Abkhazia Institute for Social and Economic Research

Assuming insufficient vaccine initially to protect all hospital staff, health departments and health care organizations should work together to define front-line health care workers who would have priority for vaccination or chemoprophylaxis. Absenteeism may result from illness, the need to care for ill family members, and possibly from fear of exposure and infection. As part of preparedness planning, health care organizations should develop strategies to cope with staffing shortages. Strategies to increase available staff:

1. Ensure that the facility’s time-off policies and procedures adequately consider staffing needs in periods of clinical crisis.
   
2. Consider or expand hospital-sponsored sick care services for the children of hospital staff to reduce staff absenteeism.
   
3. Within reasonable limits of clinical competency, consider use of registered nurses and other health care providers serving in administrative positions to provide patient care.
   
4. Consider appropriate clinical care roles for trainees (such as medical or nursing students), retired health care providers, and community volunteers for some patient care roles and other functions such as patient or specimen transport and for maintaining good patient flow in crowded emergency department settings.
5. When vaccine becomes available, sponsor local immunization programs for all staff members, physicians and their families, and other at-risk members of the community.
   
6. Preferentially use immunized staff to care for those with suspected or confirmed influenza infection.
   
7. Generally, health care workers who have respiratory illness should be excluded from work to avoid infection of patients, many of whom are at high risk for severe or complicated disease. In a pandemic, and faced with critical staff shortages, such restrictions could be relaxed on a case-by-case basis, such that health care workers who have mild respiratory illness could provide care for cohorted influenza patients.
   
8. In addition to chemoprophylaxis begun before exposure and vaccination, other strategies to decrease the risk that a health care worker will be infected include good infection control and post-exposure chemoprophylaxis. Antiviral treatment using a neuraminidase inhibitor shortly after onset of symptoms can decrease the duration of illness and time missed from work as well as reducing the amount of viral shedding and risk to other staff and patients. Early therapy also is the most efficient approach to antiviral use when supplies are limited. Bed Availability: Additional beds can be made available for those who require admission for influenza or its complications by decreasing other admissions, implementing more stringent triage, and decreasing the length-of-stay. Hospitals also may be able to add acute care beds in a public health emergency, although staffing those beds may be a limitation.