Many Hospitals Are Not Ready for H1N1: Nurse Survey Shows Deficiencies in Hospital Swine Flu Readiness

A patient health and safety survey of 190 American hospitals
from coast to coast compiled by registered nurses in eight
different states finds that a disturbing number of our nation's
healthcare facilities are not prepared for the coming H1N1/swine
flu pandemic, according to results released today by the
California Nurses Association/National Nurses Organizing
Committee.

The data reflects a survey conducted over the past four weeks
by RNs in hospitals in Arizona, California, Florida, Illinois,
Maine, Minnesota, Nevada, Pennsylvania, and Texas. And it
comes just a day after release of a report from the President's
Council of Advisors on Science and Technology predicting nearly
2 million Americans could be hospitalized due to swine flu
infections this winter, and as many as 90,000 could die, nearly
triple the deaths that occur in a normal flu season.

What the RNs reported are wide gaps in safety gear, infection
control training, and post-exposure procedures. Among key
findings:

• At more than one-fourth of the hospitals, nurses
  cite inadequate isolation of swine flu patients, increasing the
  risk of infection to others.

• Nurses at 15 percent of hospitals do not have access
  to the proper respirator masks, exposing nurses and patients to
  infection; at up to 40 percent of the hospitals,
  nurses are expected to re-use masks, in violation of
  Centers for Disease Control
  Guidelines.

• At 18 percent of the hospitals, RNs report that
  nurses have become infected; one Sacramento, Calif. RN has
  already died.

CNA/NNOC is calling on all hospitals to adhere to the highest
standard of protection for patients and nurses to combat the
expected onslaught of new cases this fall and winter, and urging
legislators to strengthen public protections.

"These continuing problems increase the risk that many
hospitals will become vectors for infection, with inadequate
patient protections leading to a spread of the pandemic among
other patients, their friends, family, and caregivers, and the
surrounding community," warned Deborah Burger, RN, CNA/NNOC
co-president. "What we're hearing from around the country is
dangerous to patient health and safety, but with smart and
clinically appropriate leadership we can fix policies in time
for the upcoming pandemic."

On Wednesday, nurses at more than 50 of these
hospitals, mostly large hospital systems, will hold actions to
demand hospital administrators immediately implement safety
improvements for nurses and patients. Contact CNA/NNOC to
find out about what nurses are doing in your area.

CNA/NNOC leaders will also be testifying in a joint
California Senate hearing in Sacramento Thursday on preparedness
for swine flu in the state's health and education systems.
The hearing is at 9 a.m. in Room 112 at the State
Capitol.

"This report should serve as a wake-up to hospital
management, policy makers, and healthcare workers across the
country. We need to urgently increase our readiness,"
Burger said. "We do not yet have a complete picture of the
morbidity of the H1N1 pandemic. But that is no justification for
hospitals making inadequate preparations and endangering the
health and safety of patients and their community. When
September comes, we expect that infection rates of H1N1 will
spike due to the beginning of the school year, prompting
overcrowded emergency rooms, which will put our public health
readiness to the test."

"The swine flu is not the type of flu we are used to.
This pandemic will stress every aspect of our healthcare
system. Hospitals must be proactive in protecting the
public," said Houston RN Terry Hardin.

"The state of Maine has identified over 300 cases of H1N1
infection, resulting in at least 19 hospitalizations and one
death," said Cokie Giles, EMMC, president of Maine State Nurses
Association/NNOC. "A recent survey of our membership
indicates that there may be some areas of serious concern
regarding preparedness policies. We are calling on
MSNA/NNOC represented facilities to ensure that patients and
nurses are protected to the fullest extent from exposure to
H1N1."

"It is important for hospitals to meet full safety standards
for swine flu so that our patients and our nurses are
protected," said Temple University Hospital RN Patricia Eakin,
president of the Pennsylvania Association of Staff Nurses and
Allied Professionals/NNOC.

"I don't know how the local hospitals will staff up for the
pandemic. Nurses at my institution don't accrue sick time, we
use our accrued vacation time to call out sick. We also
work short [staffed] instead of having a replacement when
someone does call out. In these economic times, you tell
me who will be staffing the hospitals?" said Tampa Bay area RN
Peggy Bowen.

Illinois hospitals, says Chicago RN Brenda Langford, "are not
prepared to deal with this pandemic. We have provided our
copies of our surveys to management and they have not moved to
change our practice to be in compliance with the recommendation
set for by the CDC. If the Cook County Health and Hospital
System won't make these needed changes and the Cook County
Department of Public Health won't support our efforts to protect
the nurses and the public, it is left up to the NNOC to make
sure these needed protections are implemented."

Findings of the survey include:

• Half the hospitals have seen infected patients. At 18
  percent, RNs have been infected, nurses say.
• Nurses at 15 percent of hospitals report that they do not
  have access or only some have access to the appropriate N95
  respirator masks, and at 19 percent of the hospitals all or some
  masks were not "fitted," to ensure their effectiveness against
  the virus
• More than one in five, 22 percent of the facilities, do not
  have enough masks, say nurses.
• At almost 40 percent of those which do have sufficient
  masks, all or some of the masks are expected to be reused, say
  nurses. That puts nurses and patients at risk of infection and
  violates CDC guidelines which say all healthcare personnel who
  enter rooms of patients in isolation for H1N1 should wear a
  fit-tested disposable N95 mask, and that the masks should not be
  reused.
• Nurses at 26 percent of hospitals report that infected
  patients are not being properly isolated, in appropriately
  ventilated rooms, raising the possibility of the infection
  spreading to others in the facility. At nearly a third of the
  facilities, proper infection controls are not being
  followed.
• Nurses at fewer than half of facilities (49 percent) report
  that they have been adequately trained on H1N1 issues, including
  identification of infected patients, and procedures for caring
  for these patients.
• Nurses at only 35 percent of facilities report that they are
  guaranteed adequate sick leave if they become ill while caring
  for a patient, penalizing them for appropriately staying home
  while infectious.

These numbers are borne out by the controversies that have
been reported at hospitals across the country. Examples
include:

• At the University of California Davis Medical Center (near
  Sacramento), a patient who subsequently died from H1N1 was
  transferred to an intensive care unit as the patient's condition
  deteriorated. But rather than be kept in strict isolation with
  proper ventilation, the door to the patient's room was kept open
  the entire time, placing other high-risk patients, visitors, and
  caregivers at risk.
• Nurses at Temple University Hospital, a major acute-care
  hospital in Philadelphia, are concerned that the level of
  preparedness is not sufficient. The hospital has yet to make
  clear to nurses its plans and procedures for dealing with H1N1
  which is expected to worsen with the start of the school year.
  The nurses are already seeing an influx of more patients due to
  the closure of one of Temple's nearby facilities, Northeastern
  Hospital, and are concerned that without better preparation and
  sufficient staff, the anticipated influx of patients due to the
  pandemic would be especially dangerous.
• At Sutter Solano Medical Center in Vallejo, Calif., there
  were not enough masks to deal with three infected patients in
  the ICU. Within short order, approximately 10 nurses were
  affected. The state office of occupational health and
  safety is investigating.
• Nurses report that a Kaiser Hospital South Sacramento has
  informed patients and visitors that N95 respirator masks are not
  necessary and that simple "surgical" masks will suffice, which
  directly contravenes standards issued by every government
  agency.
• Nurses at Los Alamitos Medical Center near Los Angeles
  report that Tenet has eliminated sick benefits that would ensure
  nurses could afford to take time away from work if they develop
  symptoms.

In conjunction with the report, CNA/NNOC is releasing a list
of demands - "The Nurses' Swine Flu Safety
Agenda" - to adequately prepare for this
pandemic.

• Minimize infection of hospital patients and workers by
  strict adherence to the highest standard of infection control
  procedures, including identification and isolation with
  appropriate ventilation of infected patients
• All hospital workers and visitors must be provided with
  appropriate protection gear at the highest government standards,
  including N95 respirator masks or better for all who enter the
  isolation room of a confirmed or suspected H1N1 patient.
• Guarantee all patients and workers full transparency after
  any exposures to H1N1, in as timely a manner as possible
• Healthcare workers and facility visitors must receive full
  information and guidelines on risk exposure and facility
  infection control recommendations
• Any RN who is unable to work due to contracting a
  communicable or infectious disease identified or treated in his
  or her hospital/clinic shall be guaranteed sick leave, not face
  disciplinary action, and shall be presumptively eligible for
  workers' compensation benefits
• Implement a moratorium on any closures of emergency rooms,
  layoffs of direct healthcare personnel, and reductions of
  hospital beds.
• Federal guidelines for protection must be developed that are
  consistent across agencies
• Disposable respirator masks must not be re-used. In the
  event of a demonstrated national mask shortage, facilities
  should adhere to government recommendations on mask
  conservation.