Editor's Note: CIDRAP's Promising Practices: Pandemic Influenza Preparedness Tools online database showcases peer-reviewed practices, including useful tools to help others with their planning. This article is one of a biweekly series exploring the development of these practices. We hope that describing the process and context of these practices enhances pandemic planning.
Jan 2, 2008 (CIDRAP News) – As healthcare facilities become overwhelmed during pandemic influenza, many of the sick may have to receive care elsewhere, including at home. The "Stay at Home Toolkit for Influenza," developed by health officials in Maryland's Montgomery County, offers the public practical guidelines on how to nurse ill household members.
The simple guide, from the Montgomery County Department of Health and Human Services Public Health Services, highlights prevention and caregiving with outlines on what people should or should not do when assisting those sick with the flu.
Rachel Abbey and Betsy Burroughs of the county's Advanced Practice Center (APC) for Public Health Emergency Preparedness and Response compiled the toolkit and said the idea developed following suggestions from other public health officials about the necessity for home care guidelines.
"During a pandemic, in order to deal with surge, we would need residents to take care of sick people," said Abbey, a program specialist at the APC.
Determining the need
According to federal estimates based on past pandemics, as many as 90 million people nationwide could become infected in either a moderate or a severe pandemic. At least 45 million will require outpatient care in either scenario; during a severe pandemic, 9.9 million may need hospitalization. Demand is expected to outpace hospital capacity, forcing people to rely on alternate care sites, including homes.
Montgomery County has the highest population in the state of Maryland, with nearly a million people. A "medium-level" pandemic could cause almost a quarter of a million illnesses in the county, with 133, 235 requiring outpatient care and 2,742 hospitalizations, while a severe pandemic could infect almost 300,000 residents, according to county statistics. Of these, about 160,000 would need outpatient care and 3,290 would require hospitalization.
Prevention tips are especially essential, because each infected person is expected to transmit infection to two other people, according to the US government's planning Web site (http://www.flu.gov/).
Abbey and Burroughs said they solicited expert feedback from nurses and other healthcare workers while creating the content areas for the toolkit, which also uses public health information from various sources, including the Centers for Disease Control and Prevention, the US Department of Health and Human Services, and Public Health – Seattle & King County, among others.
The county has developed other tools to help the public prepare. Aside from a pandemic flu Web site, www.montgomerycountymd.gov/pandemicflu, staff members have made presentations on preparedness at community forums and events about pandemic influenza. In addition, the county has launched a bus ad campaign encouraging hand washing and cough etiquette specific to seasonal influenza.
The home care influenza toolkit includes:
- Checklists on what to keep in the home
- Tips on how to recognize flu signs and symptoms
- Instructions on using thermometers, isolating the sick, making disinfectant with bleach, and cleaning potentially contaminated areas
- A personal care log to help caregivers track observations and actions
- Guidelines for those returning to work after recovering from flu
- Items to keep on hand for pets for disaster preparedness
"It's really basic information," said Burroughs, a communication specialist at the APC. "We actually had a consultant to tame the language to make it more understandable. I think this goes a long way in how it is received."
There is little medical jargon in the user-friendly toolkit. For example, when advising people to wash hands for 20 seconds after coming in contact with a sick person, the guide recommends singing "Happy Birthday" twice to keep time.
The creators sought public input through focus groups, which Abbey said was very useful in creating the final product.
Despite the toolkit's simplicity, it doesn't skimp on necessary details and is medically accurate, Abbey said. "It's still very comprehensive on specifics on what to do."
"If you were bereft of information, you could turn to this," Burroughs added.
Assessing the toolkit
The kit is mainly available through the county's Web site. Burroughs said that, because of limited resources, dissemination to all households in the county has not been possible. During an influenza pandemic, the county plans to distribute the toolkit when quarantine and isolation plans are handed out and to also send messages through the media on how people can download the kit.
It will be impossible to evaluate the toolkit's strengths and weaknesses until a pandemic actually occurs, Abbey and Burroughs said.
"We just don't know how it's going to be utilized," noted Abbey.
In addition, the plan in its current state cannot be used by everyone.
"It doesn't address specific populations that we serve, and we recognize that," Abbey said, pointing out, for instance, that despite its simplicity, the toolkit might still pose a barrier for those with limited English proficiency. According to 2000 census data, 31.6% of Montgomery County's population speaks a language other than English at home.
Burroughs said the county doesn't have the capabilities to translate the guide into the eight other languages they make available in the county. She added that the county intends to make additional modifications to the toolkit to make it more accessible for various populations.
"We might provide a more simplified version in the future that is more streamlined," she said.
While the guide was born out of concerns about pandemic flu, its creators say it is applicable for caregiving during regular flu season as well.
Burroughs said the toolkit has been generally well received.
"It's a useful tool for other localities and hopefully other populations," she said.
View tools and reviewers' comments for the "Stay at Home Toolkit for Influenza" practice