US: Homeless clinic plans to open H1N1 wing
Via the Salt Lake Tribune: Homeless clinic plans to open H1N1 wing. Excerpt:

Plans are underway for an overnight ward for transient patients with H1N1.

"We don't have the ability to say, 'Get in bed and rest for five days,'" said Jennifer Hyvonen, spokeswoman for the Fourth Street Clinic, a nonprofit clinic for the homeless. "Instead they're going to go to an overcrowded shelter or they're going to go onto the street."

The clinic hopes to raise $80,000 in cash donations and $75,000 in donated supplies and labor to open the new wing by Thanksgiving. The Salt Lake Valley Public Health Department has pledged $20,000, Hyvonen said.

When patients have been diagnosed with H1N1 previously, the clinic has put them in motel rooms, making regular trips to bring them food and medication.

"It was a haphazard way of providing care, and not cost-effective," Hyvonen said.

The objective is to keep H1N1 out of shelters, where the living quarters are tight, where residents come and go daily and where many are without regular health care.

"The homeless are exposed to the elements, ... and they often go without medical services, which can affect the immune system," said Chris Croswhite, director of The Rescue Mission shelter.

To help manage the risk of H1N1, the Rescue Mission is providing hand sanitizer and napkins. A nurse has given a presentation on simple hygiene measures, such as sneezing into the cleft of the elbow.

"Some people have personal hygiene and social habits that make them more susceptible to spreading a virus," Croswhite said.

Domestic violence shelters are making similar preparations. One resident at the South Valley Sanctuary recently was diagnosed with H1N1, said Director Karla Arroyo.

She spent daytimes at a friend's house and was confined to her room at night, when other residents made dinner for her so she would not have to go to the communal kitchen. Residents have been cleaning floors, doorknobs and railings with bleach, Arroyo said.

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Hospitals restricting visitors to stop swine flu
Some banning kids from visiting in hopes of protecting patients from H1N1
The Associated Press
updated 3:15 p.m. CT, Mon., Oct . 19, 2009

WASHINGTON - Visiting a loved one in the hospital? Better check on new flu limits first. Hospitals around the country are turning away visiting children and tightening restrictions on adults, too, in hopes of limiting spread of swine flu in the hallways — although there's little science the limits work.

Utah and Colorado are recommending visitor limits for hospitals statewide. But mostly it's a hospital-by-hospital decision, meaning clinics in the same town can have different rules.

The result? Huge variation. The large Stanford University Hospital in California on Monday barred anyone under 16 from visiting, while the small Central Vermont Hospital turned away the under-12 crowd. Other hospitals have settled on 14 or 18.

The Indiana Heart Hospital announced it isn't checking for age but for symptoms: Visitors are supposed to answer some questions and wear a green sticker showing they were cleared to enter.

In the Washington, D.C., suburbs, the Inova Health System hospital chain is warning pregnant women they can have just one visitor during their stay in the maternity ward, and it has canceled its popular what-to-expect tours for the soon-to-deliver.

Still other hospitals are trying education instead of rules, posting signs that urge people of any age to postpone that visit if they have a sniffle or cough. Atlanta's Emory University is discouraging but not barring children — while stocking lots of hand sanitizer and face masks for visitors that, judging by frequent refills, are getting used.

"There's no perfect way," said Dr. William Schaffner, a flu specialist at Vanderbilt University Medical Center, which is going with the signs but reassesses weekly. "We cannot hermetically seal the institution. You can have people who are going to get sick tomorrow who already are excreting the virus."

It makes for a confusing time as hospitals struggle to balance the recuperative effects of having loved ones visit with the fear that they'll carry in swine flu to people already weakened from something else.

But Dorothy Powers of Overlea, Md., was thrilled with the change. When her 9-year-old son Tyler underwent another round of chemotherapy for leukemia last week, for the first time the halls at the University of Maryland Hospital for Children weren't full of other patients' siblings and friends. New rules bar visitors under 12, limit each patient to two visitors — and require those people to stay inside the child's room.

'Forces parents to be aware'
"It forces parents to be aware of how they can carry germs," said Powers, who added that the new policy also made it easier to explain to her just-over-the-limit 12-year-old daughter that she couldn't visit, either, because of a cold. "It's hard on the family when you can't be together, but if you can't be together because of germs. ..."

On the other side, nurses describe some tears when new mothers learn they'll have to go home before introducing all the relatives to the newborn. And hospitals hasten to say they make exceptions if, for instance, a family member is dying.

This isn't about patients admitted for flu treatment; hospitals are supposed to follow specific infection-control steps for them.

Not clear if limiting visitors works
The problem: There's been little study of whether curbing visitors, or screening them for symptoms, keeps flu from sneaking into other parts of the hospital.

Visitors aren't the only risk. Health care workers might wear masks while caring for a flu patient, but they can catch the virus at home and bring it back to work. One major difficulty in fighting flu is that people can spread it up to 24 hours before their own symptoms appear.

Consequently, neither the Centers for Disease Control and Prevention nor the American Hospital Association have set guidelines on the issue.

Why so many child bans? Because this new flu, what scientists call the 2009 H1N1 strain, spreads so easily among children.

"This has not been a policy that has been taken lightly," infectious disease chief Dr. Yvonne Maldonado says in a video posted on Stanford's Web site to warn the public of Monday's change at the hospital.

But University of Washington epidemiologist Ira Longini, a well-known expert in how influenza spreads, calls banning all children "a little extreme." He prefers for short-term visitors to wear a mask: "If somebody's washing their hands and wearing a mask, they're probably not going to infect anybody else."

Vanderbilt's Schaffner recalls being a forlorn little boy waving to his father, hospitalized for appendicitis, from the street. Today, there's good evidence that support from family and friends can hasten recovery. So in recent years, many hospitals have ended visitation restrictions outside of intensive care units or other especially vulnerable rooms, and even install fold-out couches and other amenities to encourage families to stay.

Stay tuned: The new limits are supposed to disappear when flu season ends.

"Hopefully, it's going to be a short one," said University of Maryland pediatrics chairman Dr. Steven Czinn. "We'll be very conservative in lifting the policy."

This article could be called "lack of adequate plans".

US: California nurses plan one-day strike over hospitals' poor H1N1 safety
Via the California Nurses Association website: Major Nurses Strike and Picket Looms October 30 As RNs to Protest Hospital Gaps in Swine Flu Safety. Excerpt from a long and alarming media release:

As many as 16,000 registered nurses from three large Catholic hospital chains in California and Nevada will join a one-day strike and picket October 30, as RNs step up the protest over poor readiness by many hospitals to confront the H1N1 swine flu pandemic, the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) announced today.

The strike will affect hospitals across California from San Bernardino and Long Beach in the south to Eureka and Redding in the north, and include major facilities in Los Angeles, Sacramento, San Francisco, San Jose, Bakersfield, Stockton, and the Central Coast.

Additionally, nurses will picket major facilities in Las Vegas and Reno, Nevada.

Protecting nurses, patients and families in the center of the pandemic storm Central to the nurses' walkout is ongoing concern over the failure of the hospital chains to assure adequate safety precautions for patients, their families, nurses, and other healthcare employees in the wake of the escalating H1N1 “swine flu” pandemic.

In particular, the RNs say, many hospitals continue to do a poor job at isolating patients with H1N1 symptoms and other steps to limit contagion, or provide sufficient fit-tested N95 respirators and other protective gear for healthcare workers and patients.

(con. here: http://tinyurl.com/yjjpxk4 )

http://crofsblogs.typepad.com/h5n1/2009 ... afety.html

Major strike by nurses looming in California and Nevada:
+
http://www.calnurses.org/media-center/p ... ober/maj...

Major Nurses Strike and Picket Looms October 30 As RNs to Protest
Hospital Gaps in Swine Flu Safety

As many as 16,000 registered nurses from three large Catholic
hospital chains in California and Nevada will join a one-day strike
and picket October 30, as RNs step up the protest over poor readiness
by many hospitals to confront the H1N1 swine flu pandemic, the
California Nurses Association/National Nurses Organizing Committee
(CNA/NNOC) announced today.

The strike will affect hospitals across California from San
Bernardino and Long Beach in the south to Eureka and Redding in the
north, and include major facilities in Los Angeles, Sacramento, San
Francisco, San Jose, Bakersfield, Stockton, and the Central Coast.
Additionally, nurses will picket major facilities in Las Vegas and
Reno, Nevada.

Protecting nurses, patients and families in the center of the pandemic storm

Central to the nurses' walkout is ongoing concern over the failure of
the hospital chains to assure adequate safety precautions for
patients, their families, nurses, and other healthcare employees in
the wake of the escalating H1N1 "swine flu" pandemic.

In particular, the RNs say, many hospitals continue to do a poor job
at isolating patients with H1N1 symptoms and other steps to limit
contagion, or provide sufficient fit-tested N95 respirators and other
protective gear for healthcare workers and patients.

Updated Centers for Disease Control recommendations released last
week re-affirmed guidelines for isolation and safety equipment, and
urged hospitals to avoid policies that encourage employees to work
when sick, another problem in many hospitals.

The Occupational Safety and Health Administration said last week that
it plans to issue a compliance
directive to ensure uniform procedures "to identify and minimize or
eliminate high to very high risk occupational exposures" to H1N1.

CNA/NNOC wants hospitals to formally adopt all CDC and Cal-OSHA
guidelines to make them enforceable by CNA/NNOC contract provisions
assuring the highest safety measures are met, are uniform, and
consistently applied throughout the systems.

For months, RNs have repeatedly voiced alarm at inadequate H1N1
hospital safeguards. In August, CNA/NNOC released the findings of a
survey of 190 U.S. hospitals where RNs cited widespread problems with
poor segregation of patients, lack of sufficient N95 masks, numerous
hospitals where nurses have been infected, inadequate training for
hospital staff, and punitive sick leave policies.

But substantial problems remain. In California alone, more than 3,000
people have been hospitalized, and over 200 have died, including an
RN infected on the job at one of the hospitals where RNs will strike.
"Our hospital isn't being proactive in preparing for the expected
onslaught of H1N1 infected patients," said Kathy Dennis, RN at Mercy
General Hospital in Sacramento. "We can't get enough N95 masks,
patients are not being properly isolated, and RNs are not being kept
informed of the latest guidelines. Last time I worked, it took me
more than four hours to get masks when we ran out. We must put the
proper precautions in place now before flu seasons peaks or we will
all be in serious trouble."

"When nurses are exposed to tuberculosis, the hospital notifies us.
When nurses are exposed to head lice the hospital notifies us. Why
then are we not told when we are exposed to H1N1? All staff have the
right to know if they have been exposed in order to keep our patients
from further unnecessary exposure," said Carol Koelle, RN at St.
Bernardine Medical Center in San Bernardino.

Adherence to safe staffing ratios

Complicating swine flu preparedness, RNs say many hospitals fall far
short in assuring proper RN staffing as required under a California
law requiring minimum, safe RN-to-patient staffing ratios. CNA/NNOC
proposes RN monitors to assure compliance with the law in all
hospital units.

snip

RNs also want to stop the practice of some of the hospitals that
mandate RNs to "float" - work in clinical areas outside their
expertise, training, and orientation - which puts patients at risk.
Additionally, the RNs are insisting that hospitals withdraw efforts
to reduce healthcare benefits by shifting more costs to nurses and
reducing coverage options. In several areas, hospitals are also
demanding a wage freeze.

"As nurses, we see the consequences when employers reduce coverage,
it's disgraceful to see our hospitals taking the same step," said
Debra Amour RN at Seton Medical Center in Daly City. "Such demands,
would also sharply undermine the ability of the hospitals to keep
nurses at the bedside and recruit new RNs."

RNs will be participating in the strike or picketing at the following
facilities:

Catholic Healthcare West

California
Arroyo Grande Community Hospital
Bakersfield Memorial Hospital
Bruceville Terrace - Sacramento
California Hospital Medical Center - Los Angeles
Community Hospital of San Bernardino
Dominican Hospital - Santa Cruz
French Hospital Medical Center - San Luis Obispo
Glendale Memorial Hospital and Health Center
Marian Medical Center - Santa Maria
Mercy General Hospital - Sacramento
Mercy Hospital - Bakersfield
Mercy Hospital of Folsom
Mercy Medical Center - Merced
Mercy Medical Center Redding
Mercy Medical Center - Mt. Shasta
Mercy San Juan Medical Center - Carmichael
Mercy Southwest Hospital - Bakersfield
Methodist Hospital - Sacramento
Sacramento Foundation Clinics
Saint Francis Memorial Hospital - San Francisco
St. Bernardine Medical Center - San Bernardino
St. Joseph's Behavioral Health Center - Stockton
St. Joseph's Medical Center - Stockton
St. Mary Medical Center - Long Beach
St. Mary's Medical Center - San Francisco
Sequoia Hospital - Redwood City
Sierra Nevada Memorial Hospital - Grass Valley
Woodland Healthcare

Nevada
Saint Mary's Regional Medical Center - Reno
St. Rose Dominican Hospital, Rose de Lima - Henderson
St. Rose Dominican Hospital, Siena - Henderson
St. Rose Dominican Hospital, San Martin - Las Vegas
Daughters of Charity Health System
O'Connor Hospital - San Jose
Saint Louise Regional Hospital - Gilroy
Seton Medical Center - Daly City
St. Vincent Medical Center - Los Angeles
St. Joseph Health System
Petaluma Valley Hospital
St. Joseph Hospital - Eureka
St. Mary Medical Center - Apple Valley

US: Flu clinics reveal challenges of mass vaccinations

Via the Salt Lake Tribune: Flu clinics reveal challenges of mass vaccinations. Excerpt:

People lined up by the thousands early Saturday outside Salt Lake County public health clinics, heeding officials' calls to get themselves and their children vaccinated against the H1N1 flu virus.

Yet hundreds were turned away soon after the clinics opened their doors, leaving many discouraged and frustrated.

Dosages, 7,000 in all, had been spoken for by 7:30 a.m. Saturday at the county's four mass-vaccination sites, Salt Lake Valley Health Department spokeswoman Kate Lilja said.

"It's sad there's a limited number of doses. I hope the people who need it can get it," Emily Green, who drove in from Orem, said as she stood in line at the Southeast Public Health Center in Sandy.

As a pregnant woman, Green is in one of five groups targeted for priority vaccination against the flu that already has claimed eight Utahns and hospitalized another 274 this season.

Still, Lilja said county health officials viewed Saturday's clinics as a success. "We will be reviewing everything we did today to refine our process," she said.

Lilja added more clinics will be held in future but it's unlikely another mass vaccination will occur next Saturday.

The specter of around-the-block lines could be a seen as a public-health success story or a sign of a coming logistical train wreck as federal, state and local health authorities struggle to mass vaccinate children and adults in five special target groups.

"It's really gratifying to see a high level of interest," said David Sundwall, state Department of Health executive director.

"We don't have any precedent for this. When we have enough for everyone, by late November and early December, it will be routinely available at vaccine clinics."

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Lawnwood tightens visiting policy after swine flu-related death
By Hillary Copsey

Monday, October 26, 2009

FORT PIERCE — Following the weekend H1N1-related death at Lawnwood Regional Medical Center & Heart Institute, hospital officials are announcing a more restrictive visiting policy aimed to stop the spread of swine flu.

Children younger than 16 will not be allowed in any intensive care unit at Lawnwood. Children are more likely to become sick with the flu or spread the H1N1 virus, which was first identified this spring and is now widespread throughout the Treasure Coast and Florida.

Lawnwood planned to start restricting visitors’ access this week, but spokeswoman Jana Eschbach said the need was highlighted by the weekend death of a patient from swine flu complications. A 47-year-old Okeechobee County woman died after being transferred Saturday from Raulerson Hospital in Okeechobee to Lawnwood with flu-like symptoms, said Okeechobee County Health Department spokesman Mitch Smeykal.

Hospital officials said samples from the patient were at a state lab to confirm the H1N1 diagnosis, a process that can take days.

Children visiting patients at Lawnwood’s birthing center, pediatrics department and women’s and children’s unit also will be under special restrictions, Eschbach said. Additionally, the hospital is restricting intensive care visits to 10 a.m. to noon, 2 to 4 p.m. and 7 to 8 p.m.

Lawnwood is discouraging patient visits during the flu season, which lasts until May. Anyone who has been exposed to H1N1 or has flu-like symptoms — including fever, cough, sore throat, body aches, vomiting or diarrhea — should stay home.

Canada: Swine flu could force surgery cancellations in Nova Scotia
Via Google News, a report from The Canadian Press: Swine flu could force surgery cancellations in N.S.'s largest health authority. Excerpt:

Nova Scotia's largest health authority is facing the possibility of having to cancel all scheduled surgeries as it increases the number of beds and staff dedicated to swine flu cases.

Officials with Capital Health said Friday that they are down to 45 per cent of the surgeries they would normally perform because more people with H1N1 are being placed in intensive care units.

Chris Power, CEO of Capital Health, said they're expecting the number of people with swine flu to double each week for the next couple of weeks, placing more demand on already stressed resources.

That would add about six to 10 people a week to intensive care units, leading to the possibility that all non life-threatening surgeries may be postponed for a time.

"That may come to be," she said. "We're assessing it on a day-to-day basis."

The hospital cancelled 37 surgeries Friday and expects that number to grow. That included urology, ear, nose and throat, orthopedic, neurological and cardiac procedures.

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