National Implementation of H1N1 Preparedness Plans within Higher Education in the United States

1. National Implementation of H1N1 Preparedness Plans within Higher Education in the United States Team Members: Erik Kneubehl, Judith Moore, Henry Young, Denise Larner, Tina Smilie, Chris Futterknecht

2. Historical Perspective of Organizational Management of Sick Students • An influenza pandemic is an epidemic of an influenza virus that spreads on a worldwide scale and infects a large proportion of the human population. • The World Health Organization (WHO) warns that there is a substantial risk of an influenza pandemic within the next few years. • On 11 June 2009, a new strain of H1N1 influenza was declared to be a global pandemic (Stage 6) by the World Health Organization.

3. Description of Problem • 2009 H1N1 (sometimes called a "swine flu") is a new influenza virus which was first detected in people in the United States in April 2009. The virus is speading worldwide. On June 11, 2009, the World Health Organization signaled that a pandemic of the 2009 H1N1 flu was underway. • Cases of H1N1 virus range from mild to severe. Hospitalizations and deaths from the virus have occurred. Flu activity is now widespread in 46 states. Flu related hospitalizations and deaths continue to go up nation wide and are above what is expected for this time of year (www.cdc.gov/h1n1/flu/update.htm).

4. Description of Problem (continued) • Stakeholders - students, faculty, parents, administrators, the community in general. • While everyone is at risk, the CDC is targeting schools to help stop the spread of this disease. • Approximately 1/5 of the U.S. population attends or works in schools (U.S. Dept. of Ed., 1999) • Some viruses and bacteria can live from 20 minutes up to 2 hours or more on surfaces like cafeteria tables, doorknobs, and desks (Ansori, 1988, Scott, Bloomfield, 1989) • Nearly 22 million school days are lost annually due to the common cold alone (CDC, 1996) • Addressing the spread of germs in schools is essential to the health of our youth, our schools and our nationwww.cdc.gov/flu/school/

5. Description of Problem (continued) • Organizational challenges: • Prevention- Vaccination- Hand Cleaning Stations • Education Programs • Preemptive Planning • Policy and Procedures- Stockpiling Medication • Developing Organizational Capacity • Establish Operational Communications Network with Stakeholders • Post Outbreak- Quarantine- Close School • Continuity of Education- Return to School Procedures

6. Case Studies Chosen • STONY BROOK: The Student Health Service offers comprehensive and cost-effective health services for both medical and psychosocial health problems. The staff includes physicians, physician assistants, nurse practitioners, registered nurses, pharmacists, laboratory technologists, a social worker, health educators, and a substance abuse and addictions counselor. • UNIVERSITY OF IOWA: The University of Iowa student health services is a primary care facility staffed with an extensive team of dedicated professionals. The providers are all board certified and include eight family practice physicians, two psychiatrists, one gynecologist and two physician assistants. Many of the nurses hold a special college health certification. The mission is to provide comprehensive and quality care to each and every student at the University of Iowa.

7. Description of Positive/Negative Organizational Change Reflected in Case Studies • Critical External Change Factors • Data collected from the Center for Disease Control and Prevention on international impact of the 2009 H1N1 and seasonal influenza • Data from the Iowa Influenza Surveillance Network (IISN) • Consumers (students) are in the age range (6 month through 24 years of age) that are most affected by the influenza • Political and Social Trends • Emergency Response Team to manage major epidemic outbreak • Immunization policy • Awareness and prevention information on dedicated web site • Consultations with local health experts on possible vaccine distribution, allocation, reporting and development of a prioritization plan • Isolating students who show signs of influenza type symptoms

8. Description of Positive/Negative Organizational Change Reflected in Case Studies (continued) • Critical Internal Change Factors • Partnerships formed between University of Iowa and the University of Iowa Health Care system to address influenza concerns • Added a Public Information Officer position to the organization • Created an Emergency Response Team • Created a multi-disciplinary group from university offices and resources to address needs and issues related to influenza concerns • Added hand hygiene kiosks for additional preventive measures and sanitation • Structural shifts • Educating staff to protect potentially vulnerable staff (i.e. pregnant staff members • Developed guidelines for staff exposure • Isolation guidelines • Letters sent to students, parents and faculty/staff • Online Illness Absence Form to report illnesses to instructors • No grades will be penalized if students are following health official recommendations • Students asked to refrain from contact with others during illness

9. Description of Positive/Negative Organizational Change Reflected in Case Studies (continued) • Negative Aspects of Change • Students, parents and staff concerns about possible exposure can cause stress and anxiety • Students, parents and staff can experience a loss of security as a heightened awareness of the potential for an epidemic outbreak is openly discussed • Concerns for newness of vaccine and availability of vaccine

10. Major Findings and Limitations of Research • Previously students who had the flu were simply kept home. Little preparedness was done at the K-12 level. • The difference now is the H1N1 virus which showed up in April 2009 has resulted in student deaths (previously thought to be a low risk category) and in the closing of schools. • The response from the federal Dept. of Ed. and the CDC is a multitude of information aimed at trying to prevent the spread of H1N1, reduce school closings and to assure the continuity of learning for schools K-12 - http://www.ed.gov/h1n1flu. While previous plans were aimed at health and safety, the focus now includes maintaining a continuity of learning.

11. Major Findings and Limitations of Research (continued) • New for preparedness plans -http://www.cdc.gov/h1n1flu/school • Students may be spending time at home and outside of the classroom due to H1N1 outbreaks. This may include sick students, healthy high-risk students. Schools may also close due to significant teacher illnesses. • In all cases, continuity of learning plans are essential for keeping students on track with their learning while at home. Schools need to look at their resources to ensure learning continues - this would include hard copy take-home packets online materials, social networking through YouTube, Twitter, PCs, laptops, DVD, MP3 and other audiovisual recording devices, conference calls, teacher check ins, etc.

12. Major Findings and Limitations of Research (continued) • Also new is the encouragement of schools hosting H1N1 influenza vaccination clinics. Benefits include: large numbers of children are found in schools, schools are conveniently located in communities, communities are generally familiar with and trust schools, school facitlites can generally accommodate mass vaccination clinics, school nurses may be available to assist and be familiar with the health of students, school staff have access to parental contact info which could facilitate communications, others prioritized for vaccination besides students may also be vaccinated.

13. Major Findings and Limitations of Research (continued) Potential challenges include: disrupting educational activities, finding enough staff to conduct the clinic, immunization activities may need to be tailored to each school or district complication efforts and the handling and transporting of vaccines requires considerable planning, equipment and training.

14. Recommendations • Long-term studies needed to see how helpful these procedures were over the long term • Learn from all institutions and identify best practices for dealing with student/campus health crisis • Stony Brook – To deal with the change in general, the people on the change team need to be the real players and meet regularly • Crisis management needs to be proactive. Relationships must be developed with outside agencies that would be involved in crisis. The relationships must meet regularly rather than just something on paper. • Communication plan from the schools to the stakeholders among the major community agencies (connect-ed, reverse 911, community notification systems, etc.