July 14, 2009
It is critical to assure that medical offices1 and other outpatient facilities (e.g., outpatient/ambulatory clinics, outpatient surgery centers, urgent care centers, physical therapy/rehabilitation offices or clinics) that provide routine, episodic, and/or chronic healthcare services can manage an increased demand for services in the midst of a novel H1N1 influenza outbreak. Ensuring a sustainable community healthcare response will be important for a likely recurrence of novel H1N1 flu in the fall. See CDC's H1N1 website for up-to-date information.
1. Develop a Business Continuity Plan -- Novel H1N1 flu outbreaks will impact your organization, employees, suppliers of critical materiel, and your family. Identify your office/clinic's essential functions and the individuals who perform them. Make sure you have trained enough people to properly work in these essential functions and allow for potential absenteeism. Develop a plan that will sustain your core business activities for several weeks. Make sure you have alternate plans for critical supplies in case there is disruption in your supply chains. For information about planning see: http://www.ready.gov/business/plan/index.html.
2. Inform employees about your plan for coping with additional surge during pandemic -- Provide clear and frequent communication to ensure that your staff are aware and understand the plan. Explain any policies and procedures that will be used to protect staff and your patients, and to manage a surge of patients. Improve the resiliency of your staff by advising that employees have a pandemic family plan or personal plans.
3. Plan to operate your facility if there is significant staff absenteeism -- Are you ready for 20 to 40% of your employees not being able to come to work? Cross training your staff is key to resilience here. What else can be done to assure continuity of operations with reduced staff?
4. Protect your workplace by asking sick employees to stay home -- Be sure to ask sick staff to stay home. All personnel should self monitor daily for signs and symptoms of febrile respiratory illness. Staff who develop these symptoms should be instructed not to report to work, or if at work, should cease patient care activities and notify their supervisor. Be sure to align your sick leave policies so ill staff can stay home. See What to Do If You Get Flu-Like Symptoms for more information.
5. Plan for a surge of patients and increased demands for your services -- Consider using your telephone system to deliver messages to incoming callers about when to seek medical care at your facility, when to seek emergency care, and where to go for information about caring for a person with flu at home (see Interim Guidance for H1N1 Flu (Swine Flu): Taking Care of a Sick Person in Your Home). Consider extending your hours of operation to include telephone triage of patients during a community outbreak.
6. Care for patients with novel H1N1 flu in your facility -- Make plans to screen patients for signs and symptoms of febrile respiratory illness at entry to the facility. If feasible, use separate waiting and exam rooms for possible novel H1N1 flu patients; plan to offer surgical masks to symptomatic patients who are able to wear them (adult and pediatric sizes should be available), provide facial tissues, receptacles for their disposal, and provide hand hygiene products in waiting areas and examination rooms. For information on caring for patients see: Interim Guidance for Clinicians on Identifying and Caring for Patients with Swine-origin Influenza A (H1N1) Virus Infection.
7. Take steps to protect the health of your workforce during an outbreak of H1N1 -- All healthcare personnel who come in close contact with patients who may have novel H1N1 flu should take precautions to include use of respiratory and eye protection for all patient care activities (see: Healthcare Workplaces Classified as Very High or High Exposure Risk for Pandemic Influenza). For information on the use of infection control measures including use of personal protective equipment for staff, see Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Novel Influenza A (H1N1) Virus Infection in a Healthcare Setting. Plan now to stockpile sufficient PPE for your staff. (see: Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza).
8. Provide immunization against seasonal flu at no cost to your staff -- In the fall there may be several influenza strains circulating at the same time. Although seasonal flu immunization will not provide protection to novel H1N1 influenza, annual influenza vaccination is recommended for health care professionals and will likely protect against seasonal influenza strains. See: Influenza Vaccination of Health-Care Personnel.
9. Make sure you know about the pandemic planning and response activities of the hospitals, outpatient facilities and local public health in your community -- Actively seek information from and coordinate with key medical, clinical facilities and public health departments in your community to learn about how they will manage patients during a pandemic. Medical offices, emergency rooms, urgent care centers and hospitals in communities with outbreaks will likely have difficulty managing a large influx of patients; a coordinated community response is important to manage surge and assure optimal patient care. Develop a plan to manage your patients who do not need to seek emergency services.
10. Plan now so you will know where to turn to for reliable, up-to-date information in your local community -- Staff in healthcare settings should monitor the CDC H1N1 Flu website and local and State health department websites for the latest information. See these websites for contact information for local health departments and State health departments.
Be prepared for a range of situations. The true impact of novel H1N1 flu outbreaks in the coming months will not be known until it happens. Be prepared for a possibility that your facility will have significant increased demand for services and the possibility that the fall outbreak may have greater impact than the outbreak in the spring, 2009.
For more information see the Medical Offices and Clinics Pandemic Influenza Planning Checklist. Also sign up to receive regular updates about novel H1N1 influenza, emerging infectious diseases, and other emergency preparedness and response information by going to www.emergency.cdc.gov/clinregistry.