Hospital Pandemic Influenza Guidelines in Acute Care Hospital Settings

Here’s a link to the (55 page) document, in PDF format.

An excerpt, regarding how long the virus survives outside of the human body:

2.4 Evidence for the Mode of Influenza Transmission
Organisms, especially respiratory viruses expelled in large droplets, remain viable in droplets that settle on objects in the immediate environment of the patient. Both influenza A and B viruses have been shown to survive on hard, non-porous surfaces for 24-48 hours, on cloth paper and tissue for 8-12 hours and on hands for 5 minutes8. The virus survives better at the low relative humidity encountered during winter in temperate zones. Contact with respiratory secretions and large droplets, appears to account for most transmissions of influenza. In a report of an outbreak in a nursing home, the pattern of spread was suggestive of contact rather than airborne transmission because patients who were tube fed or required frequent suctioning had higher infection rates than those who did not require such care. Whether or not influenza is naturally transmitted by the airborne route is controversial. An outbreak of influenza on an airliner has been attributed to airborne spread; however, large droplet spread could have been responsible because the passengers were crowded together and moved about for several hours in a small, grounded airplane. Although experimental airborne transmission of influenza A virus to mice has been reported, there is no evidence of such transmission in humans.

Hospitals, doctors deal with swine flu jitters

From My Way News:

Concerns about a possible pandemic have sent people streaming into crowded emergency rooms and walk-in clinics – not with swine flu, but the swine flu jitters. While the situation varies greatly around the country, hospitals and clinics in California, New York, Alabama and other states are dealing with a surge in what New York City Health Commissioner Thomas Frieden said are “people who are worried, but not sick.”

Coughs and sneezes that might have been ignored before the outbreak emerged are now a reason to see a doctor.

“They’re so afraid this is the killer swine flu that they want someone to look at them and test them,” said Dr. John Bradley, who heads the infectious disease division at Rady Children’s Hospital in San Diego.

Red Flag Rule Implementation Delayed

News from the Iowa Medical Society

The Federal Trade Commission (FTC) voted on April 30 to delay implementation of the Red Flags Rule until August 1, 2009. This is the second time implementation of this rule has been delayed, and most recently, it was to take effect on May 1, 2009. The AMA and other medical organizations will continue efforts to persuade the FTC that physicians are not “creditors” and, therefore, should not be subject to the Red Flags Rule. For more information, visit

Heroic School Nurse Dies After Helping Fallen Coach


Santa Clara High School is mourning the loss this week of a school nurse who likely helped save the life of the school’s softball coach suffering from a heart attack just moments before collapsing herself. She later died.

On Tuesday, 59-year-old Eileen Bowden gave John Rahbar CPR minutes after he collapsed with no pulse while collecting foul balls following a team practice.

Bowden’s actions kept Rahbar alive until paramedics arrived, but then Bowden collapsed.”After that, Ms. Bowden kind of got up, in just a brief moment, she fell down and seemed to need medical assistance,” said Santa Clara School District spokeswoman Tabitha Kappler-Hurley. “So she was taken to Valley Medical Center and unfortunately died en route.”

Time: Top 5 Swine Flu “Don’ts”

From Time:

#1: Don’t rush to the ER

With the cable news networks reporting nonstop on swine flu, it feels like the disease is lurking everywhere, and that your slightest sniffle is a sign that you’ve contracted the virus. That would explain why people with no outward symptoms of illness are flooding emergency rooms in swine flu–affected states, afraid that they might be sick. That’s a really bad idea.

First of all, having to examine people who aren’t really sick only stresses the already strained resources of hospitals that are trying to prepare for a pandemic. Plus, going to an emergency room unnecessarily may even pose a slight risk to you. In past outbreaks, including SARS in 2003, hospitals were actually loci of infections — all those sick people in close proximity — and the same could be true of swine flu.

If you actually have flu-like symptoms — a fever above 100° F, headache, sore throat, body aches, chills or fatigue — and you live in an area where there have been confirmed swine flu cases, by all means report to your doctor. Otherwise, leave the hospital to the sick people.

LA Times: “ERs face a new urgency”

From the Los Angeles Times:

Many people would rather stitch themselves up, splint their own fracture or endure a fussy baby through the night than brave that wait — not to mention many ER staffs’ seeming indifference to their less-then-life-threatening affliction.

Instead, a growing number appear to be voting with their feet. Those walk-in patients are fueling the growth of a kind of healthcare provider now making a comeback — the urgent care center — and at some hospitals, a flurry of efforts to improve the ER experience.

CDC Swine Flu Update: WSJ Live Blog

From the Wall Street Journal Health Blog:

Richard Besser, the CDC’s acting director, is giving today’s media update on swine flu. Here’s what he’s saying.

11:47 Have completed deployments of pandemic stockpile goods to nine states. Deployments to all states should be complete by May 3. No shortages are being reported at this time.

11:52 How testing works: If a doctor suspects a case of possible swine flu, he or she takes a swab from your nose. A local lab tests to see if it is a commonly circulating strain of flu. If it is not, it’s sent on to a state or national lab that can determine whether it is a case of swine flu.

Free EHR from Uncle Sam

From the Wall Street Journal Health Blog:

As the New England Journal of Medicine reported in a study last month, only 1.5% of U.S. hospitals have adopted “comprehensive” electronic health records throughout their facilities and another 7.6% have basic systems installed in at least some portion of their operations. A key stumbling block to getting boosting such EHRs is cost, which can run $20 million to several times that amount for large hospitals.

But the WSJ’s Laura Landro today details how the government already has invested billions of dollars over two decades to develop a software for a records system that’s available free for any hospital that wants to use it. The system is run by the Veterans Administration and provides electronic services at more than 1,400 VA facilities.

Of course, while the so-called open-source software is free, it still costs money to adapt it for a hospital’s needs as well as to buy hardware and maintain it all.

Conficker Worm Hits U.S. Hospitals, Infecting Computers and Equipment

From Gizmodo:

Cnet says that hundreds of critical hospital devices across the U.S. have been infected by the Conficker worm. The number of hospitals affected wasn’t disclosed, but the problem isn’t thought to be widespread.

Cybersecurity expert Marcus Sachs broke the news at a security conference in San Francisco, raising the question of what would happen if this were to happen to millions of machines in the medical industry. According to sachs, the devices affected were hospital computers and devices used to control critical equipment, such as heart monitors and MRI machines.

From the Front Lines of the Swine Flu Response

From the EMED listserv:

It’s started! Our ED volume’s increased by roughly 50% over the last few days. Our ED and Rapid Care Center census for 4/29 was 347 patients. We put our panflu plan into effect this evening. We’ve still been seeing a good bit of Flu A (no known risk factors) but are starting to see kids coming in with flu-like symptoms who’ve actually traveled to Mexico recently. The few that we saw today were all Flu A negative but I think there was a positive case yesterday. We’re told the confirmatory testing will take 3-5 days. We also still have folks coming in concerned about our South Florida meningococcal meningitis outbreak – fortunately we’ve had no new patients. I don’t think we’ve had any really sick Flu A patients recently either; most go home from
the ED.

Is anyone else starting to feel the crunch?


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