Personal protective equipment and antiviral drug use during hospitalization for suspected avian or pandemic influenza.

For pandemic influenza planning, realistic estimates of personal protective equipment (PPE) and antiviral medication required for hospital healthcare workers (HCWs) are vital. In this simulation study, a patient with suspected avian or pandemic influenza (API) sought treatment at 9 Australian hospital emergency departments where patient-staff interactions during the first 6 hours of hospitalization were observed. Based on World Health Organization definitions and guidelines, the mean number of "close contacts" of the API patient was 12.3 (range 6-17; 85% HCWs); mean "exposures" were 19.3 (range 15-26). Overall, 20-25 PPE sets were required per patient, with variable HCW compliance for wearing these items (93% N95 masks, 77% gowns, 83% gloves, and 73% eye protection). Up to 41% of HCW close contacts would have qualified for postexposure antiviral prophylaxis. These data indicate that many current national stockpiles of PPE and antiviral medication are likely inadequate for a pandemic.

Outcome of emergency department patients with delayed admission to an intensive care unit.

OBJECTIVE: To compare 30 day mortality, length of stay and cost for adult emergency department patients with a delay in intensive care unit admission of up to 24 h with a group of patients admitted directly from the emergency department to the intensive care unit. METHODS: Retrospective cohort study in a 300-bed university affiliated teaching hospital. One hundred and twenty-two adult emergency department patients admitted to the intensive care unit either directly from the emergency department (direct group) or within 24 h of ward admission (delayed group) were identified. The main outcome measures investigated were 30 day mortality, length of stay and cost. RESULTS: Thirty day mortality in the delayed group was significantly higher, the risk ratio being 2.46 (95% confidence interval 1.2-5.2). The length of stay and cost were similar in the direct and delayed groups. Baseline estimate of risk of death derived from the mortality probability model calculated from the emergency department data was similar for the two groups (P =0.10). Emergency department triage categorization and emergency department staff seniority was significantly different (chi2 for trends, P = 0.002 and 0.023, respectively), with patients in the delayed group more likely to be triaged as less urgent and to be initially assessed by junior staff. CONCLUSION: Our study shows that patients transferred to the intensive care unit within 24 h of ward admission from the emergency department had a significant increase in 30 day mortality compared with patients admitted to the intensive care unit directly from the emergency department, but no difference was found in terms of length of stay and cost.