A Regional Hospital's Response to 2009 Pandemic Influenza A

Background: Geelong Hospital is a tertiary care facility in Geelong, Victoria, Australia with 400 beds, and a catchment area of 400,000 persons. In May 2009, Pandemic Influenza A reached Victoria.

Objective: To describe the response of a regional hospital to pandemic influenza A in 2009.

Methods: The Geelong hospital infectious diseases service developed a regional response to the pandemic, incorporating; • Modification of infection prevention policies • Regular meetings & communication • Establishment of a community influenza clinic • A bed management strategy • Local PCR testing • A debriefing session after the influenza season

Results: Geelong hospital held its first H1N1/Pandemic meeting on May 1st prior to the identification of cases in our state. Pandemic meetings grew to a daily meeting with representatives from hospital administration, infection prevention, infectious diseases, pediatrics, Emergency Department, staff care and external stakeholders from Ambulance Services, General Practitioners Association, and the regional health department. Existing Avian Influenza policies incorporating infection control guidelines and clinical algorithms were modified for use. In early June 2009, when the number of patients presenting to the Geelong Hospital Emergency Department increased, a community influenza clinic was activated. In addition, a bed management strategy was instituted whereby a daily census of all single and negative-pressure rooms was determined early in the morning. In June 2006, 2 weeks into the pandemic, H1N1 PCR capabilities were established at a local laboratory to allow for timely case identification. In Victoria, there were a total of 3065 laboratory-confirmed cases of H1N1 infection and 24 deaths, while in Australia there were 36,991 laboratory-confirmed cases and 186 deaths. Victoria experienced the largest number of cases in Australia. During the outbreak period 25 patients were admitted to our hospital with H1N1 infection, and a total of 150 patients presented to the Emergency department with an influenza-like illness. The median age of admitted patients was 32 years (range 2 months-66 years), and their date of onset of symptoms ranged from 10th June until 26th July 2009. Four patients had diabetes (16%), 9 were current smokers (36%), 6 were pregnant (24%), and 16 had chronic lung disease (64%). Eleven patients (44%) had pneumonia, 3 required admission to the intensive care unit (12%), and 1 patient died. A debriefing session held in October for key stakeholders involved in the pandemic management identified shortcomings in the pandemic response. Participants identified poor communication, and constantly changing case definitions, testing and management strategies at the state and national levels as the most significant problems.

Conclusions: Regional centers can respond well to global pandemics with appropriate planning, communication and leadership