Personal Protective Equipment and Antiviral Drug Use during Hospitalization for Suspected Avian or Pandemic Influenza1

For pandemic infl uenza 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 infl uenza (API) sought treatment at 9 Australian hospital emergency departments where patient-staff interactions during the fi rst 6 hours of hospitalization were observed.Based on World Health Organization defi nitions 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 qualifi ed for postexposure antiviral prophylaxis.These data indicate that many current national stockpiles of PPE and antiviral medication are likely inadequate for a pandemic.A lthough a new infl uenza pandemic may appear inevi- table, critical parameters of transmissibility and attack rate are uncertain.Estimates based on extrapolations from the 3 infl uenza pandemics of the 20th century suggest that healthcare facilities in the United States alone may be required to cope with 314,000-734,000 additional hospitalizations and 18-42 million outpatient visits (1).During the early containment phase of a pandemic, patients with suspected infection are likely to be referred to hospitals for isolation, diagnosis, and treatment until the transmissibility and virulence of the pandemic strain are known.Although social distancing and school closures may reduce risk in the wider community (2), healthcare workers (HCWs) are likely to encounter repeated close exposures.If hospitals are to continue to function adequately, reliable access to effective personal protective equipment (PPE; gowns, N95 masks, gloves, and eye protection) and antiviral drug therapy will be necessary for an unpredictable period.With awareness of the recent severe acute respiratory syndrome (SARS) outbreak and with growing concern about human deaths from avian infl uenza (H5N1), governments worldwide have begun to stockpile PPE and antiviral medication.Key strategies to control the speed and extent of viral spread within healthcare settings have been advocated by national government guidelines (3-6) and the World Health Organization (WHO) (7).These include rigorous infection control practices, prescriptive instructions for the use of PPE, and dissemination of antiviral medication.However, information regarding the required quantity and rate of use of these valuable resources in an outbreak situation is lacking, thereby limiting valid assessments of the adequacy Personal Protective Equipment and Antiviral Drug Use during Hospitalization for Suspected Avian or Pandemic Infl uenza 1