title: Initial response of health care institutions to emergence of H1N1 influenza: experiences, obstacles, and perceived future needs.
abstract: BACKGROUND
  The emergence of H1N1 influenza is cause for great concern. Although one of the most important components of the response to the H1N1 crisis is the work of health care epidemiology professionals, the beliefs and experiences of this community are unknown, and the optimal approach to managing H1N1 in the future has not been delineated.
  
  
  METHODS
  To assess attitudes and responses of health care epidemiology professionals to the H1N1 influenza crisis, we conducted a cross-sectional survey of members of the Society for Healthcare Epidemiology of America. We assessed beliefs regarding (1) importance of H1N1, (2) institutional preparedness, (3) time spent on the H1N1 crisis, and (4) the institution's response to H1N1.
  
  
  RESULTS
  Of 323 respondents, 195 (60.4%) reported that their hospitals were well prepared for a pandemic. Furthermore, the majority reported that senior administrators provided adequate political support and resources (85.1% and 80.2%, respectively) to respond to H1N1. However, 163 (50.9%) respondents reported that other important infection prevention activities were neglected during the H1N1 crisis. Shortages of antiviral medication were reported by 99 (30.7%) respondents. Furthermore, 126 (39.0%) reported that personal stockpiling of antiviral medications occurred at their institution, and 166 (51.4%) reported that institutional actions were initiated to prevent personal stockpiling. Also, 294 (91.0%) respondents believed that H1N1 influenza would reappear later this year. Vaccine development, health care worker education, and revisions of pandemic influenza plans were identified as the most important future initiatives. Finally, 251 (77.7%) respondents felt that health care workers should be mandated to receive influenza vaccine.
  
  
  CONCLUSIONS
  Although generally institutions are well prepared for the H1N1 crisis, substantial revisions of pandemic preparedness plans appear to be necessary. Future efforts to optimize the response to H1N1 should include curtailing personal stockpiling of antivirals and vaccine development with consideration of mandatory vaccination of health care workers.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA. ebbing@mail.med.upenn.edu
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
authors.forename: David K
authors.initials: DK
authors.lastname: Henderson
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000523:psychology / Q000821:virology; D003430:Cross-Sectional Studies; D004189:Disaster Planning / Q000379:methods*; D004196:Disease Outbreaks; D005260:Female; D006268:Health Facilities; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000523:psychology / Q000821:virology; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires