Public health threats bring public attention to hospital-acquired infections. Here is how several hospitals handled the Ebola and swine flu threats:
Infection prevention measures in hospitals are always critical. However, they rarely get the attention they deserve, except when a public health threat is suddenly in the news, like ebola or swine flu.
With an epidemic on the horizon, hospitals’ preparedness comes under the magnifying glass. This may result in hospitals more strictly enforcing hand hygiene rules, among other strong measures.
But, as any infection specialist will tell you, handwashing is just the beginning of disease control. Without other preventive protocols in place, it can be easier for staff members to contract germs — and harder for them to wash the germs away.
Unfortunately, hospitals don’t always pass the preparation test. Staff members get sick, and other patients and visitors are put at risk.
Here are how several hospitals failed to take proper precautions in the midst of an infectious disease — and how other hospitals proved up to the task.
The Swine Flu Pandemic (2009–2010)
The H1N1 virus (“swine flu”) appeared in the US in late March/early April of 2009. By fall of that year, it had become widespread, leading to President Barack Obama declaring it a “national emergency.”
What Didn’t Happen:
Swine flu spread throughout the general population like wildfire. But one of the biggest concerns was how quickly it was spreading within hospitals.
Nurses noticed that hospitals were particularly lacking in personal protective equipment, like masks.
Nurses at 15% of hospitals had no access to appropriate respirator masks. At about 20% of hospitals, nurses had masks that were appropriate, but not fitted to protect them properly. At 40% of hospitals, nurses were told to re-use the masks.
What Did Happen:
Hospitals soon began taking precautions to stymie the spread of swine flu to both hospital staff and other patients.
Some hospitals started identifying potential swine flu patients as soon as they entered the hospital, allowing hospital staff to take special precautions like increased hand hygiene.
Banner Health in Phoenix mandated that all 37,000 employees receive the new swine flu vaccine, and they achieved 100% compliance. Cleveland Clinic employees who contracted swine flu were not allowed to return to work until they had been cleared by a nurse.
At St. Patrick Hospital and Health Sciences Center in Missoula, Montana, a group of employees from many departments — storage and distribution, infection control, nursing clinics, occupational health, emergency room, and radiology — met weekly to discuss swine flu updates. Updates were sent out to every employee in the morning staff communication email.
St. Patrick’s also took steps to prevent cross-contamination, and reduce the amount of germs that could be spread from hand to hand. They removed magazines from waiting rooms, created waiting areas just for sick patients, and wiped down high-touch areas twice a day.
The Ebola Crisis (2014–2016)
The Ebola crisis that began in 2014 rampaged several countries in West Africa. In the three most affected countries — Sierra Leone, Guinea, and Liberia — there were over 28,000 cases, and 11,300 deaths.
Although the crisis began in December, 2013, it took almost a year for it to be on Americans’ radar. US Google searches for “Ebola” peaked on October 12, 2014 — just one day after an Ebola nurse at Texas Health Presbyterian Hospital Dallas became the first patient to contract Ebola on US soil.
What Didn’t Happen:
Nurse Nina Pham, who had been treating Ebola patient Thomas Eric Duncan, followed the hospital’s safety protocols, but still managed to become infected. A second nurse, Amber Vinson, was diagnosed shortly after. It didn’t take long for infection control specialists and civilians alike to attempt to uncover what went wrong in Dallas.
As the investigation into the nurses’ Ebola cases continued, several occurrences emerged:
The guidelines for handling Duncan’s care constantly changed.
There were inconsistencies in the guidelines for safely removing personal protective equipment.
Special protocols for disposing Duncan's waste and soiled sheets were not implemented.
For the first few days, nurses were not given proper personal protective equipment (e.g. their necks and hair were not covered).
The hospital did not educate nurses about caring for a patient with Ebola.
Pham had not been given disposable scrubs or new clothes on the first day of caring for Duncan. She was forced to go home wearing clothing that may have been contaminated with the virus.
With each of these lapses in preparation and protocols, there was no shortage of ways for germs to spread. Even with typical protective measures like handwashing, it was almost impossible for the nurses to avoid contact with the virus.
What Did Happen:
After the cluster of Ebola cases surfaced in Texas, hospitals across the US took measures to make sure they could safely treat Ebola patients.
By December 2014, the US Department of Health and Human Services deemed 35 hospitals equipped and prepared to handle to treat Ebola. These treatment centers had numerous special precautions in place, such as medical suites specifically for Ebola patients, and extensive training for staff members.
Massachusetts General Hospital went to the next level, investing about $1 million in equipment, renovations, and staff training — even though they conceded that an Ebola case in their hospital was unlikely.
The Ebola crisis also shed light on the prevalence of hospital-acquired infections and the need for improved infection control. It heightened awareness of the importance of infection control, leading to hospitals establishing a culture accountability for control measures like handwashing.
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