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Southwest Florida hospitals preparing for surge of swine-flu patients
By LIZ FREEMAN
Posted September 7, 2009 at 4:42 p.m.
Southwest Florida hospitals are ready for swine flu to strike mildly or in full force this winter, with disaster plans to address employees and potential onslaughts of sick patients.
With the expectation that a vaccine for the H1N1 virus, which causes swine flu, will be on hand in mid-October, officials with the NCH Healthcare System and Physicians Regional Health System in Collier County will first vaccinate high-risk employees who would be susceptible to becoming sick and exposed to patients with flu-like symptoms. From there, the vaccine will be offered to all hospital employees.
Officials with the Lee Memorial Health System in Lee County, which operates Lee Memorial, Gulf Coast and Cape Coral hospitals and HealthPark Medical Center, will take a similar approach.
Employees in emergency rooms, intensive-care units, radiology, pediatrics and obstetrics will be the first target for the vaccine, which could be about 25 percent of the 1,000 people employed at Physicians Regional Medical Centers at Pine Ridge and Collier Boulevard, said Dee Hawks, the hospital system?s infection prevention director.
?There are going to be those employees who do not want the vaccine,? she said. ?All we can do is give them a declination form. We can?t force an employee to get a vaccine.?
What?s still unknown are potential side effects that will impact employee participation, she said.
The Lee Memorial system will offer the swine flu vaccine first to pregnant employees, front-line nurses and emergency-room staff and then to the remaining work force, said Stephen Streed, director of epidemiology.
Mandating employees get the vaccine or require they wear masks is under consideration, similar to a decision by Virginia Mason Medical System in Seattle, Streed said. The state of New York passed a law requiring all health-care workers to get the swine flu vaccine, he said. There are caveats for individuals with allergies, he added.
?We are actually talking about that,? Streed said of a mandatory vaccine. ?No decision has been made. I think it will be made pretty soon. I think we have a responsibility as health-care workers and a responsibility to take care of patients. I think (the state of) Florida should do that.?
Last week, the Association for Professionals in Infection Control and Epidemiology restated its 2008 position that all hospitals and medical centers require employees get both the seasonal flu and swine flu vaccine.
In Collier, NCH officials said the issue of a mandatory swine vaccination for the 3,400 work force is a hot topic right now but nobody will be required to get the seasonal or swine flu vaccines, said Scott Wiley, director of emergency management. NCH runs Downtown Naples and North Naples hospitals.
?It is a new vaccine and some employees are concerned about it,? said LeAnna Hatcher, director of infection control for NCH. ?They are concerned and cautious once the vaccine trials are done.?
With respect to swine-flu patients, the Physicians Regional hospitals will ramp up separate triage and inpatient areas as necessary in the event of patient surges.
The two campuses will have separate triage areas for patients with flu-like symptoms from patients with other medical conditions, Hawks said.
?Because the emergency departments would be filled with patients with flu-like illnesses, we will keep them there,? she said. ?Regular patients would not be triaged in the emergency room.?
That would be achieved with a preliminary triage outside the emergency room and directing all others with other conditions to a different area, she said.
That approach is acceptable to the U.S. Centers for Medicare and Medicaid, which recently sent notices to hospitals nationwide about what is acceptable to be in compliance with the federal law that requires hospitals to treat and stabilize all patients who come to the emergency room regardless of ability to pay. The law is the Emergency Medical Treatment and Labor Act, also called EMTALA.
?We have set up an alternative emergency department and that is well within the written guidelines of EMTALA,? Hawks said.
For an influx of admissions, the plan is to use 30 post-operative beds at the Collier Boulevard hospital for swine-flu patients, she said. That will be possible because the hospital will have cancelled elective surgeries and discharged as many patients as possible. The Pine Ridge hospital has 37 post-operative beds that can be used for the same purpose.
Apart from that, the Collier campus has 100 private rooms and the Pine Ridge campus has 112 private rooms where many can be converted into semi-private rooms to co-locate patients with similar illnesses. All the private rooms have recliners and both hospitals have cots that can be used in the event of a patient surge, Hawks said.
?We could be looking at three months without a doubt,? she said of an epidemic. ?We would probably peak at 11⁄2 months into it. It could affect tourism, our peak (flu season) is January to March.?
Moreover, a decision has yet to be made at Physicians Regional whether to restrict children?s visits to loved ones in the intensive care units, because they are more susceptible to H1N1, she said.
Officials at Lee Memorial last week announced that children younger than 12 will not have access to critical care areas where the patients are most fragile.
Lee Memorial intends to triage patients with flu-like illnesses in the emergency rooms as usual and set up separate triage areas when a surge happens, Streed said. The hospitals will go to early discharge and cancellations of elective surgery when necessary, he added. Depending on the severity of the swine flu outbreak, those patients will be admitted to intensive care units or general/medical floors, he said.
?We haven?t put them in a separate place,? he said. ?If we have to expand our air-borne isolation (units) we could do that.?
At NCH, the plan is to have pre-triage areas outside of the emergency rooms and the people with flu-like symptoms will go to a second entrance next to the emergency room and be treated separately from other patients, Wiley, emergency management director, said.
?If things get really hairy and out of control, we are prepared to do tent triage and in the parking garage and will consider drive-up triage,? he said.
That would be based on a worst-case scenario of 35 percent to 40 percent of the population getting sick and how aggressive the outbreak is, he said. Some private rooms would become semi-private rooms and certain parts of the hospital will be for flu patients.
?We have designated a critical care and general patient floor for that with 40 beds downtown,? he said.
Another component of the plan is to have separate entrances to the obstetrics unit at the North Naples hospital and one side of the unit would be allocated for flu patients and the other side for the traditional patients, Hatcher, the infection control director, said.
?We?ve taken on scenarios with fairly mild influenza to the worst-case scenario where we take no elective procedures. We hope it doesn?t reach that point.
http://www.naplesnews.com/news/2009/sep/07/southwest-florida-hospitals-preparing-surge-swine-/
By LIZ FREEMAN
Posted September 7, 2009 at 4:42 p.m.
Southwest Florida hospitals are ready for swine flu to strike mildly or in full force this winter, with disaster plans to address employees and potential onslaughts of sick patients.
With the expectation that a vaccine for the H1N1 virus, which causes swine flu, will be on hand in mid-October, officials with the NCH Healthcare System and Physicians Regional Health System in Collier County will first vaccinate high-risk employees who would be susceptible to becoming sick and exposed to patients with flu-like symptoms. From there, the vaccine will be offered to all hospital employees.
Officials with the Lee Memorial Health System in Lee County, which operates Lee Memorial, Gulf Coast and Cape Coral hospitals and HealthPark Medical Center, will take a similar approach.
Employees in emergency rooms, intensive-care units, radiology, pediatrics and obstetrics will be the first target for the vaccine, which could be about 25 percent of the 1,000 people employed at Physicians Regional Medical Centers at Pine Ridge and Collier Boulevard, said Dee Hawks, the hospital system?s infection prevention director.
?There are going to be those employees who do not want the vaccine,? she said. ?All we can do is give them a declination form. We can?t force an employee to get a vaccine.?
What?s still unknown are potential side effects that will impact employee participation, she said.
The Lee Memorial system will offer the swine flu vaccine first to pregnant employees, front-line nurses and emergency-room staff and then to the remaining work force, said Stephen Streed, director of epidemiology.
Mandating employees get the vaccine or require they wear masks is under consideration, similar to a decision by Virginia Mason Medical System in Seattle, Streed said. The state of New York passed a law requiring all health-care workers to get the swine flu vaccine, he said. There are caveats for individuals with allergies, he added.
?We are actually talking about that,? Streed said of a mandatory vaccine. ?No decision has been made. I think it will be made pretty soon. I think we have a responsibility as health-care workers and a responsibility to take care of patients. I think (the state of) Florida should do that.?
Last week, the Association for Professionals in Infection Control and Epidemiology restated its 2008 position that all hospitals and medical centers require employees get both the seasonal flu and swine flu vaccine.
In Collier, NCH officials said the issue of a mandatory swine vaccination for the 3,400 work force is a hot topic right now but nobody will be required to get the seasonal or swine flu vaccines, said Scott Wiley, director of emergency management. NCH runs Downtown Naples and North Naples hospitals.
?It is a new vaccine and some employees are concerned about it,? said LeAnna Hatcher, director of infection control for NCH. ?They are concerned and cautious once the vaccine trials are done.?
With respect to swine-flu patients, the Physicians Regional hospitals will ramp up separate triage and inpatient areas as necessary in the event of patient surges.
The two campuses will have separate triage areas for patients with flu-like symptoms from patients with other medical conditions, Hawks said.
?Because the emergency departments would be filled with patients with flu-like illnesses, we will keep them there,? she said. ?Regular patients would not be triaged in the emergency room.?
That would be achieved with a preliminary triage outside the emergency room and directing all others with other conditions to a different area, she said.
That approach is acceptable to the U.S. Centers for Medicare and Medicaid, which recently sent notices to hospitals nationwide about what is acceptable to be in compliance with the federal law that requires hospitals to treat and stabilize all patients who come to the emergency room regardless of ability to pay. The law is the Emergency Medical Treatment and Labor Act, also called EMTALA.
?We have set up an alternative emergency department and that is well within the written guidelines of EMTALA,? Hawks said.
For an influx of admissions, the plan is to use 30 post-operative beds at the Collier Boulevard hospital for swine-flu patients, she said. That will be possible because the hospital will have cancelled elective surgeries and discharged as many patients as possible. The Pine Ridge hospital has 37 post-operative beds that can be used for the same purpose.
Apart from that, the Collier campus has 100 private rooms and the Pine Ridge campus has 112 private rooms where many can be converted into semi-private rooms to co-locate patients with similar illnesses. All the private rooms have recliners and both hospitals have cots that can be used in the event of a patient surge, Hawks said.
?We could be looking at three months without a doubt,? she said of an epidemic. ?We would probably peak at 11⁄2 months into it. It could affect tourism, our peak (flu season) is January to March.?
Moreover, a decision has yet to be made at Physicians Regional whether to restrict children?s visits to loved ones in the intensive care units, because they are more susceptible to H1N1, she said.
Officials at Lee Memorial last week announced that children younger than 12 will not have access to critical care areas where the patients are most fragile.
Lee Memorial intends to triage patients with flu-like illnesses in the emergency rooms as usual and set up separate triage areas when a surge happens, Streed said. The hospitals will go to early discharge and cancellations of elective surgery when necessary, he added. Depending on the severity of the swine flu outbreak, those patients will be admitted to intensive care units or general/medical floors, he said.
?We haven?t put them in a separate place,? he said. ?If we have to expand our air-borne isolation (units) we could do that.?
At NCH, the plan is to have pre-triage areas outside of the emergency rooms and the people with flu-like symptoms will go to a second entrance next to the emergency room and be treated separately from other patients, Wiley, emergency management director, said.
?If things get really hairy and out of control, we are prepared to do tent triage and in the parking garage and will consider drive-up triage,? he said.
That would be based on a worst-case scenario of 35 percent to 40 percent of the population getting sick and how aggressive the outbreak is, he said. Some private rooms would become semi-private rooms and certain parts of the hospital will be for flu patients.
?We have designated a critical care and general patient floor for that with 40 beds downtown,? he said.
Another component of the plan is to have separate entrances to the obstetrics unit at the North Naples hospital and one side of the unit would be allocated for flu patients and the other side for the traditional patients, Hatcher, the infection control director, said.
?We?ve taken on scenarios with fairly mild influenza to the worst-case scenario where we take no elective procedures. We hope it doesn?t reach that point.
http://www.naplesnews.com/news/2009/sep/07/southwest-florida-hospitals-preparing-surge-swine-/