Salinas Sees Successes to Build On

As winter shrinks in the rearview mirror, another season also begins to recede from most people’s memory: flu season. But more than a few people within University of Iowa Health Care continue to examine how the institution responded to one of the most severe flu seasons in years. Jorge L. Salinas, MD, Hospital Epidemiologist and Clinical Assistant Professor in Infectious Diseases, is a leader in that post-season review.

One of the most significant challenges in any flu season, Dr. Salinas says, is balancing the wave of new patients against the already-high census of complex cases. “University of Iowa Hospitals and Clinics is a busy place. We treat the sickest patients in this part of the country,” he says. Caring for someone with, say, advanced heart failure becomes even more of a complicated project if they also contract the flu. Protecting them from infection becomes just as important as whatever brought them to the hospital.

Though the response teams at University of Iowa Hospitals and Clinics could not have anticipated every twist this last flu season produced—including a hurricane in Puerto Rico that led to a depleted national saline supply—they had received notice that the vaccine was likely to be less effective against the coming strains. Once they learned that news, “we activated our Bioemergency Response Team,” he says. A former member of the Centers for Disease Control and Prevention Epidemic Intelligence Service, Dr. Salinas knew how to design and implement an effective series of protocols in order to be ready.

One protocol, post-exposure prophylaxis, Dr. Salinas says, “is still controversial,” but may have prevented an increase in absenteeism among the hospital’s staff. “We gave oseltamivir [Tamiflu] to people that had been in contact with influenza, irrespective of their vaccination status.” After exposure, the drug must be taken within 48 hours to be effective, but the health care worker does not always know right away that they have been exposed. To speed up the delivery of this antiviral medication once discovered and to reduce the burden on the University Employee Health Clinic, Dr. Salinas says hospital pharmacists took on the service. “They provided the medicine very rapidly. That was a good thing.” Pharmacists provided this service around the clock.

While his team continues to sort through the data from this last season, Dr. Salinas says they have already identified some areas they intend to bolster next season. Communication, both internally and to the public, will receive additional attention. This last winter, his team worked with Marketing and Communications to increase public awareness of alternatives, like UIeCare and telemedicine, to QuickCare clinics and the Emergency Department. Treating people in their homes decreases the clinics’ burden and reduces transmission points. “I think we did a robust campaign,” Dr. Salinas says, “but we can always improve.”

As the hospital’s epidemiologist, Dr. Salinas remains responsible for more than just monitoring the institution’s ability to manage influenza. While they wait to see what next winter will bring, he and his team are developing better surveillance tools for monitoring a variety of healthcare associated infections (HAIs). By paying attention to and cataloging all the details that can affect whether an HAI can occur—optimizing hand hygiene, compliance with central line and catheter insertion bundles, or the frequency and quality of chlorhexidine bathing—Dr. Salinas knows that infection rates can be controlled. As the team gets better at managing other types of infections, they will only be more prepared by the time the next winter rolls around.

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