The United States experienced its first wave of 2009 H1N1 pandemic activity in the spring of 2009. A second wave of 2009 H1N1 flu followed in the fall as expected, with surges occurring in October and early November.
At the start of the first wave of novel H1N1, Upstate University Hospital activated Incident Command to monitor and address immediate actions. In anticipation of increased activity in the fall, to include seasonal flu expectations, a multidisciplinary steering committee was assembled. The steering committee was charged with undertaking the hospital response to the impending flu season. The committee met weekly to conduct a risk assessment and develop an action plan based on the needs at University Hospital and Onondaga County, utilizing information and guidance from the State and Federal Government. Upstate worked closely with county and state government to maintain an efficient response through frequent conference calls and training updates.
The following areas were identified as the core areas for effective response:
- Staff Vaccinations
- Infection Control
- Education & Communication
- Human Resources
- Sentinel Reporting
A surge plan was developed for both a surge of symptomatic patients in the Emergency Department utilizing NYS Alternate Triage Site guidelines and a surge of pediatric patients requiring inpatient services.
Staff Vaccinations were accomplished through a large scale point of dispensing plan. The plan included Incident Command activation, staff training and education, including Just in Time Training and daily briefings to review activities and improvement opportunities. An area centrally located was used to provide easy access for staff to receive the vaccination. Upstate was able to vaccinate 5500 of our health care workers over a 6 day period.
To maintain the required infection control protection, staff was required to wear N-95 respirators for all suspected H1N1 patients. During the fall of 2009, the usage of N-95's was well above the normal average. The hospital maintains a stockpile of N-95 respirators which provided us with the ability to maintain an adequate supply, even during the shortage period. Also, the committee developed and implemented an N-95 priority use plan in the event of a need for an elongated response regarding H1N1.
In addition, New York State recommended limiting visitors to hospitals. Based on this guidance and the desire to reduce the spread of flu, Upstate implemented a limited visitation policy starting in late October of 2009.
Education & Communication
Education to address both staff and the public was developed. Staff education focused on vaccination and proper infection control procedures and was coordinated through the hospital's Occupational Training and Development Department. Public education focused on symptoms and reducing transmission, and was overseen by the Public Relations Department, working with media outlets in the city and county.2010 Flu Poster
The Human Resources and Relations Departments were an important part of our team structure. These departments were instrumental in working with the unions representing hospital staff and providing communications regarding the mandatory vaccination ruling for health care staff that was in place during the 2009-2010 flu season.
The New York State Department of Health Bureau of Communicable Disease Control established the Sentinel Hospital Influenza Surveillance program to survey a representative network of hospitals across the state (one hospital in each of six regions) to help determine the magnitude and severity of circulating strains of influenza and determine which groups of people are at higher risk for developing complications of novel influenza (H1N1) virus.
The coordination and implementation of the Sentinel Hospital Surveillance program at Upstate University Hospital is carried out by the Department of Emergency Management. The provision for the Sentinel Hospital Surveillance Program was added to the New York State Department Health Office of Health Emergency Preparedness deliverables for 2009-2010.
Should flu resurface at some point in the future, Upstate University Hospital will re-enact its committee structure to implement the best work practices employed during the 2009- 2010 season.