Will it be chaos?

As winter approaches, the number of swine flu cases requiring hospitalization is expected to increase considerably. Experts say patients will fill up wards and intensive care units, placing healthcare services under unprecedented strain. Will hospitals be able to cope?

While we can’t say for certain what will happen, an interesting insight into the likely scenario comes from a study in the Journal of Hospital Infection.

The study is based on a real-time pandemic simulation exercise conducted in a hospital in England. For 24 hours, all staff at a general medical ward adopted special infection control measures, as required during a full-blown influenza pandemic. These measures include such things as washing hands and wearing surgical masks at all times, even if there is no contact with patients. They also involve major changes in the way care is provided, and are crucial to contain the spread of the H1N1 virus.

The ward chosen for the study is of the kind used for flu patients during a pandemic. All beds were occupied, as expected at the height of the outbreak.

Here are the key findings:

• Staff felt uncertain about what to do. The study lead researcher, Dr. Nick Phin, of Cheshire and Merseyside Health Protection Unit, Chester, UK, says: “While staff had a good grasp of basic infection control precautions, they were unsure about the additional measures recommended in the pandemic situation, despite training in the two weeks before the exercise.”
• There were too many unnecessary visits to the ward by staff from non-flu areas of the facility, with consequent increased risk of the infection spreading.
• Tasks took much longer than usual. “This was particularly obvious at night,” says Phin, “when the drug round took twice as usual to complete.” Staff felt this was due to the increased use of protective equipment – surgical masks, gowns, gloves and respirators – compared to a normal situation.
• Staff did not always communicate effectively with each other and with patients, as a result of wearing surgical masks, which also seemed to affect their hearing.

What does all this mean? This study suggests that we should expect to see at least some problems in areas that are key to quality hospital care. For example, overwhelming scientific evidence shows that poor communication and insufficient staff training increase significantly patient recovery time and the risk of medical errors. So, there is a reasonable possibility that care and safety in hospitals might be somehow compromised at the height of the pandemic.

Of course, these findings cannot be generalized to every hospital or country, but they do raise a red flag. What’s more, they support the need to ensure that hospital staff are more adequately trained in pandemic protocols, and to find effective solutions to specific practical problems, like improving communication while wearing surgical masks.

Reference
Phin N.F., Rylands A.J., Allan J., Edwards C., Enstone J.E., Nguyen-Van-Tam J.S. “Personal protective equipment in an influenza pandemic: a UK simulation exercise,” Journal of Hospital Infection, 2009, 71, 15-21.

By Lorena Tonarelli MSc