Swine flu Q&A with UPMC biosecurity expert
Dr. Eric Toner is a senior associate with the Center for Biosecurity of the University of Pittsburgh Medical Center (UPMC). He is a physician board certified in internal medicine and emergency medicine. Toner is a widely cited author on a range of biosecurity issues, including hospital preparedness, pandemic influenza response, and clinical issues related to bioterrorism response.
Q: Is the the media storm on swine flu drawing to a close?
A: Yes, it is slowing down a bit. Thank goodness.
Q: When we say pandemic, what does that mean?
A: Pandemic means a global outbreak of an infectious disease, and specifically for influenza, it means global spread of a new influenza virus. By that definition, this is a pandemic. But the word pandemic doesn't relate to severity of the illness. So we have a pandemic of a virus that causes mild illness, apparently much like we did in 1968, the last influenza pandemic. A lot of people confuse the term and think that it connotes severity, but it does not. It just means a global spread of a new influenza virus. And generally speaking, or at least as it always has in the past as far as we know, the new virus, as it spreads globally, replaces the previously circulating virus. So it's likely that starting next year, this virus will be our new seasonal flu virus and the one circulating previously will be replaced.
Q: But because of the actual severity and the upcoming creation of a vaccine, would you say we're really not at a high severity level?
A: Yes. The government and vaccine manufacturers are moving ahead as quickly as possible with the creation of a vaccine as we would expect them to do. Some time over the course of the next four to six months or so we'll see the beginning of large-scale manufacture of the new vaccine. It takes that long to grow the virus, to develop the vaccine, to test it and make sure it's effective and safe and then start to produce it on an industrial scale. So some time in the fall we'll see a new vaccine for this strain and people will be able to get a shot for it.
Q: Does anything strike you with what has happened with this outbreak as far as what quality managers need to do when something like this happens?
A: You know, most hospitals have been doing a lot of work over the course of the last four years or so on pandemic preparedness, as well as emergency preparedness in general with Joint Commission guidelines. And I think it's important that quality managers be very involved in that process. I think that one place that emergency preparedness in general, including pandemic preparedness, can be faulted is by not having a rigorous quality improvement aspect to the program. Everybody is doing drills, which is great, but it's not always clear that lessons learned from those drills are incorporated into revisions of the plan and subsequent drills as a rigorous cycle of quality improvement. I think that quality managers could be very helpful if they were very involved in the emergency preparedness process at their hospitals. I think every hospital is going to have lessons to learn from the response to this epidemic over the last couple of weeks. I think from hospitals that I know about, things have gone pretty well so far. But I think everybody has some lessons to learn, some things have not gone so well. And some need to make some revisions to their plans, do some additional drills, and they need to get the people who know about quality improvement to help them. All of us who study flu think that this virus will be back in the fall. We think first of all, it will subside over the course of the next few weeks because the flu always subsides as the weather gets warm. We think it will subside except maybe for some isolated outbreaks here and there, primarily related to schools and colleges. But then it will come back in the fall, and it probably will be a pretty significant flu season next year as the virus comes back. So hospitals really need to be preparing for the fall. I don't think it will be a catastrophe, but it certainly looks like it will be a pretty memorable flu season.
Q: Are hospitals doing a pretty good job with continual drilling and testing?
A: We just completed a big national study of hospital emergency preparedness over the last eight years, since 2001. And clearly hospitals have done much better emergency preparedness than they did before, and one of the ways they're much better prepared is that their drills and exercises have much improved over that period of time. Not only are they doing a better job with internal drills but also with community-based drills, as is required by The Joint Commission. Hospitals across the country are doing a much better job. (To view the report, visit http://www.upmc-biosecurity.org/.)
Q: Do you think The Joint Commission guidelines get at what should be done?
A: Yes. I think The Joint Commission emergency management standards are very good. They're excellent, as a matter of fact. I think you would find many hospitals would say they're really hard to comply with, because they are much more demanding than they were in the past. But I think a hospital that is truly complying with those standards would be pretty well prepared.
Q: Any other resources you would suggest?
A: The Centers for Disease Control and Prevention (CDC) has guidelines for preparedness. I think The Joint Commission standards for emergency management are about the best there are out there. If hospitals are really complying with that and they're following CDC guidelines, I think they'd be in very good shape.
Q: What is the main lesson learned here? Should QI directors go back and get a refresher on emergency preparedness and make sure they're fulfilling what needs to be fulfilled?
A: Yes. But in addition, I think that hospitals need to do an after-action review of their response to the outbreak when the outbreak has subsided and then really incorporate the lessons from that after-action review and make sure they have a rigorous process for incorporating that into their revised plans and future exercises.
Dr. Eric Toner is a senior associate with the Center for Biosecurity of the University of Pittsburgh Medical Center (UPMC). He is a physician board certified in internal medicine and emergency medicine.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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