Chapter 8. Medical procedures. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.
OBJECTIVE
To provide recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza pandemic or mass disaster with a specific focus on ensuring that adequate resources are available and appropriate protocols are developed to safely perform procedures in patients with and without influenza illness.


METHODS
Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including performing medical procedures.


RESULTS
Key recommendations include: (1) specify high-risk procedures (aerosol generating-procedures); (2) determine if certain procedures will not be performed during a pandemic; (3) develop protocols for safe performance of high-risk procedures that include appropriateness, qualifications of personnel, site, personal protection equipment, safe technique and equipment needs; (4) ensure adequate training of personnel in high-risk procedures; (5) procedures should be performed at the bedside whenever possible; (6) ensure safe respiratory therapy practices to avoid aerosols; (7) provide safe respiratory equipment; and (8) determine criteria for cancelling and/or altering elective procedures.


CONCLUSIONS
Judicious planning and adoption of protocols for safe performance of medical procedures are necessary to optimize outcomes during a pandemic.
Zimmerman
Janice L
JL
Critical Care Division, Department of Medicine, The Methodist Hospital, Houston, TX, USA.
Sprung
Charles L
CL
D003422:Critical Care / Q000379:methods / Q000592:standards*; D004189:Disaster Planning / Q000379:methods / Q000458:organization & administration*; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D004865:Equipment and Supplies, Hospital / Q000592:standards; D006739:Hospital Administration; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology* / Q000628:therapy*; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D054527:Mass Casualty Incidents; D010564:Personnel, Hospital / Q000193:education; D017751:Safety Management / Q000379:methods / Q000592:standards