Swine Flu: How a Hospital Prepares for Patients

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Practice makes perfect in most walks of life. From sports to music, from school to trades, the opportunity to practice an activity develops skills that get better and better with each repetition. So it goes for hospitals and disaster drills, practicing to care for large numbers of potential victims. Whether it is a natural disaster with numerous injured patients or a medical crisis such as the swine flu (now being referred to as the H1N1 influenza) in the spring of 2009, the people that staff a hospital need to be able to react when a surge of patients arrives at the door.

The swine flu outbreak showcased the planning and preparation that occurs at every hospital. When a patient with symptoms of swine flu shows up at the hospital door, not only does that person need to be treated, but a system needs to be in place to prevent the rest of the patients and staff in the hospital from becoming infected by that patient. What can be done?

Even before a patient enters the building, hopefully public education efforts have told them to call ahead and let the ER, the clinic, or the doctor's office know they are coming so that they can be met prior to entering the building and be given a mask. It doesn't do much good to walk up to a desk unannounced and potentially infect the receptionist.

A triage, or screening, exam might be done to assess whether the symptoms may be potentially due to swine flu. The exam might be brief, involving a few questions and perhaps recording a temperature, accessing for fever. Again, little benefit occurs if the nurse doing the initial exam is exposed to the virus. Don't be surprised if the medical staff are wearing masks in addition to the patient.

If swine flu is a concern, the patient might be taken directly to an isolation room so that he or she is removed from other people in a waiting room or main treatment area. The isolation room may have special air flow and filters to prevent virus spread by coughing or sneezing.

Once the patient leaves, the room needs to be cleaned thoroughly, since the swine flu virus can live on countertops or other surfaces for up to two hours.

These steps seem reasonable and seemingly easy to implement for one patient. But if medical facilities become inundated with scores of patients, there needs to be a systematic approach to prevent becoming overwhelmed by sheer numbers.

Some hospitals may set up triage tents in parking lots, examining patients before they enter the building. Those who aren't significantly ill may be sent home, allowing only those with more critical symptoms to enter the hospital. Since the virus spreads among people in close quarters, using large outdoor spaces that provide good ventilation goes a long way toward prevention of infection.

Health care staff training will stress the compulsive use of face masks and hand washing to avoid getting ill or passing the infection along to others. The housekeeping and laundry crew will work overtime to keep the hospital clean and as sterile as possible. But if enough people require hospitalization, there may not be enough isolation rooms to deal with the potential number of sick people, and the hospital itself may need to come under quarantine, not letting people come or go until the threat of contamination lessens. Imagine the commitment required by health care workers to come to work, knowing that they may not be able to leave for home for days. Imagine the dedication of those who willfully risk infection to care for those who are ill.



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