The top 10 lessons learned from H1N1: Part 2

Part 2 will share lessons 6 through 10 gleaned from recent experiences assisting hospitals and other healthcare facilities with their pandemic response. The challenges they faced were daunting – in a matter of days concern escalated to fear and even panic as organizations rushed to respond to an unknown threat.

The key takeaway in all of this? Prepare, prepare, prepare, incorporating the lessons from the past into proactive plans for the future.

6. Establish ownership. Ownership refers to the selection of an individual to steward the process. The sooner a leader is identified, the sooner others can comfortably begin to accept their own roles.

Successful crisis management is strongly linked to the existence of an individual or small team dedicated to the process, timing, and flow of response. Departments and individuals know their responsibilities and are accountable for specific outcomes. Communication is clear and consistent. Everyone knows where the buck stops.

7. Replenish inventory. You need a replenishment plan that describes how to maintain appropriate levels of protective equipment, masks, medications, etc. The quantities your facility requires should be determined based on an estimate of the number of patients likely to show up for treatment. Kimberly-Clark, CDC and other sources offer calculator tools for this purpose.

We witnessed this challenge relative to the need for N95 respirators during the H1N1 outbreak. Concerned hospital administrators were taking boxes of N95s from their inventory, placing them in ERs and other settings and encouraging their use by members of the public. As a result, the supplies diminished quickly, typically without a plan for replacement. A protocol should trigger action based on specific reductions in inventory.

8. Perfect your protocol. This guidance is closely related to the above, and it refers to establishing a detailed protocol for what products are indicated for what use. For example, in the receiving area of the emergency department, contact protocol might be standard practice. However, if a patient is suspected of a target condition (for example H1N1), an isolation protocol would take effect. This would require a higher level of protection and appropriate products.

Industry bodies including CDC and AORN have published guidelines on isolation protocols to assist with this determination. But it’s incumbent on infection preventionists to analyze the isolation protocol data and interpret and communicate them so they are understood by personnel at every level of the organization. Some hospitals have developed an operational version of the guidelines. This can be valuable when there is a possible discrepancy, for example, whether to use surgical masks or respirators during an airborne infection outbreak such as the flu. A clear, consistent protocol helps improve compliance and reduce chaos.

9. Educate everyone. Proactive, effective education on infection control protocols leads to increased compliance, which contributes to better outcomes. Outbreaks are rare events and an occasional drill is simply not enough to ensure that staff knows what to do when the time comes.

The first report of H1N1 (originally known as "swine flu") came to me at 11:34 a.m. on April 28, 2009 in a call from our marketing manager in Mexico. He advised me things were looking bad and about to get worse. Within minutes I heard the same from my sources in Texas. Inside of a week, 14 cases had been confirmed and panic was beginning. By the end of the following week we were in a full-scale reactive mode.

When all hell is breaking loose is not the time for education, but it is the time when education pays off. In an informed institution, everyone knows that there’s an operational plan and if they can’t remember what it says they know where to go to find out.

10. Plan for drawdown. Like any inventory, your pandemic supplies must be properly maintained and kept fresh and effective. A drawdown plan is an important tool in protecting your investment and in avoiding costly, wasteful losses. Some chemical-containing products have relatively short expiration dates, while other durable items may be good for decades. But all must be rotated in order to ensure that they remain in top, usable condition. Your drawdown plan should address everything from how products are stored to ensure that they can be easily accessed and rotated, to a plan for how and when inventory will be used.

For example, in some hospitals, pandemic supplies are moved into the regular facility inventory if they have not been used for a certain number of months or years. The protocol must also provide for replacement – how will this happen and what department budget will pay for it? The last thing you want is to enter a warehouse at the time of need only to discover that products have been "borrowed" for another use and not replaced.

Lessons around pandemic preparedness are not limited to healthcare organizations. Like other vendors, Kimberly-Clark learned a great deal from the 2009 experience. We relied on our own emergency production plans to see us through a dramatic upsurge in orders, customer service and technical assistance. In fewer than 30 days we doubled customer service capacity in order to respond to dramatically higher requests.

We helped hospitals and other organizations understand the need and calculate demand. And we counseled buyers in various stages of pandemic-related supply chain pandemonium.

Like hospitals, we had to manage our own inventory, which meant ramping up production and responding to countless "special circumstances." And, like hospitals, we emerged from it all a bit weary but eager to improve our response, allocation and communication plans based on the experience. Testing is currently under way to extend the shelf life of various pandemic supplies, as we continue to increase the quality and value we deliver.