How the SCCA successfully suppressed pandemic flu

Aggressive infection-control and screening measures at the Seattle Cancer Care Alliance during the spring 2009 H1N1 influenza epimedic protected immunocompromised cancer patients from the flu. While the Seattle area had a 100-fold increase in H1N1 cases, there was no corresponding increase among the patient population.

These findings by researchers and physicians at the Hutchinson Center and SCCA appeared last week in the online version of the journal Blood.

Study authors Drs. Corey Casper, Janet Englund and Michael Boeckh detail how patients with blood cancers are screened, diagnosed and treated for H1N1 infections and then how the SCCA's infection-control program led to successful suppression of a potentially serious epidemic among clinic patients and staff.

"Our experience shows that aggressive infection-control procedures can minimize transmission within the immunocompromised patient population and also reduce acquisition from sources outside the system," the authors said.
    
Outpatient infection control

The SCCA's infection-control program is unique in that it is devoted entirely to outpatient infection control among cancer patients, said Casper, a researcher in the Hutchinson Center's Vaccine and Infectious Disease Institute and medical director of the SCCA's infection-control program.
    
"Lessons learned here are important ones because the majority of cancer care is provided in an outpatient setting," Casper said. "Outpatient cancer care poses more challenges when it comes to protecting patient health because the environment is less controlled than that of a hospital."
    
The SCCA infection-control program, which runs annually Oct. 1 through April 30, follows recommendations set forth from the Centers for Disease Control and Prevention.

Key elements of the SCCA program are:

1. Early identification of individuals with potential influenza infection.
2. The presence of hand hygiene stations and information about respiratory infections and respiratory etiquette at the SCCA entrance.
3. Licensed practical nurses or volunteers administer an 11-point symptom survey to all who enter clinical areas. Weekly color-coded stickers document the completion of the survey. No individual without a sticker may enter clinical areas.
4. Staff members reschedule patients with respiratory symptoms. If rescheduling is not possible, the patient receives a mask and waits in an isolated area or private room for assessment by their clinical care team.
5. Staff members with any symptoms of respiratory infection must take a leave of absence until they are symptom free. Respiratory virus testing is offered to staff members who have minimal residual symptoms but feel well enough to work after an absence of more than four days receive respiratory virus testing. A negative test allows them to return to work.
6. Outpatient and inpatient facilities receive a comprehensive isolation plan (SCCA adult cancer patients receive inpatient care at the University of Washington Medical Center; SCCA pediatric inpatients are cared for at Seattle Children's).
7. There is regular monitoring of adherence to hand hygiene and compliance with isolation guidelines.
8. Staff members must receive annual influenza vaccinations (or sign a waiver)
9. The sick-leave policy allows for absences for respiratory illnesses and provides for management of work plans for staff at all levels in the event of absences.

The authors urge that health care institutions caring for immunocompromised patients require all members of staff to receive influenza vaccination as key component of influenza control.

The National Institutes of Health funded the study.