CDC offers pandemic advice for outpatient facilities

Robert Roos News Editor

Jul 15, 2009 (CIDRAP News) – Outpatient clinics should provide separate waiting and exam rooms for possible H1N1 flu patients and prepare business continuity plans, among other steps to prepare for a potential flood of pandemic flu patients this fall, the Centers for Disease Control and Prevention (CDC) recommended today.

The CDC released 10 pandemic preparedness recommendations for outpatient facilities, such as planning for high staff absenteeism, asking sick employees to stay home, and providing staff with personal protective equipment. The recommendations are intended for outpatient clinics and surgery centers, urgent care centers, and physical therapy clinics.

"I think overall their recommendations are sound and appropriate and would encourage physicians to adopt them," said Wayne J. Reynolds, DO, former president of the Virginia Academy of Family Physicians, in response to a CIDRAP News request to look at them.

Briefly, the CDC recommendations are as follows:

• Develop a business continuity plan that includes training enough people to handle essential functions and alternative ways to get critical supplies.
• Inform employees about your plan for coping with additional surge during the pandemic.
• Prepare for potentially high absenteeism by cross-training staff members.
• Protect workers by asking sick employees to stay home and advising all staff members to monitor themselves for febrile respiratory illnesses.
• Plan for a surge of patients and increased demands for your services, which might include using your telephone system to advise callers on when to seek medical care or emergency care.
• Plan to screen patients for febrile respiratory illness when they enter your facility, use separate waiting and exam rooms for flu patients if feasible, and provide patients with surgical masks, facial tissues, and hand hygiene products.
• Take steps to ensure that staff members exposed to suspected flu patients use respiratory and eye protection and to stockpile personal protective equipment.
• Provide staff with free immunization against seasonal flu, since seasonal and pandemic strains may be circulating at the same time.
• Make sure you know about the pandemic planning and response activities of the hospitals, outpatient facilities, and local public health in your community.
• Know where to turn for reliable information, such as the CDC's H1N1 Web site and state health department sites.

"These are a good ten recommendations. Most of them are common sense, but sometimes putting them in writing is the best way to go," said Reynolds, who works at a three-physician clinic in Newport News, Va., and is a member of Virginia's state Board of Medicine.

"I don't think any of these things are terribly burdensome; it's just that people need to stop and think about them and make sure they're doing these things," he said.

But he added one suggestion: postponing healthy patients' appointments if necessary to cope with staff absenteeism and to protect the patients from exposure to the flu when cases are peaking.

If the flu is very widespread, he said, "You're probably going to be operating with reduced staff; you probably won't be able to see the volume of patients you normally see. And it's important to realize that during the pandemic sometimes you're going to want to keep healthy patients away from the office to protect them."

Concerning the recommendation to provide separate waiting rooms for possible flu patients, Reynolds said many pediatric practices already do that, because children tend to be "a little germier" and less careful with respiratory etiquette. The practice is less common at family practice and internal medicine clinics, he added.

"We really haven't done it, but our waiting room is large enough that it would not be a huge burden to put up a partition," he said. "If we sit [potential flu patients] separately from the healthy patients coming in, I think that would help cut down on transmissibility."

Reynolds said he thinks most offices provide free seasonal flu immunizations to staff members and that many are cross-training staff to prepare for absenteeism.

One thing that some practices might have trouble with is persuading workers—including physicians—to stay home when sick, he said.

"Doctors have got to bite the bullet and realize that they're human and if they get sick, they should stay home," he said. "We're trying to be heroic, trying to be diligent. But hey, we're all human; we get sick."

See also:

CDC's 10 recommendations for medical offices and outpatient facilities
http://www.cdc.gov/h1n1flu/10steps.htm