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Hospital Response to the 2009 Influenza Pandemic: A Survey of U.S. Hospital Epidemiologists

By Amesh A. Adalja, MD, February 19, 2010

While the 2009 H1N1 influenza pandemic did not prove to be highly lethal, hospital response efforts were similar to those that would be instituted during a more severe pandemic. Viewed from this perspective, the 2009 H1N1 influenza pandemic can be seen as an extensive trial run of hospitals’ pandemic response systems. As such, this experience can be used to identify strengths, deficiencies, and variables not accounted for in planning. 

Survey of SHEA Members

In their article in the February 15, 2010 issue of Clinical Infectious Diseases,1 Lautenbach and colleagues report the results of their recent survey of U.S. healthcare epidemiologists. Their purpose was to use the reported experiences of the epidemiologists to assess several aspects of the hospital response to the early spring wave of the H1N1 pandemic in the U.S. The study’s authors sent electronic surveys to all members of the Society for Healthcare Epidemiology (SHEA) on May 26, 2009, and sent a reminder one week later. They received 323 responses, which represented approximately 25.9% of the total SHEA membership.

While facilities were seen as well prepared, other infection control activities were neglected:

  • 60.4% reported their hospitals were well prepared for a potential pandemic.
  • 32.7% reported spending >60% of their time managing H1N1 influenza-related issues during the peak of the pandemic.
  • 50.9% reported that other important infection control activities were neglected during the pandemic.

Antiviral medication shortages were common:

  • 30.7% experienced a shortage of antivirals. 
  • 39.0% reported that personal stockpiling of antiviral medications occurred.
  • 51.4% reported that actions were initiated to prevent personal stockpiling.

Mandatory vaccination of HCWs is favored; many disagree with sustained use of airborne precautions:

  • 77.7% favored mandatory vaccination of healthcare workers.
  • 72% supported the recommendation for airborne precautions at the beginning of the pandemic.
  • 60% disagreed with sustained use of airborne precautions as the pandemic continued.
  • The majority of respondents experienced no problems with availability of N-95 masks, surgical masks, and alcohol-based hand sanitizers.

Neglect of Other Infection Control Activities Is Worrisome

It is important to note that this survey covered only the early stages of the pandemic, which occurred in spring 2009. However, the majority of hospitalizations occurred in the fall. While the survey confirmed that the pandemic’s impact on hospitals was fairly limited in the spring, non-influenza-related infection control activities still suffered.

Infection control departments serve a vital role in safeguarding both hospital populations and the general population (through coordination of reporting), and many are already stretched to their limits by efforts to stem the spread of such organisms as MRSA, VRE, Clostridium difficile, and Acinetobacter baumannii. In their accompanying editorial,2 Carlson and Perl indicate that hospital “administrators need to make ‘back filling’ support to infection control part of pandemic planning processes.”


  1. Lautenbach E, Saint S, Henderson DK, Harris AD. Initial response of health care institutions to emergence of H1N1 influenza: Experiences, obstacles, and perceived future needs. Clinical Infectious Diseases. 2010;50:523–7.
  2. Carlson AL, Perl TM. Responding to H1N1 in health care institutions: Is the glass half full or half empty? Clinical Infectious Diseases. 2010;50:528-530.