Advertisement

Hospital influenza pandemic stockpiling needs: A computer simulation

Published:December 02, 2016DOI:https://doi.org/10.1016/j.ajic.2016.10.019

      Highlights

      • Current influenza pandemic modeling is insufficient for informed decision making.
      • Monte Carlo simulation supports hospital influenza preparedness decisions.
      • Stockpiling needs for specified levels of preparedness can be ascertained.
      • Stockpiling improves capabilities to provide patient care during influenza pandemic

      Background

      A severe influenza pandemic could overwhelm hospitals but planning guidance that accounts for the dynamic interrelationships between planning elements is lacking. We developed a methodology to calculate pandemic supply needs based on operational considerations in hospitals and then tested the methodology at Mayo Clinic in Rochester, MN.

      Methods

      We upgraded a previously designed computer modeling tool and input carefully researched resource data from the hospital to run 10,000 Monte Carlo simulations using various combinations of variables to determine resource needs across a spectrum of scenarios.

      Results

      Of 10,000 iterations, 1,315 fell within the parameters defined by our simulation design and logical constraints. From these valid iterations, we projected supply requirements by percentile for key supplies, pharmaceuticals, and personal protective equipment requirements needed in a severe pandemic.

      Discussion

      We projected supplies needs for a range of scenarios that use up to 100% of Mayo Clinic–Rochester's surge capacity of beds and ventilators. The results indicate that there are diminishing patient care benefits for stockpiling on the high side of the range, but that having some stockpile of critical resources, even if it is relatively modest, is most important.

      Conclusions

      We were able to display the probabilities of needing various supply levels across a spectrum of scenarios. The tool could be used to model many other hospital preparedness issues, but validation in other settings is needed.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Taubenberger J.
        • Morens D.
        1918 influenza: the mother of all pandemics.
        Emerg Infect Dis. 2006; 12: 15-21
      1. HHS pandemic planning assumptions.
        (U.S. Department of health and Human Services; Available from) (Accessed November 17, 2016)
        • Abramavich M.
        • Toner E.
        • Matheny J.
        Panalysis: a new spreadsheet-based tool for pandemic planning.
        Biosecur Bioterror. 2009; 6: 78-92
        • Toner E.
        • Waldhorn R.
        What hospitals should do to prepare for an influenza pandemic.
        Biosecur Bioterror. 2006; 4: 397-402
      2. FluSurge 2.0.
        (Centers for Disease Control and Prevention website; Available from) (Accessed April 14, 2016)
        • Eichner M.
        • Schwehm M.
        • Duerr H.P.
        • Brockmann S.O.
        The influenza pandemic preparedness planning tool InfluSim.
        BMC Infect Dis. 2007; 7: 17
        • Radonovich L.J.
        • Magalian P.D.
        • Hollingsworth M.K.
        • Baracco G.
        Stockpiling supplies for the next influenza pandemic.
        Emerg Infect Dis. 2009; 15: e1https://doi.org/10.3201/eid1506.081196
        • Baracco G.
        • Eisert S.
        • Eagan A.
        • Radonovich L.
        Comparative cost of stockpiling various types of respiratory protective devises to protect the healthcare workforces during an influenza pandemic.
        Disaster Med Public Health Prep. 2015; 9: 313-318
        • Li Y.
        • Hsu E.B.
        • Links J.M.
        Healthcare system cost evaluation of antiviral stockpiling for pandemic influenza preparedness.
        Biosecur Bioterror. 2010; 8
        • Newall A.T.
        • Wood J.G.
        • Oudin N.
        • MacIntyre C.R.
        Cost-effectiveness of pharmaceutical-based pandemic influenza mitigation strategies.
        Emerg Infect Dis. 2010; 16: 224-230
        • Lugnér A.K.
        • Postma M.J.
        Investment decisions in influenza pandemic contingency planning: cost-effectiveness of stockpiling antiviral drugs.
        Eur J Public Health. 2009; 19: 516-520
        • Siddiqui M.R.
        • Edmunds W.J.
        Cost-effectiveness of antiviral stockpiling and near-patient testing for potential influenza pandemic.
        Emerg Infect Dis. 2008; 14: 267-274
        • Balicer R.D.
        • Huerta M.
        • Davidovitch N.
        • Grotto I.
        Cost-benefit of stockpiling drugs for influenza pandemic.
        Emerg Infect Dis. 2005; 11: 1280-1282
        • Meltzer M.
        • Patel A.
        • Ajao A.
        • Nystrom S.
        • Koonin L.
        Estimates of the demand for mechanical ventilation in the United States during an influenza pandemic.
        Clin Infect Dis. 2015; 60 (s52-7)
        • Carias C.
        • Rainisch G.
        • Shankar M.
        • Adhikari B.
        • Swerdlow D.L.
        • Bower W.A.
        • et al.
        Potential demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States.
        Clin Infect Dis. 2015; 60: s42-50
        • O'Hagan J.
        • Wong K.
        • Campbell A.
        • Patel A.
        • Swerdlow D.L.
        • Fry A.M.
        • et al.
        Estimating the United states demand for influenza antivirals and the effect on severe influenza disease during a potential pandemic.
        Clin Infect Dis. 2015; 60: s30-40
      3. Reports on public health and medical subjects no. 4: report on the pandemic of influenza 1918-1919. His Majesty's Stationary Office, London1920
        • Schull M.
        • Stukel T.
        • Vermeulen M.
        • Zwarenstein M.
        • Alter D.A.
        • Manuel D.G.
        • et al.
        Effect of widespread restrictions on the use of hospital services during an outbreak of severe acute respiratory syndrome.
        CMAJ. 2007; 176: 1827-1832
        • Public Health Agency of Canada
        Clinical and public health systems issues arising from the outbreak of SARS in Toronto.
        (Available from) (Accessed September 6, 2016)
        • Meltzer M.I.
        • Shoemaker H.
        • Kownaski M.
        FluAid 2.0: a manual to aid state and local level public health officials plan, prepare, and practice for the next influenza pandemic.
        Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2000
        • Zhang X.
        • Meltzer M.I.
        • Wortley P.
        FluSurge 2.0: a manual to assist state and local public health officials and hospital administrators in estimating the impact of an influenza pandemic on hospital surge capacity (Beta test version).
        Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2005
        • Zhang X.
        • Meltzer M.I.
        • Bridges C.B.
        FluWorkLoss 1.0: a manual to assist state and local public health officials in estimating the impact of an influenza pandemic on work day loss (Beta test version).
        Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2005
        • Maciejewski R.
        • Livengood P.
        • Rudolph S.
        • Collins T.F.
        • Ebert D.S.
        • Brigantic R.T.
        • et al.
        A pandemic influenza modeling and visualization tool.
        J Vis Lang Comput. 2011; 22: 268-278
        • Rudge J.
        • Hanvoravongchai P.
        • Krumkamp R.
        • Chavez I.
        • Adisasmito W.
        • Chau P.N.
        • et al.
        Health system resource gaps and associated mortality from pandemic influenza across six Asian territories.
        PLoS ONE. 2012; 7: e13800