Initial Response of Healthcare Institutions to Emergence of H1N1 Influenza: Experiences, Obstacles, and Perceived Future Needs

Background: The emergence of H1N1 influenza is cause for great concern. Although one of the most important components of the response to the H1N1 crisis is the work of healthcare epidemiology professionals, the beliefs and experiences of this community are unknown and the optimal approach to managing H1N1 in the future has not been delineated.

Objective:  To assess attitudes and responses of healthcare epidemiology professionals to the H1N1 influenza crisis

Methods: Under the auspices of the SHEA Research Committee, we conducted a cross-sectional survey of members of the Society for Healthcare Epidemiology of America. We assessed beliefs regarding: 1) importance of H1N1; 2) institutional preparedness; 3) time spent on the H1N1 crisis; and 4) the institution’s response to H1N1.

Results: Of the total 323 respondents, 139 (43.0%) were women. The age distribution of respondents was as follows: 20-29 years: 1 (0.3%); 30-39 years: 49 (15.2%); 40-49 years: 88 (27.2%); 50-59 years: 131 (40.6%); 60-69 years: 46 (14.2%); >70 years: 8 (2.5%). The roles of respondents were: hospital epidemiologist: 160 (49.5%); infection control professional: 81 (25.1%); infectious diseases physician: 54 (16.7%); and healthcare administrator: 14 (4.3%), and “other” 14 (4.3%). Of 323 respondents, 169 (52.3%) respondents reported that prior to the current H1N1 crisis, their hospital was well prepared for a potentially pandemic situation. After reflecting on their institution’s experience and response to the H1N1 crisis, 195 (60.4%) respondents reported that at the time of the survey, their hospitals were well prepared for a potential pandemic. Furthermore, the majority reported that senior administrators provided adequate political support and resources (85.1% and 80.2%, respectively) to respond to H1N1. However, 163 (50.9%) respondents reported other important infection prevention activities were neglected during the H1N1 crisis. Shortages of antiviral medication were reported by 99 (30.7%) respondents. Furthermore, 126 (39.0%) reported that personal stockpiling of antiviral medications occurred at their institution and 166 (51.4%) reported institutional actions were initiated to prevent personal stockpiling. Also, 294 (91.0%) respondents believed H1N1 influenza would reappear later this year. Vaccine development, healthcare worker education, and revisions of pandemic influenza plans were identified as the most important future initiatives. Finally, 251 (77.7%) respondents felt healthcare workers should be mandated to receive influenza vaccine.

Conclusions: While generally well-prepared for the H1N1 crisis, substantial revisions of pandemic preparedness plans appear necessary. Future efforts to optimize the response to H1N1 should include curtailing personal stockpiling of antivirals and vaccine development with consideration of mandatory vaccination of healthcare workers.