig3" ref-type="fig">Table 2</xref>
, we outline suggested responsibilities for representative departments. Specific means to meet these objectives may be left to departmental planners.</p>

<p><bold><italic>Formulation of a staged approach.</italic>
</bold>
 Once key stakeholders have been identified, the EPRI planning group should identify and review available planning resources. We relied on both bioterrorism response groundwork laid after 11 September 2001 and SARS planning at our institution, as well as input from colleagues from other health care facilities of similar size. The planning group agreed that an EPRI plan must be framed in a staged manner, as has been used by established health entities, such as the World Health Organization.</p>

<p>Staged, scalable plans must specifically address disease activity in and around the individual institution, knowledge about the epidemiology of the disease, and an understanding of vulnerable populations. The plan should provide specific, practical recommendations to health care professionals and should effectively empower infection control practitioners to contain the outbreak by all reasonable means. Our staged response was outlined to include specific direction in the following areas: (1) surveillance and screening, (2) hospital access and triage, and (3) infection control and prevention.</p>

<p>Much thought and planning for early response of novel respiratory pathogens has been shaped by the 2003 SARS experience. That outbreak was associated with a case fatality ratio of 9.6% [<xref rid="R6" ref-type="bibr">6</xref>
]. However, 2009 H1N1 influenza has presented as a mild illness with low associated morbidity and mortality rates in most patients [<xref rid="R7" ref-type="bibr">7</xref>
]. Given this low severity of disease, some stringent containment measures, such as mandatory daily symptom screening of all employees, may be more onerous and disruptive than beneficial.</p>

<p>The 2009 H1N1 pandemic demonstrated that response plans should include provisions for phased implementation based on both case location and severity of illness. As such, our initial 6-stage plan was expanded to 10 stages. In initial planning, stages were delineated by type of transmission, geographic location of cases, and nature of disease transmission at our facility. In the final plan, disease severity was included as a criterion for the various stages. The hospital epidemiologist was given the responsibility of determining severity, taking into account such variables as disease transmission patterns, morbidity, mortality, hospitalization rates, and availability of vaccine or treatment measures. To identify the stage at which the plan should be implemented, the geography and severity are plotted on the grid shown in <xref rid="fig4" ref-type="fig">Figure 2</xref>
. For example, if EPRI cases were present within the surrounding area and the hospital epidemiologist determined the severity of the illness to be moderate, a stage 8 response would be implemented. An example of the detailed response plan for stage 8 is presented in <xref rid="fig5" ref-type="fig">Table 3</xref>
.</p>

<p><bold><italic>Development of unique EPRI response leadership roles.</italic>
</bold>
 Once a staged plan has been developed, decision makers must be identified and communication strategies defined. Furthermore, given that standard all-hazards planning requires some modifications for prolonged outbreaks, planning teams may find it prudent to outline specific additions to the standard ICS.</p>

<p>Our EPRI team chose to make 3 key modifications to the ICS: (1) addition of the medical control chief (MCC), (2) addition of the situational assessment chief (SAC), and (3) development of an expert advisory panel. The MCC reports directly to the incident commander (IC) and has responsibility for coordinating assignments and responsibilities of all medical faculty and house staff through the departmental directors in concert with the operations chief. The MCC is also responsible for coordinating and advising the IC on decisions regarding standards of care, allocation of scarce resources, triage and admission criteria, and physician staffing. The role of the MCC should be filled by a physician with knowledge and/or experience in the broad range of clinical and operational issues that must be integrated in a comprehensive plan.</p>

<p>Given the unique nature of EPRI events, our planning team strongly supported the need for real-time assessment of infection control risks, triage planning, and containment strategies by an infection control expert who could be continuously available within the ICS. For this reason, the role of the SAC was instituted. The hospital epidemiologist or his/her designee serves as the SAC and reports directly to the IC and the MCC on the outlook for the event and recommended isolation, treatment, and mitigation procedures. The SAC is responsible for decisions pertaining to prevention, control, and containment of infected or infectious patients and health care personnel. He/she also directly oversees the antibiotic management program and the deployment of the infectious diseases staff in evaluation of EPRI patients. Furthermore, the SAC, along with the IC and MCC, is responsible for making decisions regarding initiating escalating stages of plan implementation. Decisions are generally made by consensus among this group, but in the case of a disagreement, ultimate authority rests in the hands of the IC.</p>

<p>Finally, to capitalize on the expertise in a large academic institution, an advisory panel should be developed to provide input in real time during biologic disasters. The aim is to establish a comprehensive inventory of local intellectual resources that might be brought to bear on complex clinical and operational challenges, recognizing that such input will be invaluable in handling both incidents of unusual magnitude and those resulting from novel pathogens.</p>

<p><bold><italic>Clarification of communication strategies.</italic>
</bold>
 After defining key leadership functions, core communication strategies should be delineated. Much communication will follow ICS guidelines, but given the nature of EPRI events, delineation of certain communication functions may be beneficial. For example, once entering a stage in which a significant EPRI threat is present in the region, our plan dictates that an incident command center be opened and initial briefing of core hospital leadership be conducted by the IC, MCC, and hospital epidemiologist or designated SAC.</p>

<p>Disaster communications strategies must be carefully coordinated to avoid mixed messages or delays in dissemination of information. In addition, provisions must be made for efficient communication among key leaders. At our institution, the SAC representing HEIC will serve as the direct contact for city, state, and federal public health officials. In all stages of the plan, HEIC staff is responsible for reporting EPRI among patients or employees to the local health departments per established guidelines, including exposure tracking. All information communicated to and received from the health departments should be transmitted in real time to the IC, incident command public information officer, and health system critical events coordinating office so that it may be disseminated across the health system in a timely and consistent fashion.</p>

<p><bold><italic>Redundant communication is essential for ensuring rapid dissemination of key messages.</italic>
</bold>
 Redundant internal communication systems should be coordinated through the incident command public information officer and institutional communications office and may include informational Web pages, e-mail alerts, posters, communication monitors located throughout the hospital, and group educational updates, when they are deemed safe on the basis of available infection control guidance. Redundant external communications may include Web sites, telephone hotlines, and regular press briefings. External communications should also be coordinated with the incident command public information officer but may alternatively be disseminated through a central health system critical event coordinating office.</p>

<p><bold><italic>Tools for implementation.</italic>
</bold>
 To augment the directives of the outlined plan, planners should adopt ready-to-use tools to facilitate plan implementation. For example, the need to screen all staff, patients, and potential visitors as the plan progresses through higher stages will likely present the planning teamwith a daunting task because it will require a highly efficient means of screening hundreds of individuals at least daily at the height of an outbreak.We developed a screening tool to allow efficient, uniform screening, recordkeeping, and symptom tracking among individuals presenting to our facility for any reason during the outbreak. An abbreviated version of the tool is shown in <xref rid="fig6" ref-type="fig">Figure 3</xref>
. Of note, to maximize efficiency of symptom tracking and assessment of shifting symptom patterns, integration of the tool into electronic medical records should be a key priority. Once fully implemented, this approach can allow download of outbreak data in real time by the hospital epidemiologist.</p>

<p>Another key resource for plan implementation is an algorithm for case detection and clinical management. The goals of such an algorithm include both effective case detection and appropriate risk stratification. Effective infection control necessitates the limitation of admissions to those with identified need for and probable benefit from in-hospital support. A carefully developed tool to triage patients needing essential care will streamline efforts to manage markedly increased patient volume. A modified version of a triage and management algorithm, as developed by our EPRI team in concert with HEIC and the Division of Infectious Diseases, is shown in <xref rid="fig7" ref-type="fig">Figure 4</xref>
. Of note, such algorithms require regular updating during any outbreak as clinical data become available. Pre-event tools should not be considered to be static guidance but rather a framework from which to build event-specific responses.</p>

</sec>

<sec>

<title>2009 H1N1 and Future Directions</title>

<p>During the 2009 H1N1 influenza response, we identified 2 additional roles that were critical to effective internal and external communication. Early in the outbreak, testing of cases suggestive of H1N1 influenza was mandated and performed by the state. To facilitate efficient interactions with the state health department regarding cases at our institution, we identified a physician who was assigned as the clinical case evaluation lead (CCEL). The CCEL triaged calls to the infection control center regarding potential cases within the hospital and carefully reviewed the history and findings with the reporting physician. Once the CCEL determined that a given case met H1N1 influenza case criteria, he/she communicated with the health department and served as the point of contact for communication of test results from the state to the hospital. The CCEL kept a log of possible cases, including symptoms, testing, and disposition. The other key role identified in the early H1N1 influenza response is that of a response documents coordinator. During the early phase of the response, multiple documents were generated to facilitate information dissemination, screening, and triage. Given the rapidly evolving situation, these documents required frequent updating and, in some cases, provided overlapping information. The coordinator was appointed to review all documents before dissemination to ensure consistency, accuracy, and timely integration with changes in state and national guidance.</p>

<p>As the H1N1 influenza response progressed, it was also recognized that effective infection control required the compilation of key data regarding employees that could be rapidly accessed by occupational health and infection control personnel. Data deemed essential to these efforts included details regarding fit testing of N-95 respirators (date of testing, mask type), seasonal influenza vaccination status, reporting of exposures or epidemiologic links, data regarding symptomatic employees (date of onset, disposition), respiratory virus testing results, and whether treatment and/or prophylaxis had been administered. Given the large, complex data set needed and the necessity of reliable, real-time information, it was recognized that development and refinement of a secure, interactive database should be a key EPRI response planning priority.</p>

<p>As H1N1 influenza has demonstrated, behind each resolved planning challenge lies another more complex challenge. No EPRI response plan can anticipate every eventuality, and thoughtful planning reveals a priority list for future work. Our planning identified the following priority areas for future work:</p>

<p>

<list list-type="order">

<list-item>

<p>Development of educational plans</p>

</list-item>

<list-item>

<p>Integration with health system planning</p>

<list list-type="alpha-upper">

<list-item>

<p>Coordination of triage within a health system</p>

</list-item>

<list-item>

<p>Sharing of staff</p>

</list-item>

</list>

</list-item>

<list-item>

<p>Integration with regional and state planning</p>

<list list-type="alpha-upper">

<list-item>

<p>Scarce resources allocation</p>

</list-item>

<list-item>

<p>Interfacility communication</p>

</list-item>

</list>

</list-item>

</list>

</p>

<p>The 2009 H1N1 influenza outbreak has highlighted gaps in health care response planning in a variety of arenas. Many have been addressed. Some have not. Nature rarely provides the opportunity to implement and evaluate EPRI plans on a large scale. We must heed the lessons of the early 2009 H1N1 influenza outbreak to ensure that future EPRI responses are as effective as possible.</p>

</sec>

</body>

<back>

<ack>

<title>Acknowledgments</title>

<p>We thank Mr Howard Gwon, Ms Claudia Halko, and all the members of the Johns Hopkins Hospital Pandemic Influenza Planning Committee for their generous contributions to the development of the plan described in this article.</p>

<p><bold><italic>Potential conflicts of interest.</italic>
</bold>
 T.P. has received a grant from the Centers for Disease Control and Prevention evaluating the utility of BioSense for influenza-like illness, has served on the data monitoring board for a clinical study for Cadence Pharmaceuticals, is on advisory boards for Theradoc and BioMerieux, and has received honoraria from Viropharma. All other authors: no conflicts.</p>

</ack>

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<sec sec-type="display-objects">

<title>Figures and Tables</title>

<fig position="float" id="fig1">

<label>Figure 1.</label>

<caption>

<p>Example of an incident command system adapted for epidemic and pandemic respiratory illness to include critical infection control resources.</p>

</caption>

<graphic mimetype="image" xlink:href="50-8-1145-fig001.tif"></graphic>

</fig>

<fig position="float" id="fig2">

<label>Table 1.</label>

<caption>

<p>Essential Epidemic and Pandemic Respiratory Illness Response Functions</p>

</caption>

<graphic mimetype="image" xlink:href="50-8-1145-tab001.tif"></graphic>

</fig>

<fig position="float" id="fig3">

<label>Table 2.</label>

<caption>

<p>Epidemic and Pandemic Respiratory Illness (EPRI) Response Functions of Selected Departments</p>

</caption>

<graphic mimetype="image" xlink:href="50-8-1145-tab002.tif"></graphic>

</fig>

<fig position="float" id="fig4">

<label>Figure 2.</label>

<caption>

<p>Example of an implementation grid for staged epidemic and pandemic respiratory illness response. The numbers in the grid correspond to epidemic and pandemic respiratory illness plan stages. The implementation stage is determined by the combination of geographic spread of disease and severity of the epidemic, as determined by the hospital epidemiologist. That determination is based on disease transmission patterns and associated morbidity, mortality, hospitalization rates, and availability of vaccine or treatment. HHS, United States Department of Health and Human Services.</p>

</caption>

<graphic mimetype="image" xlink:href="50-8-1145-fig002.tif"></graphic>

</fig>

<fig position="float" id="fig5">

<label>Table 3.</label>

<caption>

<p>Example of Detailed Stage 8 Response</p>

</caption>

<graphic mimetype="image" xlink:href="50-8-1145-tab003.tif"></graphic>

</fig>

<fig position="float" id="fig6">

<label>Figure 3.</label>

<caption>

<p>Example of the respiratory virus screening tool. ED, emergency department; JHOC, Johns Hopkins Outpatient Center; NP, nasopharyngeal aspirate; OHS, Occupational Health Services; OPD, outpatient dialysis.</p>

</caption>

<graphic mimetype="image" xlink:href="50-8-1145-fig003.tif"></graphic>

</fig>

<fig position="float" id="fig7">

<label>Figure 4.</label>

<caption>

<p>Example algorithm for case detection and management in the context of epidemic and pandemic respiratory illness (EPRI) with moderate or high severity and person-to-person transmission localized outside the United States. CDC, Centers for Disease Control and Prevention; HEIC, Department of Hospital Epidemiology and Infection Control; RT-PCR, reverse-transcription polymerase chain reaction.</p>

</caption>

<graphic mimetype="image" xlink:href="50-8-1145-fig004.tif"></graphic>

</fig>

</sec>

</back>

</article>
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<name type="personal" displayLabel="corresp"><namePart type="given">Elizabeth Lee</namePart>
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<name type="personal"><namePart type="given">Abigail L.</namePart>
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<affiliation>Department of Hospital Epidemiology and Infection Control, Johns Hopkins University, Baltimore, Maryland</affiliation>
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<name type="personal"><namePart type="given">Trish M.</namePart>
<namePart type="family">Perl</namePart>
<affiliation>Department of Hospital Epidemiology and Infection Control, Johns Hopkins University, Baltimore, Maryland</affiliation>
<affiliation>Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland</affiliation>
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<dateIssued encoding="w3cdtf">2010-04-15</dateIssued>
<dateCreated encoding="w3cdtf">2010-01-07</dateCreated>
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<abstract>The recent outbreak of novel H1N1 influenza has underscored the importance of hospital preparedness in responding to epidemic and pandemic respiratory illness. Comprehensive planning for the emergence of novel respiratory pathogens should be based on an all-hazards approach, with the input of key stakeholders. A staged, scalable model allows for a flexible response, and the addition of a medical control chief and a situational assessment chief to the incident command system provides the clinical and epidemiologic expertise essential for effective implementation. Strategies for coordinated and efficient communication both within and outside the institution should be clearly outlined. Furthermore, the outbreak of novel H1N1 influenza demonstrated the necessity of (1) additional support roles within the hospital, (2) development of employee databases, and (3) incorporation of disease severity into staged planning. Careful consideration of these issues will allow institutions to better meet the challenges of treating epidemic and pandemic respiratory illness, both now and in the future.</abstract>
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<part><date>2010</date>
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<extent unit="pages"><start>1145</start>
<end>1154</end>
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<relatedItem type="references" displayLabel="R3"><titleInfo><title>Report to the President on U.S. preparations for 2009-H1N1 influenza</title>
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<note>President's Council of Advisors on Science and Technology Report to the President on U.S. preparations for 2009-H1N1 influenza 2009 Washington, DC President's Council of Advisors on Science and Technology</note>
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<note>Auf der HeideE Disaster planning, part II: disaster problems, issues, and challenges identified in the research literature Emerg Med Clin North Am 1996 14 453 480</note>
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Planning for the Inevitable: Preparing for Epidemic and Pandemic Respiratory Illness in the Shadow of H1N1 Influenza

Planning for the Inevitable: Preparing for Epidemic and Pandemic Respiratory Illness in the Shadow of H1N1 Influenza

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