Hospitals well-prepared if H1N1 flu cases arise

Kevin Tabb

Stanford Hospital & Clinics and Lucile Packard Children's Hospital have activated their comprehensive pandemic response plan and are fully prepared to handle any local cases of H1N1 influenza that require hospitalization.

The new virus has triggered an intense hum of activity at the two hospitals. Lab technicians are running extra flu-screening tests, pharmacists are taking inventory of antiviral drugs, and the occupational health department is making sure every health-care provider who works directly with patients has been fit-tested for a respirator mask.

"We have a detailed plan for dealing with pandemics, which is now up and running in exactly the way we had anticipated," said Kevin Tabb, vice president for medical affairs at Stanford Hospital & Clinics. The hospitals' plan ramps up in six stages matching the World Health Organization's six-phase pandemic alert system, Tabb said. The WHO alert is now at phase 5, meaning a widespread pandemic is imminent.

H1N1 flu has been a full-time job for Tabb and his team since the disease, also known as swine flu, first surfaced in California in late April. Over the last two weeks, as laboratory-confirmed cases surged from a handful to hundreds worldwide, the pandemic team has ensured everyone at both hospitals is ready to handle local cases. They're also coordinating efforts with local public health officials and the federal Centers for Disease Control and Prevention. "We're talking frequently with the county and the CDC," Tabb said.

No cases of swine flu have been found or treated at either campus hospital, Tabb noted. The two confirmed and eight probable cases identified in Santa Clara County have been mostly mild, with only one hospitalization needed, according to Marty Fenstersheib, MD, the county's health officer. All patients are now recovering.

Even so, caution is essential.

To keep possible flu cases safely contained, all entering patients at SHC are being screened for the flu symptoms of fever with cough or sore throat.  As soon as they pass through the doors, patients who are identified as at risk of having the H1N1 flu - such as individuals with these symptoms who recently travelled to Mexico - are immediately given surgical masks and escorted to an isolation room, where they must stay until they can be evaluated by a health-care provider wearing appropriate personal protective gear.

As is usual for children's hospitals, Packard Children's and the Johnson Center for Pregnancy and Newborn Services are being even more cautious, screening visitors as well as patients for fever and respiratory symptoms.

So far, 48 patients, more than half of them children, have been placed in isolation before it was determined that they did not have the flu.

Yvonne Maldonado

Staff members at both hospitals are being reminded not to come to work if they're sick. The hospitals have increased flu-specific security measures, such as posting extra signage asking people not to enter if they have a fever with cough or sore throat. And hospital leaders are contributing to public-education efforts, speaking to the media to urge sensible personal health measures and discourage panic.

"We're reminding the local community about basic precautions they should take to prevent germs from spreading," said Yvonne Maldonado, MD, chief of pediatric infectious diseases at Packard Children's. "That means regular hand-washing, covering your mouth and nose when you cough and staying home if you are sick." Patients who are worried about their health should call their physician for advice, Maldonado added, and should limit emergency-room visits to true emergencies.

The number of visits to the Emergency Department has increased sharply, said Eric A. Weiss, MD, associate professor of emergency medicine and medical director of disaster planning for the Stanford medical center. The influx is largely people with mild respiratory symptoms who normally would not come to the medical center.

In the meantime, as these preventive efforts are progressing, the pandemic team is ensuring they're ready to handle any local H1N1 flu patients who require hospital care. They've verified that adequate supplies, such as antiviral medication and protective equipment for health-care providers, are on hand. They have, for instance, fully stocked the hospitals' departments with gowns, gloves, goggles, respirator masks and face shields. They are also expanding the emergency department capacity at Stanford Hospital by temporarily relocating the General Clinical Research Center to make space for additional emergency beds. And perhaps most important, they are checking that resources are not wasted, so that any patient who comes through the hospital's doors will be able to get the right care.

Christy Sandborg

The response plan, which covers pandemics and bioterrorism, began as a joint effort of the two hospitals, the main Stanford campus and the School of Medicine after the anthrax attacks of October 2001. The plan was previously activated during the 2003 outbreak of Severe Acute Respiratory Syndrome.

"We learned a lot of lessons from SARS that we are applying now," said Weiss, who has led the plan's development.

"It's been an intense team effort, and we aren't stopping now," said Christy Sandborg, MD, chief of staff at Packard Children's. "I'm so proud of how hard everyone is working to make sure we're fully prepared. We hope local swine flu cases will stay mild, but in the event that things get more serious, we'll be ready."