Transcript Community Hospital Stroke Program

COMMUNITY HOSPITAL
MERS EXPOSURE
OCTOBER 10, 2014
PRESENTERS
• Marlene Madrigal RN, BSN
Infection Prevention Coordinator
• Gary McKay, MPM, CEM, CHEC
Manager of Emergency Preparedness, Safety, &
Bioterrorism Prevention
COMMUNITY HEALTHCARE
SYSTEM
Community Healthcare
System
Community Hospital -445 bed hospital in Munster, IN
(Chicago Suburb)
St. Mary Medical Center – 190 bed hospital in Hobart, IN
St. Catherine Hospital- 180 bed hospital in East Chicago, IN
COMMUNITY HOSPITAL
• ER volumes exceed 65,000 visits per year
• More admissions than any single hospital in Lake
County, Indiana
• Critical Care Transport
CommunityCommunity
Hospital
Hospital
Healthgrades®
America’s 50 Best Hospital
7 years in a row
• Only Hospital in Indiana to be named one of
America’s 50 Best Hospitals seven years in a row.
• Top 1% in the Nation for Overall Quality
HEALTHGRADES®
2014 DISTINGUISHED HOSPITAL
AWARD FOR CLINICAL EXCELLENCE
11 Years in a row 2004-2014
BACKGROUND
• Middle East Respiratory Syndrome
(MERS) is a viral respiratory illness
coronavirus
• MERS is caused by a coronavirus called
Middle East Respiratory Syndrome
coronavirus (MERS-CoV)
• First identified in a patient from the
Saudi Arabia in June 2012
• As of July 23, 2014, a total of 836
laboratory-confirmed cases, including
288 deaths of MERS-CoV infection have
been reported by the World Health
Organization
• All cases have resided in or had recent
travel to the Arabian Peninsula
CASE SCENARIO
• The patient developed a low-grade fever on April 14
while in Saudi Arabia
• The patient traveled from Saudi Arabia via London to
Chicago by air, arrived at O’Hare Airport on April 24 and
traveled by bus to Indiana
• April 27th, patient experienced a high fever, cough, and
shortness of breath
• The case patient sought medical care at the
emergency department at Community Hospital in
Munster, Indiana on April 28, was admitted as an
inpatient
VIRUS IDENTIFICATION AND
ANNOUNCEMENT
• Community Hospital recognized the possibility of the MERS -CoV infection
• Instituted isolation protocols to contain the possible spread of the virus
• Specimens received at the Indiana State Department of Health (ISDH)
Laboratory tested positive for MERS-CoV during preliminary testing
• May 1 and were confirmed positive at The Centers for Disease Control
and Prevention (CDC) on May 2
• On May 2, 2014, the CDC and the ISDH conducted a joint press briefing to
announce the first confirmed case of MERS -CoV in the United States
• Community Hospital worked cooperatively with the CDC and ISDH
• Implementation of tracking system for staff for family and patients of
patient family members
• Monitoring of exposed health care workers (HCW)
THE SITUATION UNFOLDS
• April 28, 2014
• Patient presented To
ED
• differential diagnosis of
pneumonia
• Direct admission to
private ED room
• Patient Admitted to
Hospital (private
room)
• April 29, 2014
• Infectious disease
consult ordered
• Patient in Airborne &
Contact Precautions
for R/O MERS-CoV per
Infectious Disease MD
due to recent travel
from Riyadh, Saudi
Arabia
• Testing continues
ROLE OF THE ID COORDINATOR
• ISDH notification
• specimen going out to ISDH for R/O MERS-CoV
• Middle East Respiratory Syndrome (MERS) Patient Under
Investigation (PUI) Short Form completed
• Coordination and Liaison with External Entities
• ISDH
• CDC
• Obtained and communication of additional patient
information requested by the CDC
• Liaison with CDC and HCW
• Quarantine Department of Illinois
ROLE OF ID COORDINATOR
• Above all – Maintain patient, visitor and staff safety
• Coordinate with multiple internal hospital
departments
• Administration
• Safety Officer
• Department Heads
• Additional collection of specimens (oral/pharyngeal, serum,
stool requested per the CDC sent to state lab
• Medical Director of ID
• Marketing
• Employee Health
SITUATION CONTINUED
April 30, 2014
• Infectious Disease
(ID)consult completed
• ID physician assesses patient
• Additional testing
• Additional precautions
• Patient placed in negative
pressure isolation room
• ID Nurse
• Notified CDC & state of
potential MERS-Cov patient
• Life as you know it will change
May 1, 2014
• Positive diagnosis for MERSCoV by ISDH
• Daily conference calls
begin with CDC and ISDH
• Hospital Incident Command
center activated
• Incident Action Plan
developed
Incident Action Plan and Role of Incident
Commander
• Maintain hospital operations
• Develop Incident Action Plan
• Maintain safety of patients, staff, and visitors
• Maintain hospital security
• Continually educate staff, visitors, patients, and
community
• Work to communicate with media
SITUATION CONTINUED
May 2, 2014
May 3, 2014
• Positive Diagnosis form CDC
of MERS- CoV
• 53 healthcare workers with
direct exposure were taken
out of service, tested, and
sent home for 14 day
isolation period
• ISDH representatives arrive
at hospital for assistance
• Conference calls continue
• Incident Command Team
meetings begin twice per
day
• Team from CDC arrives at
Community Hospital
• Hot line for information
established for community
concerns
• Home quarantined
employees start reporting in
to hospital
• Conference calls continue
• Hospital assists in gathering
data from patient of travel
and contacts
• Incident Command Team
meetings continue
SITUATION CONTINUED
May 4, 2014
May 5, 2014
• Testing complete on
employees
• Internal meeting of
hospital departmental
managers
• Conference calls
continue
• CDC begins interviews
with exposed employees
and family members
• Incident Command Team
meetings continue
• Indiana Governor & ISDH
Director arrive at
Community Hospital
• Nationally televised press
conference at hospital
• Conference calls
continue
• Incident Command Team
meetings continue
SITUATION CONTINUED
May 6, 2014
May 7, 2014
• Incident Command
Team meetings
continue
• Conference calls
continue
• Employee status call- in
continues
• Incident Command
Team meetings
continue
• Conference calls
continue
• Employee status call-in
continues
• CDC prepares to leave
hospital and has final
meeting with staff
SITUATION CONTINUED
May 8, 2014
May 9, 2014
• Incident Command
Team meetings
continue
• Conference calls
continue
• Employee status call- in
continues
• Incident Command
Team meetings
continue
• Conference calls
continue
• Employee status call- in
continues
• Patient discharged
from hospital
SITUATION CONTINUED
May 10, 2014
May 11, 2014
• Conference calls
continue
• Employee status call- in
continues
• Hospital Command
Center deactivated
• Conference calls
continue
• Employee status call- in
continues
• Employees tested at
end of isolation period
SITUATION CONTINUED
May 12, 2014
May 13, 2014
• Conference calls
continue
• Employee status call- in
continues
• Conference calls
continue
• All employees cleared
to return to work
SITUATION CONTINUED
May 14, 2014
• After Action meeting
complete
• Hospital under normal
operations
AGENCY COLLABORATION
Collaboration
•
•
•
•
•
•
Community Hospital
CDC
ISDH
Illinois Department of Health
Chicago City Health Department
Lake County (Indiana) Health
Department
Significance
• Worked together investigating this
confirmed case of Middle Eastern
respiratory syndrome coronavirus (MERSCoV)
• This was the first confirmed case of
MERS-CoV in the Western Hemisphere
SURVEILLANCE SITE FOR CDC
• There was limited data regarding MERS
• Lack of cooperation from foreign countries
• Community Hospital became a data surveillance
site for the CDC
• First confirmed case in the United States
• Data surveillance and collect on transmission was
invaluable
PATIENT AND STAFF SAFETY
COMMUNITY EXPOSURE AND
TRANSMISSION
• Patient was not out in the local community and,
therefore, any public exposure was minimal
• MERS- CoV Transmission
• Disease requires close contact for transmission,
• However, in an abundance of caution, the exposed family
members and health care workers were monitored daily
throughout the 14 day incubation period to watch for the
development of any signs or symptoms of MERS
HOSPITAL CONSIDERATIONS
• Important to be able to understand the staff workflow
and presence during the initial phase
• Type of contact and caregiver
• Identify all staff members at risk
• Manage community information and mitigate fears
• One false move could impact not only our facility but also
panic the community
• Develop a plan for staff, physician and Board of
Directors communication and briefing
• Community Hospital had 1-hour notice prior to national
announcement from the CDC confirming MERS-Cov
• The hospital had already identified who was at risk and was
able to get them tested, out of duty and isolated
STAFF IDENTIFICATION
• Fifty-three potential HCW contacts were identified as being exposed
to MERS-CoV
• Self-identification
• Video camera surveillance
• GPS Tracer Tag Log – Rauland Responder Integration
• Medical record
• All HCW that were exposed to the patient before isolation were:
• Removed from duty – placed on paid leave
• Active surveillance for 14 days
• MERS- CoV testing
• At time placed on leave
• With any symptoms
• Re-test at the end of the incubation period
TECHNOLOGY
• Rauland Responder 5 Integration
• Unit Activity Report
• Detailed information assisted Community Hospital in quickly and
confidentially identifying staff members who were exposed to
the MERS- CoV patient
• Data collected concerning time staff exposure
• Assisted the hospital to identify each and every time a staff
member entered and exited the patient room,
• How long each staff member spent in the room
• GPS Tracer Tag Log
• Real-time access and visibility allows the hospital to locate staff quickly
and easily
• Integration with Rauland providing staff specific information
EPIDEMIOLOGY STUDIES
• CDC Data Collection
• The data from Responder 5 Reports Manager provided
unprecedented ability to study how much exposure to an
infected individual it takes before the virus can be
transmitted
• Lack of comparative data
• Because MERS has not existed in the US this was the first
data the CDC had
• High level of detail including exposed time
ENTITIES UTILIZING
DATA COLLECTED
• Epidemic Intelligence Service
• National Center for Immunization and Respiratory Diseases,
Division of Viral Diseases
• National Center for Enteric and Zoonotic Diseases, Division of
Global Migration and Quarantine
• National Center for Enteric and Zoonotic Diseases, Division of
Healthcare Quality and Promotion
• National Center for Immunization and Respiratory Diseases,
Meningitis and Vaccine Preventable Diseases Branch
• Indiana State Health Department
• Cook County Department of Public Health
• Community Hospital
• Massachusetts State Health Department
• National Transport Agencies
DATA RESULTS
• Forty-eight (94%) of 51individuals
exposed were Health Care
Providers (HCP)
• Most of the exposed HCP
exposures occurred in the ED
(69.1%)
• Nine HCP developed respiratory
symptoms during the 14 day postexposure period
• RNs (47%) were the type of
healthcare personnel most
commonly exposed
• All upper respiratory tract
specimens and sera tested
negative
• Thirty-three (68.8%) had direct
patient care
• Most healthcare personnel
contacts
• (n=26, 57.8%) were exposed to the casepatient once, and
• 18 were exposed more than 2 times, of
which four were exposed ≥10 times
• Six (12.5%) were respiratory
therapists who were potentially
exposed to the respiratory
droplets or secretions
TIME STUDIES
Frequency and duration of
reported HCP interactions
with the patient were
compared to GPS Tracer Tag
Log
• Staff reported total frequency and
duration of exposure ranged from
1—12 visits and 2 minutes—1 hour
respectively
• The median total self-reported time
exposed to the case-patient was
11 minutes, 30 seconds
• Studies revealed an inconsistent
pattern, with some staff over - and
others under -estimating their
interactions with the case-patient
SUCCESS
• On May 2, 2014, the first U.S. case of MERS was
confirmed in a traveler from Saudi Arabia to the U.S.
• The traveler was considered to be fully recovered and
released from the hospital in stable condition
• Public health officials contacted and followed
healthcare workers, family members, and travelers who
had close contact with the patient for 14 days
• None of the contacts had evidence of being infected
with MERS-CoV all testing was negative
•
The CDC and other public health partners continue to investigate and
respond to the changing situation to prevent the spread of MERS-CoV in
the U.S.
•
The cases of MERS imported to the U.S. represent a very low risk to the
general public in this country
•
The CDC recognizes the potential for MERS-CoV to spread further and
cause more cases globally and in the U.S
•
The CDC continues to closely monitor the MERS situation globally and
work with partners to better understand
• The risks of this virus
• How the virus spreads
• Prevention of infections and human to human transmission
LESSONS LEARNED
WHAT WORKED WELL
• Collaboration and
teamwork
• Disaster Training –active
command center
• Vendor support
• Senior Administration
Visibility and Support
Internal and external
communication
• Hotline set up and
functioning within hours of
announcement
• Daily briefings
Staff
• Lab and employee health
cooperation with CDC &
State
• Lab & emergency staff
cooperation
• Informational documents
supplied by hospital to staff
• CDC call back process
defined with exposed
employees
• 14 day furlough for all
employees that had
contact with the patient
LESSONS LEARNED
OPPORTUNITIES
Hospital Security & Safety
• We couldn’t have
expected the press with
no time to prepare
• Identifiable jackets
• Parking lot patrols
• Parking garage
controlled
• All visitors to hospital
required to sign in
• Lockdown or partial
lockdown to be
considered
Communication
• CDC lacked direct
guidance because of the
unknowns
• Fragmented
communication at times
working with multiple
agencies with different
agendas
Patient Screening Process
• Intake information
changed adding MERSCoV screening questions
PUBLIC – MEDIA
• “At this point, it appears that MERS picked the
wrong hospital, the wrong state and the wrong
country to try to get a foothold," Indiana Health
Commissioner William VanNess
• How an Indiana hospital got it right when MERS
showed up at the door – Washington Post
MERS INCIDENT TEAM