Infection control experience among Chicago area hospitals participating in a second biological disaster drill, May 2004

Abstract

INTRODUCTION: In May 2004, Chicago area hospitals participated in a second biological disaster drill (the first was TOPOFF2). The second experience provided more lessons for improvement. METHODS: The drill was developed and conducted by the Metropolitan Chicago Healthcare Council (MCHC). It took place over 4 pre-announced days (May 11, 12, 15, 22); each hospital was assigned one day. Participation was voluntary. The MCHC infection control subcommittee developed four biological drill scenarios. The organisms were not pre-announced; a different organism was used for each day. Personnel from the local naval training center acted as patients. Two days after the drill, MCHC held a summary conference, revealed the agents (Salmonella, meningococcal disease, tularemia, hantavirus), and requested feedback. The subcommittee also sent a questionnaire to infection control professionals about their experiences. RESULTS: The drill involved 43 hospitals, four public health departments, and 500 naval personnel. In comparison to TOPOFF2, this drill was better organized and better implemented and involved a smaller number of hospitals. It was more realistic because hospitals and health departments did not know the biologic agent and two of the drill dates fell on Saturdays. Due to the different scenarios, sharing experiences was not helpful and often caused confusion. The victims were easily identified because of their naval attire; most presented en masse to the emergency departments. Live patients were preferred over paper ones. The drill tested newly implemented SARS and influenza precautions; appropriate procedures were not always followed. Since the drill only lasted a few hours, daily routines were not seriously disrupted, but some healthcare workers and departments missed the opportunity to participate. Some public health departments did not cooperate fully. The summary conference was held immediately after the drill when memories of the experience were fresh and accurate. RECOMMENDATIONS: 1) Conduct more than one biological drill. 2) Do not pre-announce the etiologic agent or drill date, even to health departments. 3) Arrange for "victims" to present anonymously, individually or in small groups. 4) In addition to the emergency department, involve other key areas (inpatient units, clinics, etc.). 5) Test hospital systems (surge capacity, supplies, medications, etc.). 6) Train coordinators to conduct realistic drills and to sustain drills. 7) Conduct summary conference immediately after the drill ends.