title: Chapter 8. Medical procedures. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.
abstract: 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.
authors.affiliation: Critical Care Division, Department of Medicine, The Methodist Hospital, Houston, TX, USA.
authors.forename: Janice L
authors.initials: JL
authors.lastname: Zimmerman
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
mesh_terms: 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