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Fever Pitch

The flu hits hard, and Hopkins fights back—with the fundamentals


Pat Rosenbaum coined a clever anti-flu mantra.

Out with those decontamination shower tents, that cumbersome sci-fi attire, and all that other pricey, high-tech protective equipment that would save us from some post-9/11 plague. In with the hand sanitizers, the old-fashioned face masks, the Kleenex! For this latest threat, influenza, Hopkins resorted to the same common-sense approach moms have been preaching for years: Wash your hands, and please, cover your mouth with a tissue when you sneeze.

This time, the threat was for real. The flu hit hard, and it hit early, with the first cases turning up in late October. By Christmas, Hopkins Hospital was reporting 246 cases, 236 more than it had at that time the year before. By the first week in January, a total of 329 cases had been diagnosed, more than double those in the last three years combined.

At Bayview, meanwhile, in a surreal scene reminiscent of last year’s SARS epidemic, patients lined the ED wearing protective face masks. At Howard County General Hospital, more test kits had been used to diagnose flu than in the past two years combined. Everywhere, patients with respiratory illness were being isolated; high-risk patients and health care workers, vaccinated; employees with flu symptoms, cultured.

Were we ready for this? Indeed we were. Ever since the winter of 2003, when SARS raced out of southern China, a respiratory illness prevention campaign had been in the works. And as part and parcel of that program, posters urging people to “Cover your sneeze, please” promptly went up near entrances, and elevator banks and in waiting rooms in each of Hopkins’ three hospitals and its community clinics. Tissues, wall-mounted dispensers of waterless hand-washing gel (Purell), and masks appeared in waiting areas.

Mapped out by experts in Infection Control, with help from Operations Integration and representatives from all departments, the campaign was aimed not just at the flu but also at a host of respiratory maladies like the common cold, pneumonia, RSV and SARS. And it targeted everyone—employees, patients and visitors alike. Even staff with no clinical contact with patients—especially frontline folks who man registration desks and hospital entrances—were schooled in the ABC’s of respiratory etiquette. Explains Mary Myers of Operations Integration: “We learned with SARS that all you need is one case getting through the door.”

The plan was user-friendly, and it was clever. “We supplied patients, staff and visitors with Kleenex, masks and hand-washing gel, and we put it all at their fingertips,” says Pat Rosenbaum, nurse epidemiologist in Infection Control. The slogan “Cover your Sneeze, Please,” so ingenious it might have come from Madison Avenue, was actually Rosenbaum’s brainchild.

The campaign was enhanced by this season’s remarkably successful vaccination program. Approximately 15,000 Hopkins Hospital and University employees were vaccinated, compared to 11,000 last year. Availability, explains Karen Mackie, also an infection control/nurse epidemiologist, was the key. Employees could roll up a sleeve in more locations and at more times than ever before.

At Bayview, which prides itself on having one of the most aggressive vaccination programs around, the “10 Good Reasons Why You Should Get the Flu Shot This Year” are actually posted inside each and every stall in all the restrooms on campus. The real incentive, says epidemiologist Jean Leclair, was reason number 9: You might win $100 or a gift certificate. “After that,” she says, “our numbers shot up.”

By the end of December, while the vaccine supplies were depleted elsewhere, both Bayview and Hopkins Hospital had ample doses, enough to give hundreds to a needy Baltimore City Health Department.

In the second week of January, health officials with the Centers for Disease Control and Prevention announced that influenza season had reached its peak in the United States. Throughout the Health System, cases leveled off.

We’ll never know how many flu cases the respiratory illness prevention program actually thwarted, but Rosenbaum says that doesn’t really matter. This campaign was designed to disseminate information about how germs are spread and change behaviors, she explains. When employees are empowered with the know-how and confidence to deal with an array of modern-day plagues, they will be better prepared for the next, new thing.

—ABS


 

 

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