Swine flu could pose challenge for older hospitals

If swine flu sends too many people to the emergency room, olderOttawahospitals may have trouble implementing plans to keepthe diseasefrom spreading.

While Ontario hospitals are supposed to provide separate waiting rooms for those with flu symptoms to minimize the spread of H1N1 or swine flu, there is limited spaceat older hospitals that have only one official waiting room, said Dr. Kathryn Suh, an infectious disease physician and associate director of infection prevention and control at the Ottawa Hospital.

"We have a limited number of rooms where we can put them," she added.Those have already been designated,but may not be enough if patient numbers soar too high. "There is always the possibility of having a lot of crowding in the flow through the emergency room."

That could possibly extend beyond the ER, she admitted. "Isolation rooms and proper accomodation for all of our patients could potentially be a problem."

According to Canada's chief public health officer, 25 to 35 per cent of the population can become infected over 18 months during a typical pandemic. Hospitals have worked closely with Ontario's health ministry and local public health officials to prepare standardized plans to:

• Minimize the spread of the disease within a hospital.
• Deal with a potential surge in the number of patients.
• Prepare for a potential staff shortage if doctors and nurses or their families fall ill.

The plans give hospitalstwo days to get their second emergency room up and running if there is an influx of flu patients.

At the Children's Hospital of Eastern Ontario, volunteers have been manning the hospital's atrium for months, directing people to a displaycontainingpump bottles full of hand sanitizer. Hospital visitorswho admit tohaving respiratory illnessand afever won't be allowed in unless their visit is urgent.

Because CHEO is a newer building, it already has two emergency rooms, sodesignating one for flu patients isn't a problem.

"Definitely anyone that comes to CHEO with even a thought that they might have swine flu or H1N1 will be cared for separately," saidDr. Lindy Sampson, chief of infectious diseases and head of pandemic planning at the Children's Hospital of Eastern Ontario.

Cleaning, hand washing

Protocols have been developed to determine which patients with flu symptoms should be admitted, what treatment they need, and which need antivirals, Sampson said. Those who are admitted will also be kept away from other patients.

CHEO has launched an education campaign to make sure staff know how to minimize the spread of the disease. They will wear masks, gowns and gloves and wash their hands frequently when dealing with flu patients, Sampson said.

Suh said care is also being taken to clean surfaces such as doorknobs, washrooms, equipment and furniture in patients' rooms. However, she acknowledged it is a challenge to balance the amount of cleaning with the need to prepare a room in time to admit the next patient.

Sampson said CHEO also has a plan in place to deal with a surge in the number of patients at its outpatient wards, emergency room, or its intensive care unit, which could operate at double capacity if needed.

The hospital has also planned for the absence of up to 30 per cent of its staff, who may have the flu themselves or may need to care for sick family members, Sampson said.

Surgeries could be cancelled

Both Sampson and Suh said their hospitals will cancel electivesurgeries to free up more staff if needed.

Thomas Hayes, director for occupation health and emergency preparedness at the Ottawa Hospital, said in an emergency, hospitals could move resources away from non-urgent services such as weight loss and smoking cessation clinics.

But he added, "Pulling away from services is something we'll only do if the system is stressed to the point that we absolutely have to do it."

The Ottawa Hospital has also created an inventory of health care workers so non-front line staff with the right skills could provide patient care if needed, Suh said, and competent retirees or nursing and medical students could help if necessary.