Assessing hospital emergency management plans: a guide for infection preventionists

The role of pandemic planning in the management of COVID-19 in England from an infection prevention and control perspective: results of a national survey

OBJECTIVES

This national survey aimed to explore how existing pandemic preparedness plans (PPP) accounted for the demands placed on infection prevention and control (IPC) services in acute and community settings in England during the first wave of the COVID-19 pandemic.

STUDY DESIGN

This was a cross-sectional survey of IPC leaders working within National Health Service Trusts or clinical commissioning groups/integrated care systems in England.

METHODS

The survey questions related to organisational COVID-19 preparedness pre-pandemic and the response provided during the first wave of the pandemic (January to July 2020). The survey ran from September to November 2021, and participation was voluntary.

RESULTS

In total, 50 organisations responded. Seventy-one percent (n = 34/48) reported having a current PPP in December 2019, with 81% (n = 21/26) indicating their plan was updated within the previous 3 years. Around half of IPC teams were involved in previous testing of these plans via internal and multi-agency tabletop exercises. Successful aspects of pandemic planning were identified as command structures, clear channels of communication, COVID-19 testing, and patient pathways. Key deficiencies were lack of personal protective equipment, difficulties with fit testing, keeping up to date with guidance, and insufficient staffing.

CONCLUSIONS

Pandemic plans need to consider the capability and capacity of IPC services to ensure they can contribute their critical knowledge and expertise to the pandemic response. This survey provides a detailed evaluation of how IPC services were impacted during the first wave of the pandemic and identifies key areas, which need to be included in future PPP to better manage the impact on IPC services.

The PRISMA 2020 Statement: A System Review of Hospital Preparedness for Bioterrorism Events

Hospitals are an important part of a nation's response to bioterrorism events. At present, research in this field is still in the initial stage. The number of related studies is small, the research direction is relatively concentrated, and a comprehensive analysis and standard evaluation system are lacking. This literature survey was conducted using PRISMA methodology. Collective information was gathered from PubMed, Web of Science, Scopus, and available grey literature sourced through Google and relevant websites. The studies were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flowchart. Analysis and summary of the extracted data was performed according to the World Health Organization (WHO) Rapid Hospital Readiness Checklist (2020). Twenty-three articles were selected for review, data extraction, and data analysis. Referring to the WHO rapid hospital readiness checklist, six main indicator categories were determined, including emergency management, medical service capacity, surge capacity, laboratories, regional coordination, and logistical support, and fifty-two subcategories were finally identified. The study summarizes and analyzes the relevant literature on hospital disaster preparedness and extracts relevant capability elements, providing a reference for the preparation of hospitals against bioterrorism events and a basis for the design and development of hospital preparedness assessment indicators.

Pandemic Responsiveness in an Acute Care Setting: A Community Hospital's Utilization of Operational Resources During COVID-19

Background

To ensure continuity of services while mitigating patient surge and nosocomial infections during the coronavirus disease 2019 (COVID-19) pandemic, acute care hospitals have been required to make significant operational adjustments. Here, we identify and discuss key administrative priorities and strategies utilized by a large community hospital located in Ontario, Canada.

Methods

Guided by a qualitative descriptive approach, we performed a thematic analysis of all COVID-19-related documentation discussed by the hospital’s emergency operation centre (EOC) during the pandemic’s first wave. We then solicited operational strategies from a multidisciplinary group of hospital leaders to construct a narrative for each theme.

Results

Seven recurrent themes critical to the hospital’s pandemic response emerged: 1) Organizational structure: a modified EOC structure was adopted to increase departmental interoperability and situational awareness; 2) Capacity planning: Design Thinking guided rapid infrastructure decisions to meet surge requirements; 3) Occupational health and workplace safety: a multidisciplinary team provided respirator fit-testing, critical absence adjudication, and wellness needs; 4) Human resources/workforce planning: new workforce planning, recruitment, and redeployment strategies addressed staffing shortages; 5) Personal protective equipment (PPE): PPE conservation required proactive sourcing from traditional and non-traditional suppliers; 6) Community response: local partnerships were activated to divert patients through a non-referral-based assessment and treatment centre, support long-term care and retirement homes, and establish a 70-bed field hospital; and 7) Corporate communication: a robust communication strategy provided timely and transparent access to rapidly evolving information.

Conclusion

A community hospital’s operational preparedness for COVID-19 was supported by inter-operability, leveraging internal and external expertise and partnerships, creative problem solving, and developing novel tools to support occupational health and community initiatives.

Hospital Preparedness Measures for Biological Hazards: A Systematic Review and Meta-Synthesis

BACKGROUND

Biological hazards are one of the most important and common types of hazards in emergencies and disasters. Hospital preparedness measures for biological hazards are essential for a proper response and mitigation of its effects. The aim of this systematic review is to investigate hospital preparedness measures for biological hazards.

METHODS

For this research, electronic databases including Web of Science, PubMed, ScienceDirect, Scopus, ProQuest, Google Scholar, and Cochrane Library from March 1950 to June 2019 were searched. Key words such as hospital, emergency department, preparedness, plan, management, and biological hazards were used in combination with the Boolean operators OR and AND. A thematic synthesis approach through the use of MAXQDA software was applied to analyze the data.

RESULTS

In total, 5257 articles were identified, in which 23 articles meet the inclusion criteria for entering the process of final analysis. The findings showed three main administrative, specialized, and logistical issues regarding preparedness measures for biological hazards in hospitals.

CONCLUSION

Hospital preparedness for biological hazards is one of the most important hospital disaster plans. Results of this systematic review present valuable advice for policy-makers and hospital managers to prepare and enhance hospital performance against biological hazards.

How Prepared Are Hospitals' Emergency Management Capacity? Factors Influencing Efficiency of Disaster Rescue

OBJECTIVES

In light of government investment over the past decade, we explored the capacity for disaster response in Heilongjiang Province, identifying the factors that affect response capacity.

METHODS

We surveyed 1257 medical staff in 65 secondary and tertiary hospitals in Heilongjiang province to explore their perceptions of disaster management capacity using a cross-sectional multistage, stratified cluster sampling method.

RESULTS

All tertiary hospitals (100%) and most secondary hospitals (93%) have documented disaster management plans that are regularly reviewed. In secondary hospitals, drills were less prevalent (76.7%) but the occurrence of simulated training exercises was closer to tertiary hospitals (86.0%). We noted that 95.4% of all hospitals have leadership groups responsible for disaster preparedness capacity building, but only 10.8% have a stockpiled network of reserve supplies.

CONCLUSIONS

Although response capacity has improved in Heilongjiang Province, vulnerabilities remain. We recommend that priorities should be targeted at preparedness capacity building, in terms of reliable and relevant operational response plans, the expansion of existing response mechanisms to oversee local education and scenario training, and to ensure there is sufficient access to protective equipment and materials, either held in reserve, or alternatively by activating resilient supply chain mechanisms. (Disaster Med Public Health Preparedness. 2018;12:176-183).

Preparedness of Hospitals in the Republic of Ireland for an Influenza Pandemic, an Infection Control Perspective

Background

When an influenza pandemic occurs most of the population is susceptible and attack rates can range as high as 40–50 %. The most important failure in pandemic planning is the lack of standards or guidelines regarding what it means to be ‘prepared’. The aim of this study was to assess the preparedness of acute hospitals in the Republic of Ireland for an influenza pandemic from an infection control perspective.

Methods

This was a cross sectional study involving a questionnaire completed by infection control nurses, time period from June – July 2013, (3 weeks) from acute public and private hospitals in the Republic of Ireland. A total of 46 out of 56 hospitals responded to the questionnaire.

Results

From a sample of 46 Irish hospitals, it was found that Irish hospitals are not fully prepared for an influenza pandemic despite the 2009 Influenza A (H1N1) pandemic. In 2013, thirty five per cent of Irish hospitals have participated in an emergency plan or infectious disease exercise and have plans or been involved in local planning efforts to care for patients at non-health care facilities. Sixty per cent of Irish hospitals did not compile or did not know if the hospital had compiled a “lessons learned” from any exercise that were then used to revise emergency response plans. Fifty two per cent of hospitals have sufficient airborne isolation capacity to address routine needs and have an interim emergency plan to address needs during an outbreak. Fifty one percent of hospitals have taken specific measures to stockpile or have reserve medical supplies e.g. masks, ventilators and linen.

Conclusions

This is the first study carried out in the Republic of Ireland investigating the current preparedness for an influenza pandemic from an infection control perspective.

Deficits exist in the provision of emergency planning committees, testing of emergency plans, airborne isolation facilities, stockpiling of personal protective equipment (PPE) and medical supplies and organisational schemes/incentives for healthcare workers to continue to work in a pandemic. While Irish standards are comparable to findings from international studies, the health care service needs to continue to enhance preparedness for an influenza pandemic and implement standard preparedness guidance for all Irish hospitals.

Pandemic Preparedness: Implementation of Infection Prevention Emergency Plans

The H1N1 influenza pandemic provided a real-world test of hospital disaster plans. Challenges to hospitals included inconsistent use of isolation precautions; changing and conflicting guidelines; lack of available supplies, including N95 respirators and medications; and overwhelming amounts of information that required sifting. Further research is needed regarding pandemic planning.

Public Expectations for Nonemergency Hospital Resources and Services During Disasters

Objective

The public's expectations of hospital services during disasters may not reflect current hospital disaster plans. The objective of this study was to determine the public's expected hospital service utilization during a pandemic, earthquake, and terrorist bombing.

Methods

A survey was distributed to adult patients or family members at 3 emergency departments (EDs). Participants identified resources and services they expect to need during 3 disaster scenarios. Linear regression was used to describe factors associated with higher expected utilization scores for each scenario.

Results

Of the 961 people who participated in the study, 66.9% were women, 47.5% were white, and 44.6% were black. Determinants of higher pandemic resource utilization included persons who were younger (P < .01); non-white (P < .001); had higher ED visits (P < .01), hospitalization (P = .001), or fewer primary care provider visits (P = .001) in the past year; and did not having a reunification plan (P < .001). Determinants of higher earthquake resource utilization included persons who were non-white (P < .001); who were a patient or spouse (vs parent) participating in the study (P < .05 and P = .001); and had higher ED visits in the past year (P = .001). Determinants of higher bombing resource utilization included persons who were female (P = .001); non-white (P < .001); had higher ED (P = .001) or primary care provider (P < .01) visits in past year; and experienced the loss of home or property during a past disaster (P < .05).

Conclusions

Public expectations of hospitals during disasters are high, and some expectations are inappropriate. Better community disaster planning and public risk communication are needed. (Disaster Med Public Health Preparedness. 2013;0:1–8)

Communication and information sharing at VA facilities during the 2009 novel H1N1 influenza pandemic

BACKGROUND

Effective communication is critical to formulating responses to emergent events in health care settings. However, the range of factors that influenced communication in health care settings during the 2009 H1N1 influenza pandemic has received limited attention.

METHODS

Cross-sectional semistructured interviews were conducted by telephone with 33 infection control key informants at nationally dispersed Veterans Affairs health care facilities. Interviews were guided by an interview script that addressed topics on infection control practices, including information sources, methods of dissemination, barriers and facilitators to effective communication, and recommendations for future practices.

RESULTS

Communication was facilitated when information was timely, organized, disseminated through multiple channels, and included educational materials. Barriers to effective communication included feeling overwhelmed by the amount of information received, encountering contradictory information, and restrictions on information dissemination because of uncertainty and inconsistent information. Participants offered recommendations for future pandemics, including the need for standardized educational content, clearer guidance from national organizations, and predefined communication plans for hospital staff.

CONCLUSION

The findings of the present study provide insight about improving communication efforts within Veterans Affairs health care facilities during emergent events. The communication experiences discussed-and barriers and facilitators identified-can also be used in planning for future pandemics and other emergent situations.

A home health agency's pandemic preparedness and experience with the 2009 H1N1 pandemic

BACKGROUND

Adequate pandemic preparedness is imperative for home health agencies.

METHODS

A 23-item pandemic preparedness survey was administered to home health agencies in the spring of 2010. The Kruskal-Wallis (KW) test was used to evaluate the relationships between agency size and preparedness indicators. Significant findings were further analyzed by the Mann-Whitney (MW) U post hoc test.

RESULTS

The response rate was 25% (526/2,119). Approximately one-third of respondents (30.4%; n = 131) reported experiencing trouble obtaining supplies during the 2009 H1N1 pandemic. Small agencies were significantly more likely (Krusal-Wallis [KW] = 9.2; P < .01) to report having trouble obtaining supplies than larger-sized agencies (Mann-Whitney [MW] = 14,080; P < .01). Most home health agencies (87.3%; n = 459) reported having a pandemic influenza plan. One-third (33.5%; n = 176) reported having no surge capacity; only 27.0% (n = 142) reported having at least a 20% surge capacity. The largest agencies were significantly more likely (KW = 138; P < .001) to report having at least 20% surge capacity than medium-sized agencies (MW = 7,812; P = .001) or small agencies (MW = 8,306; P < .001). Approximately 80% (n = 414) reported stockpiling personal protective equipment. Three-quarters (71.3%; n = 375) reported fit-testing staff, and half (49.2%; n = 259) reported participating in disaster drills. The majority of home health professionals (75.1%; n = 395) reported having a personal/family disaster plan in place.

CONCLUSION

There are gaps in US home health agency pandemic preparedness, including surge capacity and participation in disaster drills, that need to be addressed.