May 10, 2010
H1N1 drills expose gaps in hospital infection protection
Resuscitation drills conducted during the first weeks of the H1N1 outbreak in May 2009 have exposed critical gaps in basic protection among hospital first-responders, according to a Johns Hopkins Children’s Center study.
Failing to use personal protection such as gowns, glasses, respirator masks and gloves during infection outbreaks makes hospital staff vulnerable to infection and increases the risk for transmission to patients, the researchers say.
The findings, presented May 4 at the Pediatric Academic Societies meeting, emphasize the need for repeat mock drills, the researchers say, and suggest that personal-protection exercises should be included in monthly mock crisis sessions held at the Johns Hopkins Children’s Center.
“Having another contagious outbreak is a matter of when, not if, and the time to master protection techniques is now, before it hits us,” said study lead investigator Christopher Watson, a pediatric critical-care fellow.
The researchers conducted 11 drills on all inpatient units at the Johns Hopkins Children’s Center. The scenarios involved a pediatric patient infected with H1N1 experiencing a cardiopulmonary arrest.
Of the 84 participants, only 51 used protective eyeglasses, while 73 used gowns and 68 used a special respirator mask.
The mock drills showed that two simple measures—stacking carts with isolation materials in key areas and designating a “gatekeeper” to control access to the patient’s room and ensure that everyone is wearing protection—can go a long way toward improving performance.
Teams that had a designated gatekeeper managed to start ventilation of the patient much faster (2.7 minutes) than teams that didn’t have one (4.7 minutes). The target time for initiating this lifesaving maneuver is less than one minute, the investigators say. In teams with assigned gatekeepers, all members used respirators, compared to 77 percent among teams without a gatekeeper.
Co-authors on the study were Jordan Duval-Arnould, Michael McCrory, Stephan Froz, Trish Perl and Elizabeth Hunt.