Use of Portable Treatment Structures for Decreasing Hospital Spread of Novel H1N1 Influenza

Background: In fall 2009, San Antonio healthcare facilities were overwhelmed with increased numbers of influenza like illness (ILI). At the Audie L Murphy Division (ALMD) of STVHCS the rate of ILI visits to the emergency department (ED) increased to > 20% during the week of September 28, 2009.   Symptomatic patients were difficult to segregate after they entered the hospital through the main lobby despite availability of masks at the entrance and signs placed to encourage mask use and cough etiquette.  Several instances of employees requiring antiviral prophylaxis after exposure to patients and coworkers with influenza A had recently occurred. 

Objective: Describe the implementation of an emergency preparedness plan (EPP) using portable structures separate from permanent hospital structures to prevent influx of patients with ILI to the main hospital, during a community surge of patients with ILI.

Methods: Hospital leadership convened a committee that included infection control, administration, environmental services, pharmacy, ED leadership, engineering, public affairs, and security to review options to decrease the risk of hospital spread of novel influenza A H1N1.  ALMD’s EPP was implemented by placing two large tents in front of the main hospital entrance to treat patients with ILI (Flu Treatment Center, FTC).

Results: Staff stationed outside the main hospital entrance diverted persons with self-reported ILI to the treatment tents and gave out face masks.  Patients were assessed in one tent by nursing staff measuring vital signs and triaging urgency, and were treated in the second tent by medical providers.  Tents were open a total of 11 days from October 4 to October 24, 2009. Due to the additional staffing requirements, treatment tents were operated only Monday thru Friday 8am- 4pm, and were closed on weekends, nights and one holiday.  ILI was tracked using ICD-9 codes and numbers of patients seen at the FTC.

A total of 1310 patients were seen over the 3 week period including the FTC and ED. The FTC was open for 11 days; 110 patients were seen there for ILI. During the days that the FTC was open, 110/167 (65.9%) ILI patients were seen there.

No cases of healthcare-associated influenza transmission were identified in the hospital during this time period. 

Diverting patients with ILI to the FTC decreased the number of ILI patients walking into the main hospital building.

Two major deficiencies identified on the EPP included lack of a FTC roster of available staff; and limited tolerance of staff to N95 respirators requiring frequent personnel rotation, leading to poorer staff acceptance.

Conclusions: Implementation of a free-standing portable treatment center separate from the hospital decreased the entry of ILI patients into the hospital during an influenza pandemic.  This action may lower the risk of healthcare-associated influenza infection.  The EPP was implemented successfully, and deficiencies were identified.