Role of Infection Prevention and Control (IPC) in Influenza H1N1 Preparedness

Background: Influenza (H1N1) preparedness encompasses many functions which require IPC involvement. 

Objective: To describe IPC involvement in a comprehensive Disaster Preparedness approach to planning for H1N1, prior to influenza season.

Methods: At a 634 bed tertiary care hospital, a 9 person IPC department  (6 nurses, 1 director, 1 hospital epidemiologist, 1 secretary) and the IPC Committee Chair quantified time spent on H1N1 from July-October 2009.  Key functions were classified as critical, supportive, or limited.    

Results:

The table below shows IPC involvement and functions

	Key Functions of IPC	Hours/ week
Critical
Communications	Assure accuracy of all information to staff, patients, visitors.   Maintenance of hospital intranet H1N1 site Visitation restriction planning	4
Infection control	Respond to all regulatory, CDC, Dept of Health guidance Establish IPC precautions Educate frontline staff in IC management of suspect/confirmed cases   Train security & patient registration Surveillance of influenza like illness (ILI) and H1N1. Surveillance of precautions use and testing ILI surveillance of staff with Occupational Health Assess surveillance for nosocomial transmission.  Assess surveillance for need for surge planning.	14
Laboratory	Surveillance of tests ordered. Set strategies to ensure accurate ordering	5
Occupational health	Return to work algorithm. Develop strategies to prioritize vaccine distribution. Assist with staff vaccination campaign.	1.5
Supportive
Emergency Dept	Triage of ILI pts with IPC precautions. Develop system to track ILI pts.	1
Inpatient:	Throughput initiatives to open beds for surge. Care plan for laboring women and newborns Protocols for patient and caregiver vaccination.  Care of children with viral syndromes.	4
Outpatient	Triage of ILI pts with IPC precautions. Appropriate advance directions for callers, placement for ill pts	0.75
Supply	Assure adequate supply of personal protective equipment. Establish supply stations of masks, tissues, hand sanitizer	1.5
Limited
Finance	Plan for increased/altered IPC hours for pandemic.	0.25
Human resources	Assist with identification of vaccination priority groups and staffing requirements	0.25
Pharmacy	Be knowlegable of restrictions and availability of medications for influenza treatment and prophylaxis.	0.25

Conclusions: A 9 person IPC department at a tertiary care hospital required 0.8 FTE time per 40 hr week to concentrate on key elements of preparedness planning in leadership, supportive and consultative roles prior to seeing increased influenza cases. Some of this time consisted of >1 department member attending the same meetings, which smaller departments may not have the need or ability to do.  This stratification may assist with efficient use of limited IPC resources.  A similar strategy will  be needed for activities during the influenza season.