Assessing hospital preparedness using an instrument based on the Mass Casualty Disaster Plan Checklist: results of a statewide survey

BACKGROUND: Hospitals would play a critical role in a weapon of mass destruction (WMD) event. The purpose of this study is to assess preparedness for mass casualty events in short-term and long-term hospitals in Kentucky. METHODS: All short-term and long-term hospitals in Kentucky were surveyed using an instrument based on the Mass Casualty Disaster Plan Checklist and a brief supplemental bioterrorism preparedness questionnaire based on a checklist developed for the Agency for Healthcare Research and Quality. RESULTS: Responses were received from 116 of the 118 (98%) hospitals surveyed. Hospitals reported surge capacity equal to 27% of licensed beds, and virtually all respondents were engaged in planning for weapons of mass destruction events. However, advanced planning and preparation were less common. Large regional differences were observed, especially in the area of pharmaceutical planning. Preparedness planning in general and pharmaceutical management planning in particular were more advanced in counties participating in the Metropolitan Medical Response System Program (MMRS). CONCLUSIONS: Hospital mass casualty preparedness efforts were in an early stage of development at the time of this survey, and some critical capabilities, such as isolation, decontamination, and syndromic surveillance were clearly underdeveloped. Preparedness planning was more advanced among hospitals located in MMRS counties.     

Der Notfallplan des Krankenhauses bei ABC-Gefahrenlagen

Hospital emergency department preparedness for mass-casualty incidents involving nuclear, biological or chemical (NBC) threats relies on close cooperation between hospital and pre-hospital emergency staff. It is essential that the hospital is immediately secured from unauthorized intrusion in order to avoid contamination of the hospital area and staff. The strategy of the pre-hospital emergency staff to avoid the unnecessary spread of contaminated material involves thorough decontamination of exposed persons near the site of the incident and coordinated transport to the primary care hospitals after decontamination. However, uncoordinated access of contaminated victims requires emergency decontamination by hospital staff. Thus, hospital staff must be prepared to provide in-hospital decontamination. Coordinated admission of contaminated patients into the NBC primary care hospital relies on a thorough decontamination by pre-hospital emergency staff at a decontamination site installed outside the hospital. Screening of patients is performed by hospital staff with special expertise in emergency medicine. Following admission, each patient is assigned to a team of specialists. Pre-hospital patient documentation is switched to inhospital documentation after admission using machine-readable electronic admission numbers.     

Establishing and training health care facility decontamination teams

Recent terrorist events, changes in Joint Commission on Accreditation of Healthcare Organizations requirements, and availability of grant funding have focused health care facility attention on emergency preparedness. Health care facilities have historically been underprepared for contaminated patients presenting to their facilities. These incidents must be properly managed to reduce the health risks to the victims, providers, and facility. A properly equipped and well-trained health care facility team is a prerequisite for rapid and effective decontamination response. This article reviews Occupational Safety and Health Administration (OSHA) training requirements for personnel involved with decontamination responses, as well as issues of team selection and training. Sample OSHA operations-level training curricula tailored to the health care environment are outlined. Initial and ongoing didactic and practical training can be implemented by the health care facility to ensure effective response when contaminated patients arrive seeking emergency medical care.     

An analysis of the current status of hospital emergency preparedness for infectious disease outbreaks in Beijing, China

BACKGROUND: In the event of a large-scale infectious disease outbreak, hospitals will play a critical role. The objective of our study is to understand the current status of hospitals preparedness for infectious disease outbreaks in Beijing and to provide basic information for infectious disease prevention and control in hospitals. METHODS: One hundred fifty-two secondary and tertiary care hospitals in Beijing were surveyed by a standardized questionnaire. Data related to hospital demographic information and their emergency plans, laboratory diagnosis capacity, medical treatment procedures for infectious diseases, stockpiles of drugs and personal protective equipment, and staff training were collected. RESULTS: Responses were received from 134 (88.2%) of the 152 hospitals surveyed. Overall, hospitals reported that the number of physicians and nurses in infectious disease accounted for only 1.8% of the total physicians and 2.5% of the total nurses, and surgery beds accounted for 8.5% of all the fixed beds. Approximately 93.3% of the hospitals surveyed reported that they had an emergency plan, and none of those reported that their laboratories were able to isolate and identify all 8 kinds of common pathogens of infectious diseases: 22.4% of the hospitals had medical treatment procedures for all these infectious diseases, 23.1% had stored specific drugs for treatment, 2.2% had all personal protective equipment, and 30.6% reported that their health care staff had been trained in hospital emergency preparedness for infectious diseases. In general, emergency preparedness for infectious diseases in tertiary care hospitals was better than that in secondary care hospitals; the preparedness at general hospitals was better than that at specialized hospitals; and that at teaching hospitals was better than that at nonteaching hospitals. CONCLUSION: Emergency preparedness for infectious disease at hospitals in Beijing was in an early stage of development during this survey. Comprehensive measures should be developed and implemented to enhance their capacity for infectious disease emergency.     

Hospital infectious disease emergency preparedness: a survey of infection control professionals

BACKGROUND: Hospital preparedness for infectious disease emergencies is imperative for local, regional, and national response planning. METHODS: A secondary data analysis was conducted of a survey administered to Infection Control Professionals (ICPs) in May, 2005. RESULTS: Most hospitals have ICP representation on their disaster committee, around-the-clock infection control support, a plan to prioritize health care workers to receive vaccine or antivirals, and non-health care facility surge beds. Almost 20% lack a surge capacity plan. Some lack negative pressure rooms for current patient loads or any surge capacity. Less than half have a plan for rapid set-up of negative pressure, and Midwest hospitals are less likely than other areas to have such plans. Smaller hospitals have less negative pressure surge capacity than do larger hospitals. About half have enough health care workers to respond to a surge that involves < or =50 patients; few can handle > or =100 patients. Many do not have sufficient ventilators or can handle < or =10 additional ventilated patients. Most do not have enough National Institute for Occupational Safety and Health-approved respirators, and less than half have sufficient surgical masks to handle a significant surge. CONCLUSIONS: United States hospitals lack negative pressure, health care worker, and medical equipment/supplies surge capacity. Hospitals must continue to address gaps in infectious disease emergency planning.     

中国急性心肌梗死和梗死后2级预防治疗状况调查

目的 :了解我国各医院对急性心肌梗死 (AMI)临床诊治以及出院后长期 2级预防治疗的基本模式。方法 :在全国选择较有代表性的 2 5 0 0余家医院 ,采用统一问卷的方式对各院心血管病主管医生进行调查。结果 :本次调查共收回有效问卷 1919份 ,应答率为 77%。调查显示 ,具有降低死亡等积极疗效的抗血小板、静脉溶栓和血管紧张素转换酶抑制剂 (ACEI)等药物已成为我国AMI治疗的常规手段。 90 %左右的被调查医生对这些药物的疗效均有明确认识。 82 %的医生认为 β 受体阻滞剂对AMI有积极疗效 ,但有 5 0 %左右医生以选择性使用为主 ,且用药剂量很小 (约为国外常用剂量的 1/4) ,开始使用的时间也相对较迟。一些对改善患者预后并无积极疗效的药物 (如硫酸镁、钙通道阻滞剂 )或疗效尚不明确的药物 (如中药制剂 ,蛇毒等 )常规使用的情况仍较为普遍 ,尤其是硫酸镁 (47% )和中药制剂 (45 % )。在AMI后的 2级预防中 ,除阿司匹林外 ,对其余几类有效的治疗药物常规使用比例均较低 ,包括ACEI(5 0 % ) ,β 受体阻滞剂 (35 % )和他汀类降胆固醇药物 (2 5 % )。 结论 :目前我国AMI和梗死后 2级预防药物治疗模式与欧美等国家基本相似 ,但仍有不够规范之处。尤其是一些已被证明并无积极疗效的药物使用过度 ,而一些疗效确切的药物     

Availability of diagnostic facilities in the Netherlands for patients with suspected pulmonary embolism. ANTELOPE Study Group. Advances in New Technologies Evaluating the Localisation of Pulmonary Embolism

Pulmonary embolism remains a complex diagnostic problem. Although accurate and cost-effective, the 'Dutch consensus' strategy is not widely applied. We assessed the availability and investment plans of the different facilities used in this strategy. Furthermore, the current and future availability of new diagnostic modalities was investigated. A questionnaire was sent to all Dutch hospitals. The questionnaire contained separate sections with questions for the hospital management and the medical practitioners at the departments of radiology, nuclear medicine, internal medicine and pulmonology. Five hundred and eighty-four questionnaires were sent out (response rate 68%). Forty-three percent of the hospitals had no nuclear medicine facility, 11% had no pulmonary angiography facility, and 59% had no spiral CT scan (SCTA). Forty-six percent of the responding hospitals had a nuclear medicine facility; and 5% used Technegas for ventilation studies. Strategies with SCTA were available in about 27% of the hospitals. Due to future investments this number will increase to approximately 55%. Strategies with Technegas were available in 2.4% of the hospitals, this number might increase to 25% if Technegas is proven accurate. The 'Dutch consensus' strategy is available in two-thirds of the hospitals. All other strategies were less feasible. Several equivalent strategies for diagnosing pulmonary embolism should be developed. These strategies should be accurate, widely available and accepted.     

Responding to and managing casualties: detection, personal protection, and decontamination

Unfortunately, a mass casualty caused by chemical or biologic terrorism has become a real threat to the United States. A well-considered preparedness plan is needed to minimize tOe impact of a chemical or biologic attack on civilians and responders. This article describes some of the key elements in a preparedness plan, specifically issues regarding early detection, decontamination. and personal protection. Although chemical and biologic terrorism is often considered as a single entity, there are important distinctions in detection, decontamination, and personal protection procedures that effect preparedness planning. Therefore, any preparedness plan needs to be flexible enough to deal with both biologic and chemical terrorism. Preparedness plans also need to be thorough enough to deal with the differences in response to a variety of specific chemical or biologic agents.     

Techniques and uses of nosocomial infection surveillance in U.S. hospitals, 1976–1977

From personal interviews in a representative sample of hospitals, we found that 97 per cent of them had some type of infection surveillance system; most involved continuous, hospital-wide surveillance, written definitions of infections, active case-finding methods and basic analytic techniques. Infection control nurses spent an average of about half of their time on surveillance. In larger hospitals (≥ 200 beds), the heads of the infection surveillance and control programs reported a greater awareness of most nosocomial infections if they were in hospitals with more intensive surveillance systems, and most indicated that surveillance data were used for a variety of specific purposes. Although 81 percent of persons who described surveillance reported using surveillance data in inservice education, only 31 percent of U.S. staff nurses recalled its having been presented. “Clean” wound, surgeon-specific rates of surgical wound infection were reported back to surgeons in only 16 percent of the hospitals. Ninety-seven percent of the hospital administrators believed that surveillance data are not a hindrance in defending the hospital against litigation for alleged malpractice, and 65 percent considered the information more often a help.     

Sexual risk-taking and HIV testing among health workers in Zambia

Health workers (N=692) in five Zambian hospitals were interviewed to assess HIV/AIDS risk-taking and status awareness. They comprised of physicians, nurses, clinical officers and paramedics. Only 33% had been tested for HIV and only 24% said their partner had been tested. 26 percent of sexually active respondents had multiple partners; thirty-seven percent of these had not used condoms. Only 60% of respondents believed condoms were effective in preventing HIV. Women were less likely to trust or use condoms even in high-risk relationships. The data suggest a need to develop HIV/AIDS programs for health workers, with emphasis towards gender-based obstacles hampering safer behaviors.     

Weight loss effects of circuit training interventions: A systematic review and meta‐analysis

This meta‐analysis aimed to assess the weight loss effects of circuit training interventions in adults. A computerized search was conducted using the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE online databases. The analysis was restricted to randomized controlled trials that evaluated the effects of circuit training interventions on body weight and body mass index in adults aged 18 years or older. Meta‐analyses were conducted using the random‐effect model to estimate the weighted mean difference (WMD) with 95% confidence interval (CI). Nine randomized controlled trials (837 participants) were included. Significant intervention effects were identified for body weight (WMD = ?3.81 kg, 95% CI ?5.60 to ?2.02) and body mass index (WMD = ?1.77 kg/m², 95% CI ?2.49 to ?1.04). Subgroup analysis by body mass index status showed that the intervention effect was significant only in participants with obesity or overweight (obesity: WMD = ?5.15 kg, 95% CI ?8.81 to ?1.50 and overweight: WMD = ?3.89 kg, 95% CI ?7.00 to ?0.77, respectively) but not in those with normal weight. Current evidence suggests that circuit training effectively reduces body weight and body mass index in adults with overweight and obesity.     

Emergence and control of methicillin-resistant Staphylococcus aureus in a children's hospital and pediatric long-term care facility.

BACKGROUND: After a 6-year quiescence, methicillin-resistant Staphylococcus aureus (MRSA) was isolated from 30 patients in a children's hospital and a pediatric long-term care facility from November 1987 through April 1989. After six nosocomial cases had occurred at the children's hospital, increased infection control measures directed at MRSA were initiated in August 1988. Because MRSA had been identified in three patients in the pediatric long-term care facility within 24 hours of their admission to the children's hospital, other patients transferred from the pediatric long-term care facility to the children's hospital were isolated and screened for MRSA. METHODS: We reviewed the medical records of these patients and evaluated their response to therapy with rifampin alone or in combination with trimethoprim-sulfamethoxazole. RESULTS: In the 8-month period after initiation of infection control measures, MRSA was identified in 10 residents of the pediatric long-term care facility; there was also one nosocomial children's hospital case. Phage typing showed that one MRSA strain predominated in patients at the pediatric long-term care facility but did not implicate this strain as the source for MRSA introduction into the children's hospital. Of 16 patients with MRSA who completed therapy and were available for follow-up, 13 (81%) had elimination of colonization. CONCLUSION: Prompt institution of MRSA surveillance, barrier isolation, and therapy to eliminate colonization should be considered in hospitals with a new introduction of MRSA.     

Infection control practitioners' perceptions and educational needs regarding bioterrorism: results from a national needs assessment survey

BACKGROUND: The perceived threat that biological weapons will be used in an act of terror against the United States has escalated sharply since the discovery of anthrax-tainted letters after the terrorist attacks of September 11, 2001. These events underscore the critical nature of health care and public health preparedness and the need to augment infection control practitioner education and training. METHODS: Between October 2000 and August 2001 a national needs assessment was conducted by use of a 35-question survey. The survey measured infection control practitioners' (ICPs') perception of the risk for bioterrorism in the United States and in their community, the proportion of ICPs with prior training in bioterrorism preparedness, and preferences for delivery media of future bioterrorism education. RESULTS: The assessment of the perceived threat of bioterrorism in the United States during the next 5 years (P =.022) and in the ICPs' work community (P <.001) revealed significant regional differences. Only half (56%) of the respondents reported prior training in bioterrorism preparedness. Respondents reported that the 2 most common barriers to receiving training were lack of training opportunities (70.2%) or no dedicated work time for training (19.4%). CONCLUSIONS: The results of this study indicate an urgent need for more resources and opportunities for clinical education in bioterrorism preparedness that will provide continuing education credit. Successful bioterrorism education will require a variety of instructional designs and media delivery methods to address ICPs' preferences and needs.     

Exploring the Supportiveness and Preparedness of Child Care Settings for Children with Asthma: A Needs Assessment

Background. The role of child care centers has increased to extreme importance as the majority of young children are in some form of child care setting. Child care centers are increasingly faced with providing health-related care to children with asthma. Purpose. The purpose of this study was to examine child care workers' perceived knowledge and confidence and their perceptions of their child care setting's preparedness to handle asthma-related issues. Methods. The study used a cross-sectional postal survey design that followed a modified Dillman's protocol. Questionnaires were sent to staff in 235 randomly selected child care centers across four Ontario public health regions. The questionnaire assessed several asthma-related areas: identifying and caring for children with asthma, emergency plans for asthma, and confidence in ability to handle asthma-related issues. Results: A total of 489 (69% overall response rate) questionnaires were returned and 180 centers (76.6%) of the 235 child care centers participated. Most child care workers (67%) cared for a child with asthma, but only 21% ever received formal training on caring for a child with asthma. When asked about having an emergency plan for a child having an asthma flare-up/attack, 52.3% of the workers reported that their center lacked such a plan or they were unaware of it. Many (45%) reported feeling uncertain about how to manage worsening asthma. The area of trigger identification and management was also an issue regarding child center preparedness: 43.6% of centers had a plan or process and 48% of staff felt uncertain of their abilities in this area. Child care workers who reported receiving formalized training were more likely to have higher confidence scores in their ability to handle asthma-related issues compared with those who did not receive training in many areas. Conclusions. Gaps in asthma care preparedness exist within the child care system. The provision of formalized learning opportunities is one strategy that could narrow these gaps.     

Testing a Family‐Centered Intervention to Promote Functional and Cognitive Recovery in Hospitalized Older Adults

A comparative trial using a repeated‐measures design was designed to evaluate the feasibility and outcomes of the Family‐Centered Function‐Focused‐Care (Fam‐FFC) intervention, which is intended to promote functional recovery in hospitalized older adults. A family‐centered resource nurse and a facility champion implemented a three‐component intervention (environmental assessment and modification, staff education, individual and family education and partnership in care planning with follow‐up after hospitalization for an acute illness). Control units were exposed to function‐focused‐care education only. Ninety‐seven dyads of medical patients aged 65 and older and family caregivers (FCGs) were recruited from three medical units of a community teaching hospital. Fifty‐three percent of patients were female, 89% were white, 51% were married, and 40% were widowed, and they had a mean age of 80.8 ± 7.5. Seventy‐eight percent of FCGs were married, 34% were daughters, 31% were female spouses or partners, and 38% were aged 46 to 65. Patient outcomes included functional outcomes (activities of daily living (ADLs), walking performance, gait, balance) and delirium severity and duration. FCG outcomes included preparedness for caregiving, anxiety, depression, role strain, and mutuality. The intervention group demonstrated less severity and shorter duration of delirium and better ADL and walking performance but not better gait and balance performance than the control group. FCGs who participated in Fam‐FFC showed a significant increase in preparedness for caregiving and a decrease in anxiety and depression from admission to 2 months after discharge but no significant differences in strain or quality of the relationship with the care recipient from FCGs in the control group. Fam‐FFC is feasible and has the potential to improve outcomes for hospitalized older adults and their caregivers.     

Microbiologic sampling of the inanimate environment in U.S. hospitals, 1976–1977

Data obtained in the first two phases of the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) indicate that in 1975 three-quarters of U.S. hospitals performed environmental culturing on a routine basis; however, between 1970 and 1975, one-quarter had reduced the extent of environmental culturing permanently. Large hospitals (≥ 200 beds) and those with an infection control nurse who had completed a training course in hospital epidemiology were more likely to have reduced the extent of culturing. In 1976–1977 hospitals that performed such culturing collected an average of 500 environmental cultures per year, whereas larger hospitals and those with an infection control nurse collected significantly fewer cultures. Only 28 percent of the approximately two million environmental cultures collected in U.S. hospitals in 1975 were indicated by recommendations of the Centers for Disease Control and the American Hospital Association current at the time.     

Infection control program disparities between acute and long-term care facilities in Maryland

BACKGROUND: In January 2003, the Maryland State Department of Health and Mental Hygiene (DHMH) surveyed, for the first time, all acute care hospitals (ACHs), long-term care facilities (LTCFs), and specialty hospital (acute rehabilitation and behavioral health) facilities in the state to determine the current state of infection control resources and practices in Maryland. Federal health care facilities in Maryland were not surveyed. METHODS: A self-administered questionnaire was sent to all 40 ACHs, 247 LTCFs, and 20 specialty hospitals in the state. The senior infection control professional (ICP) in the facility completed the questionnaire. RESULTS: The response rates were 85% for ACHs, 39% for LTCFs, and 95% for specialty hospitals. Data were analyzed separately for each type of facility. The ICPs in acute care reported 1.2 full-time equivalent positions (FTEs) for each 200 acute care beds, whereas ICPs in LTCFs reported 0.3 FTEs per 200 LTCF beds. Ninety percent of acute care ICPs reported taking some type of basic infection control course, whereas only 3% of long-term care ICPs reported taking a basic infection control course. CONCLUSION: In this survey of ICPs in Maryland, striking differences were noted between ACHs and LTCFs in the ratio of ICP FTEs to beds and in basic infection control educational preparation for ICPs. These findings suggest that Maryland LTCFs could benefit from basic infection control training and from regulatory actions addressing staff-to-resident ratios.     

Bioterrorism preparedness: a survey of Nebraska health care institutions

In March 2001, a 6-question survey was mailed to all hospitals and long-term care facilities in Nebraska to assess preparedness for bioterrorism. Only half of the respondents at that time believed that bioterrorism was something their community was likely to experience. We found that most facilities (98%) believed that they were unprepared for a bioterrorism event, and many did not know whom to contact in the event of such an emergency. We concluded from the results of the survey that the greatest needs to facilitate preparation were policies and procedures, identification of contacts, medications, protective equipment, laboratory support, and communication.     

Effect of a security system on violent incidents and hidden weapons in the emergency department

STUDY OBJECTIVE: To determine the number of weapons confiscated and assaults reported in an urban county emergency department before and after the implementation of a security system. METHODS: This is a retrospective review of security records for a 54-month period from 1992 to 1996. We determined the number of weapons and assaults before and after the implementation of a security system consisting of metal detectors, cameras, limited access, and a manned security booth at the ED entrance. We calculated the rates of weapons confiscated and assaults per 10,000 ED patients treated. RESULTS: Twenty-four weapons were confiscated before the implementation of the security system, and 40 were confiscated after the implementation ( P<. 001). The percentage of weapons confiscated in the patient care area decreased from 92% to 42% after the security system was installed (P<.001). Seven of the 17 weapons (41%) found in the patient care area after implementation were brought in by ambulance patients who bypassed the security booth and metal detector. The reported assaults per 10,000 patients, however, did not change significantly. CONCLUSION: The implementation of an ED security system increased the number and percentage of weapons confiscated before patients were placed in patient care areas, but did not decrease the number of assaults. This emphasizes the importance of continued training of ED personnel in the management of violent patients and potentially violent situations.