Better safe than sorry

Experts are saying a bird flu pandemic is not a matter of if, but when. If we do have a pandemic, the proportions of this disaster will likely result in the death of a large number of persons of all ages that reside in nursing facilities, both long-term care and acute care. Exacerbating the risk, there is a real problem today with the sterile and clean techniques practiced in medical facilities, as evidenced by lengthened hospital stays, return admissions, and increased home health visits resulting from infections caused by these sloppy practices. Is there a problem with the quality of these techniques performed in your long-term care facility?

Please don’t wait for the government to take care of the planning for this, and absolutely do not think that the government will be able to manage the situation when it occurs. That is totally unrealistic. We are all responsible for our own health and welfare and for the residents in our care.

Policies and procedures of what to do at every level of resident need should be planned, written, and ready to be implemented at a moment’s notice as soon as the bird flu virus mutates—hopefully, before it reaches the United States. Such planning must anticipate the “worst case scenario”—i.e., the people who deliver products and services to your facility may themselves become ill and unable to perform their duties.

Consider such issues as:

  • Determining adequate protection against spreading and contracting the virus.

  • Retaining adequate staff to care for even the basic care needs to sustain life, such as providing medicines; food and fluids; oxygen (and respirators); bathing and toileting; wound dressing changes; suctioning of patients’ airways; changing linens and incontinence pads, etc.

  • Delivery of medications and food to the facility.

  • Death and dying issues, e.g., when to and when not to resuscitate.

  • What to do with bodies after death according to time of year (accounting for outside temperatures). Deaths may not involve only residents, but staff members, as well.

  • What to do if heat or air-conditioning is interrupted.

  • Other key maintenance issues, such as plumbing.

  • Disposal of blood and body fluids.

Ask yourself, what staff can you count on to stay at the facility and not be at home with their families during quarantine? Will staff be safe to go back and forth from home to the facility, and under what conditions will this be so if the flu breaks out in the facility and not in the community, or vice versa?

Quarantines resulting from a pandemic could mean that those residents you would historically transport to a hospital for acute care needs will have to remain in your nursing home. How will you care for them?

Consider stocking a predetermined, amount of supplies for your patient population, such as masks, nonperishable food and fluids, and first-aid and laundry supplies. Also, if staff members are required to remain at the facility during quarantine, their personal needs will have to be considered, too. Another crucial question: What responsibility will family members have to take their loved ones home during this crisis? What about those residents who have no one who can do this? Remember, finally, that the plans you make for this crisis can be adapted to address other potential threats, such as terrorist attacks, earthquakes, or extreme weather. Of course, I don’t anticipate that we can ever be totally ready for a catastrophic event of this magnitude. But the best we can do is to prepare, beginning withasking ourselves the key questions.

Karen L. Bonn, RN, COF, ROF, is Founder and President of Restorative Medical, Inc., Brandenburg, Kentucky

She is Chairman of the Board of the National Association for the Enhancement of Patient Care (NAEPC) and President of Mission Restore, an organization that teaches continuing education courses designed to improve quality of life. For further information, phone (800) 793-5544 or visit To send your comments on this editorial to the author and editors, e-mail

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