Develop strategies now for surviving swine flu season personally and professionally

Health agencies say infection control and plans for dealing with sick patients can keep practices viable.

Orthopedic surgeons should be aware of which of their patients are at-risk for swine flu, take steps to keep themselves and their staff well and develop contingency practice operation plans in case the situation worsens this fall, according to infectious disease specialists.

The swine flu, or H1N1 virus, has already exhibited different illness patterns than seen with normal seasonal flu epidemics, World Health Organization (WHO) officials said, noting in a briefing that it has been infectious, severe or fatal in generally younger age groups.

Lungs affected

WHO reported most deaths to date from the virus were in adults younger than 50 years old. “This age distribution is in stark contrast with seasonal influenza, where around 90% of severe and fatal cases occur in people 65 years of age and older,” the briefing said.

Those with underlying medical conditions, like asthma, cardiovascular disease and diabetes, are also at-risk.

Furthermore, swine flu affects otherwise healthy individuals and tends to infect the lungs. An alert from the American Academy of Orthopaedic Surgeons said to suspect the infection in patients with febrile respiratory illness, joint pain and more common flu symptoms.

“It is unique in that it affects younger people,” pediatric orthopedist and Orthopedics Today Editorial Board Section Editor Alvin H. Crawford, MD, said.

Hand washing

Crawford and Robert E. Eilert, MD, also a member of the Orthopedics Today Editorial Board, discussed minimizing H1N1 virus’ impact on orthopedic practices and patients.

Alvin H. Crawford

Eilert, of The Children’s Hospital, Denver, said, “We are a bit more conscientious about hand washing, even shaking hands with moms.”

The Centers for Disease Control and Prevention (CDC) is among organizations recommending health care workers frequently wash their hands between patients and after coughing or sneezing.

According to Crawford, of Cincinnati Children’s Hospital Medical Center, guidelines issued by his chief of staff last month mentioned staying home when sick and sneezing and coughing into your sleeve at the elbow.

“We do encourage people to reschedule if the child is sick,” Eilert noted.

Fever watch

Crawford’s hospital urges those with prolonged fevers, difficulty breathing or evidence of dehydration to seek medical treatment. Since fever is the main sign of H1N1 infection, those with temperatures should stay away from the hospital, he said.

Crawford has first-hand experience in this area after he was forced to spend 7 days quarantined in Hong Kong when he was exposed to someone with H1N1 virus on an airplane while traveling to Asia (See Orthopedics Today August, page 24; ORTHOSuperSite keyword search: H1N1).

“If there’s difficulty breathing or wheezing, that’s probably it,” he said.

Some institutions put all symptomatic people together, noted Crawford, who expects more information on containment tactics as the flu season gets underway.

“If we can keep sick patients out of our outpatient areas, that will be a good thing.”

Personal protection

Another key recommendation: Wiping down tables, countertops and doorknobs in examination rooms after every patient visit.

An Institute of Medicine (IOM) report recommended health care workers in contact with those infected with H1N1 virus use fit-tested N95 respirators until more effective protection techniques are identified.

The CDC recommends wearing eye protection during patient-care activities.

Eilert, who was sickened after a recent flight from Europe, now prefers wearing a mask on planes, but not in the office. “I am not too worried, as long as I watch out for spreading things by hand,” he said.

Since his practice is positioned between two pediatric offices, if Eilert believes a patient is sick he sends him or her to the pediatrician.

Your practice

Suggestions such as these were included in 10 steps the CDC developed to help medical offices and outpatient facilities stay operational should H1N1 flu increase in intensity. Other steps were developing a business continuity plan, preparing for up to 40% staff absenteeism and providing free seasonal flu immunizations to employees.

Cross-training employees will impact how resilient hospitals and practices are to disruptions from the H1N1 virus’ effects and allow for operational continuity, the CDC’s 10 Steps document stated.

Editor’s note: For the latest news on the H1N1 virus, please visit our sister publication Infectious Disease News.

For more information:

• Alvin H. Crawford, MD, can be reached at Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Building C, MLC #2017, Cincinnati, OH 45229; 513-636-4787; e-mail: alvin.crawford@cchmc.org.
• Robert E. Eilert, MD, can be reached at The Children’s Hospital/Orthopedic Center, 1056 E. 19th Ave., Denver, CO 80218; 303-861-6615; e-mail: eilert.robert@TCHDEN.org.

References:

• The IOM respiratory protection report is available at http://www.iom.edu.
• 10 steps you can take is available at http://www.cdc.gov/h1n1flu/10steps.htm.