Clinical Focus on Quality

In the spring of 2009, a new strain of influenza appeared in Mexico and quickly spread worldwide. This pandemic strain of influenza A was initially referred to as "swine flu" but is now generally known as Novel H1N1 Influenza A, or simply H1N1. Despite years of pandemic preparedness planning on the local, state, and national levels, this pandemic generated intense media coverage and some degree of fear and panic in the community.

The first wave of H1N1 in Utah occurred in May and June, after the typical flu season. Our hospitals and clinics saw large numbers of individuals with respiratory illness. Many patients required treatment in our Intensive Care Units and there were a number of deaths in the state caused by this new strain of influenza.

During the first wave of illness, a multidisciplinary group led by Brent Wallace, MD, chief medical officer for Intermountain Healthcare, met on a nearly daily basis to track the progress of the epidemic, respond to rapidly evolving national and local guidelines, and provide frequent updates to our front-line clinical staff.

Logistical challenges included supply and distribution of antiviral medications, proper use of personal protective equipment (e.g. masks, gowns, respirators), and laboratory testing protocols.

The second wave. Knowing that a second wave of H1N1 was expected in the fall, the pandemic planning group continued to meet during the summer to plan to apply the lessons learned during the first wave. Thanks to this advance planning and preparation and to the diligent work of our front-line clinicians, we were much better prepared for the second wave of H1N1 in October and November. During this time we provided excellent care to a much larger number of influenza patients.

Intermountain employees consistently followed guidelines on the use of personal protective equipment, and very few employees have required treatment with prophylactic antiviral medication due to an unprotected exposure. Thanks to strategic stockpiling, supplies of masks, gowns, gloves, and hand sanitizer were adequate. The Central Lab purchased and utilized new technology that enabled it to process from 200-300 samples daily for H1N1 testing. Supplies of antiviral medications were adequate, and thousands of patients were started on appropriate medication in a timely fashion.

In mid-October, Intermountain hospitals implemented visitor restrictions based on guidance from the Centers for Disease Control and the Utah Hospital Association. With the recent decline in H1N1 cases, these restrictions have been relaxed at some of our facilities.

Vaccine supply. Supplies of H1N1 vaccine were initially in short supply. This vaccine has been distributed by local health departments; some regions had more vaccine available for healthcare workers than others. At the current time, H1N1 vaccine is in abundant supply in Utah, and we continue to encourage vaccination to healthcare workers and the general public if they have not yet done so.

Previous pandemics have been characterized by a third wave of illness in mid-winter. It is still possible we may see a resurgence of "seasonal flu" cases this winter, especially in the elderly. Consequently, we have advised clinicians to continue to be vigilant and to promote vaccination for both seasonal and H1N1 influenza, as well as to continue to emphasize hand hygiene.

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