Preparing for Pandemonium

As this edition of Celebrations goes to press, H1N1/09
continues to escalate, and President Obama has declared it a national emergency, with the potential “to overburden health care resources.”

In April 2009, the threat of H1N1/09 influenza re-ignited
pandemic and disaster preparation, following the lessons learned from the 2005 H5N1“avian” flu scare and Hurricane Katrina in 2006. Building on these experiences, healthcare organizations in particular had to quickly update their old plans to be ready to prevent, protect, and respond to the newly developing pandemic event.

In 2009, the Department of Health and Human Services
(“HHS”) took the lead to guide the private sector in precautionary efforts, populating www.pandemic.com and www.cdc.gov, and coordinating efforts with OSHA to provide healthcare guidelines.

Essentially, all preparedness plans follow similar recommendations to these guidelines.

But healthcare organizations, which will be expected to have a continuity of service throughout any pandemic, must do more. The people most necessary in the battle against the virus are those most at risk: doctors, nurses, nurse’s aides, infection control, housekeepers, meal passers, patient transporters, and laundry and linen
suppliers. Healthcare workers who contract H1N1 must isolate themselves for fear of spreading the virus for up to seven days following onset or 24 hours following fever resolution, whichever is longer. Without serious planning, there is a very real chance that as patient
census multiplies, rising numbers of sick healthcare workers will impact patient care. While hospitals consider a less-strict CDC guideline, the House is considering a bill that would mandate 5 days of paid sick leave for H1N1 illness.

Directives from OSHA In 2007, OSHA published a “Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers,” which was presented to all healthcare facilities as an “overview of a particular standardsrelated topic.”

These guidelines have been updated in 2009 as OSHA 3328-05R* with H1N1 in mind. They give specific attention to protecting staff members against pandemic influenza, in particular, non-punitive exclusion of those
who are ill. In addition, because H1N1, in its worst cases, is especially harmful to the respiratory system, OSHA 1910.134 is cited, requiring organizations to establish comprehensive respiratory protection programs.

In recent weeks, however, these guidelines have become directives. The October 14, 2009, Statement by
Acting Assistant Secretary of Labor for OSHA Jordan Barab announced that OSHA would be conducting H1N1-
related inspections to assure their compliance directive to minimize exposure for healthcare workers. The Directive will closely follow the CDC’s “Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare
Personnel.”

It is imperative that a hospital’s pandemic plan include the OSHA measures. They contain essential infection-control information, an outline of the facility’s responsibilities during different pandemic alert periods, and advice about incorporating pandemic plans into disaster plans.

The Appendices contain a wealth of information, from Internet resources, to infection control communication
tools, to diagnosis and treatment of staff during the pandemic, planning checklists and example plans, risk
communication resources, sample supply checklists, and OSHA assistance and contact information.

In addition to the OSHA directives, hospitals accredited by the Joint Commission know that inspectors will pay special attention to those guidelines linked to Standards. Surveys in 2009-10 are sure to address these standards in particular. Joint Commission’s EC.4.10 (EP3) assesses whether the hospital has developed and maintained a written emergency plan
describing the process for disaster readiness and emergency management, and implemented it when appropriate. Crothall Services Group managers in all service lines are prepared to help clients meet these
standards throughout any pandemic emergency.

Crothall Managers Are Prepared for Battle Crothall’s onsite managers are well versed in both pandemic and disaster action plans. As a CIMS-certified
healthcare organization, Crothall’s plans have been approved by ISSA, the worldwide cleaning industry organization. They are based on CDC recommendations
and Crothall’s Standard Operating Procedures, Infection
Control Manual, and a temporary HR H1N1 Policy. The pandemic action plan follows stages of severity in the
spread of a pandemic influenza, beginning with preparation for and mitigation during the outbreak. It also incorporates disaster plans developed by all Crothall corporate support departments, should the corporate office succumb to an outbreak.

The H1N1 Pandemic Unit Action Plan is a tool that regional and unit managers will use to facilitate discussion with their clients and meld into the hospital’s pandemic preparedness plan. Emergency planning for additional patients and flex scheduling to handle staff fluctuations are addressed by matching Crothall’s usual staffing ratios, as outlined in our Standards of Operation, with client expectations for census at each level of severity.

Due to the inability to predict the severity of the H1N1 pandemic, it is even more important to plan for the
unexpected. With OSHA requirements protecting workers and demanding non-punitive absence policies, Crothall management is prepared to discuss remaining fully staffed throughout the pandemic crisis.

Sources:
• “EM Case Study,” Environment of Care® News,

January 2008

• “OSHA & Worker Safety,” Environment of Care® News,

January 2007

• Vanderwagen, W. Craig. Testimony. U.S. Dept of HHS, http://www.hhs.gov/asl/testify/2009/06/0090616b.html

.6.16.09

• Barab, Jordan. OSHA Statement, U.S. Department of Labor, OSHA, Office of Communications. 10.14.09