Self-Isolation: The Family Home Option

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The University of Illinois describes its H1N1 response as successful, largely due to its comprehensive approach to identifying and isolating ill students. Often, ill students recovered under the watchful eyes of their parents.

"We thought that isolating would be very helpful," said Robert Palinkas, MD, Director of McKinley Health Center on campus. "We wanted to avoid having patients just going back to a residence hall room and try to follow our advice without having some other way of making that work."

Sending students home made sense for a number of reasons, he noted, including that:

    • Isolating in the residence hall could prompt concerns from parents and roommates, could increase the spread of H1N1 on campus and raised the possibility of poorer compliance with isolation guidelines.

 

    • Sending students home reduced their risk of exposing high-risk individuals on campus, reduced parents' concerns and placed students in the hands of excellent caregivers.




To expand support for isolating sick students, Illinois conducted a communications campaign that included explaining the self-isolation plan to parents and faculty. To prevent spreading illness at the clinic, staff at McKinley Health Center re-organized the site to allow for a separate triage and treatment area for students who arrived with a cough or other influenza like illness (ILI) signs and symptoms.

"We identified coughing individuals when they entered the building," Palinkas said. "We took tremendous pains to actually find anyone who was coughing and directed them to a special clinic we had set up, called the ILI clinic. The staff in that clinic were volunteers."

As students filed into the ILI clinic, they were given a form to review and sign if they chose. The one-page form provided contact information, housing information and patient authorization to share health information relevant to their ILI. This primed the student for sharing information if the clinician thought they required isolation and provided clinicians with clear information to help them identify infection control issues (such as whether the student lived in a dormitory or a fraternity/sorority).

The vast majority of students signed the demographic/permission form before seeing a clinician, allowing health services staff to, "talk to anyone we needed to make isolation work," Palinkas said.

Clinicians in the ILI clinic were to make the diagnosis and decisions about isolation and treatment, he said. Clinicians also had to give students a good estimate of the length of their isolation.

"We recommended that some students go home and spend time with their parents. For most of our patients, going home was an option," he added.

Reaching out to parents, a step that could be problematic in other aspects of college-student health, was easy in this case, he noted. "Because we had a written consent, we asked students if they wanted us to talk to their parents. We were very comfortable about telling mom or dad that they needed to pick up their child."

While still in the ILI clinic, "They (students) would just pull out their cell phones and we would talk to mom, and mom would come get them," Palinkas said. Most UI students live within a three-hour drive of campus.

The university also had limited isolation housing available for students who could not recover away from campus.

The release form allowed health services staff to speak with other units, such as food services, to arrange for meals, or professors, to discuss a student's need to miss class due to illness.

If students could go home, they generally did, Palinkas said, adding that about 90% of the estimated 2,000 students diagnosed with ILI went home.

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