Transcript pandemic

Hospital preparedness for pandemic
Objectives
 Pandemic definition
 Historical, Current & possible future pandemics
 The impacts of pandemics on communities & health
care systems
 Planning Assumptions and Considerations in
pandemics
 Hospital preparedness & planning elements in
pandemic situations
Pandemic definition
 A pandemic is an epidemic of infectious disease that
has spread through human populations across a large
region; for instance multiple continents, or even
worldwide.
Historical pandemics
Historically pandemics have killed millions and
destroyed entire societies:
 The Black Plague in Europe in the Middle Ages
killed as much as 50% of the entire population, and
wiped out entire communities.
 The 1918 Influenza Pandemic killed more than 20
million people worldwide in less than a year, some
now estimate that it was 100 million.
Cholera
Seventh pandemic 1962–66.
Began in Indonesia, called El
Tor after the strain, and
reached Bangladesh in 1963,
India in 1964, and the USSR
in 1966
Influenza
The "Hong Kong Flu", 1968–69. An
H3N2 caused about 34,000 deaths in the
United States. from Hong Kong in early
1968 and spread to the United States
later that year. This pandemic of 1968
and 1969 killed approximately one
million people worldwide
Current pandemics
 2009 H1N1 pandemics.
 AIDS, is currently a pandemic, with infection rates as
high as 25% in southern and eastern Africa.
 AIDS could kill 31 million people in India and 18 million
in China by 2025, according to projections by U.N.
population researchers. AIDS death toll in Africa may
reach 90–100 million by 2025.
Concern about possible future
pandemics
 Viral hemorrhagic fevers
 SARS
 Influenza
 H5N1 (Avian Flu)
What Have We Learned from Past
Pandemics? (1)
 Pandemics can vary in severity.
 Hospitals and clinics will become
completely overloaded, and most
people will have to be treated at home.
 Services may be interrupted when many people are
sick
What Have We Learned from Past Pandemics? (2)
 Outside help will probably not come because many
people will be sick everywhere allover the world.
 Some families may need community help if everyone
in the family is sick.
What Will Life Be Like in a Severe Pandemic?
A. Shortages of Essential Goods
 Shortages of essential goods may occur—including
food, water, fuel, medicines, and many more.
 Lost work days (absenteeism) will result in decreased
production, reduced international and national
transports, and missed deliveries to local areas.
 The supply chain will be very vulnerable.
 Available goods may be subject to personal
consumption, looting, and hoarding.
B. Disruption in Routine Services
 Schools, government offices, the post office and some
workplaces may need to close during the pandemic
may be closed.
 Electricity, telephone service, the Internet, and
commercial radio and TV broadcasts could also be
interrupted if the electric power grid falters or fails.
 Local automated teller machines and banks may be
shut down
C. Changes in Public Transportation
and Other Municipal and Private Services
 Buses, taxis, and other
transportation services may
be stopped or limited.
 Gasoline supplies may be
limited or unavailable.
 Trash removal, road repair
and other services may be
limited.
 Utility service and repairs
may be delayed.
D. Restrictions of Personal Movement
 Isolation and quarantine
may be necessary.
 Restrictions on public
gatherings, such as
funerals, parties, and
other events—may be
necessary.
 Travel may be restricted.
Planning Assumptions and Considerations
in pandemics
It is assumed that during an pandemic:
 Health care systems may be overwhelmed and
laboratories will be unable to keep pace with testing
demands.
 Health care, emergency medical and laboratory staff may
be ill and will subsequently reduce the available
workforce.
Planning Assumptions and Considerations
in pandemics
It is assumed that during an pandemic:
 There may be shortages of equipment and
resources available to keep pace with increased
demand for patient care and testing (also might be
shortages of items such as gloves, ventilators, and
laboratory testing supplies.
 mutual aid resources might be overwhelmed due to
the pandemic situation.
Planning Assumptions and Considerations
in pandemics
It is assumed that during an pandemic:
 Routine laboratory testing be suspended in order to
redirect staff and resources to pandemic specimen
testing.
 Citizens will seek medical care once signs and
symptoms are experienced. It is also assumed that the
media will impact the decisions of citizens to seek
medical care versus staying at home.
Planning Assumptions and Considerations
in pandemics
It is assumed that during an pandemic:
 All levels of government need to a strong public
information program that will provide a level of
confidence to the citizens.
 The local surge plans will be inadequate during a
pandemic situation due to depending on other facilities
or receiving assistance from a common vendor.
Goals
The primary goals of the Pandemic Preparedness and
Response Plan is to enable countries & health care
systems to be prepared:
 To recognize and manage a pandemic.
 To decrease cases, hospitalizations and deaths (To
limit morbidity and mortality) .
 To decrease the spread of disease. Planning may help to
reduce transmission of the pandemic
 To limit its complications during a pandemic
Objectives
 Keep safety of responders, their families, and the
public.
 Keep maintenance of treatment capacity throughout
the state.
 To decrease social disruption and economic loss.
 And totally provide optimal medical care and maintain
essential community services.
 The purpose is to provide basic patient care and
laboratory services to a greater volume during a
pandemic incident.
Hospitals in pandemics
 All hospitals should be equipped and prepared for :
1) a limited number of patients infected with a pandemic
diseases
2) Or a large number of patients in the event of
escalating transmission of pandemic.
General Principles
Even in a disaster situation hospitals have to..
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Ensure continuity of essential services
Manage an extra-load of patients
Organize the response
Protect the facility and its services (staff
&patients) from harm
 Provide specific services for the prehospital phase
Hospital Planning Elements
 Determining criteria for distinguishing pandemics
 Predetermined thresholds for activating pandemic response
plans
 Mechanisms for monitoring employee absenteeism
 Mechanisms for tracking emergency department visits and
hospital admission/discharges for suspected/confirmed pandemic
patients
 Mechanisms for conducting surveillance in emergency departments
 Determine types of data reportable to state and local health
departments
Main Elements
A. Hospital Risk Communications 1
 Communicate effectively with community leaders and
the media to maintain public awareness, avoid social
disruption, and provide information on evolving
pandemic response activities.
 Use guidance from state or local health departments
for external communications.
 Identify key topics for ongoing communications.
A. Hospital Risk Communications 2
 Determine how to keep hospital personnel and
patients informed.
 Determine how public inquiries would be handled.
 Inform health care providers and the public about
disease and the course of the pandemic, the ability to
treat mild illness at home, the availability of vaccine,
and priority groups for earlier vaccination
B. Hospital Education and Training 1
 Identify educational resources for hospital
personnel.
 Develop educational policies and procedures for the
care of pandemic patients.
 Create a distribution plan for educational materials.
B. Hospital Education and Training 2
 Develop plans for training clinical personnel, intake
and triage staff to detect patients.
 Develop a strategy for “just-in-time” training of nonclinical staff.
 Develop educational materials for patients and family
members.
C. Case management
Hospital Triage and Admission Procedures
 Employ a Triage Coordinator to manage patient flow.
 Establish separate triage and waiting areas for
persons with symptoms of disease.
 Establish phone triage (Telephone hotline)
Pre-hospital triage will be needed to relieve
pressure on hospital operations
C. Case management
Hospital Triage and Admission Procedures
 Identify “trigger” points for triage (Triage criteria)
 Develop procedures for clinical evaluation.
 Develop admission procedures (admission criteria)
with streamlining techniques.
 Establish Method to specifically track admission and
discharges of patients
D. Hospital Facility Access
 Define essential and nonessential visitors.
 Identify “triggers” for temporary closing hospital to
new admissions and transfers
 Involve hospital security services to enforce access
controls.
 Establish policies for restricting visitors.
E. Human resources 1
Planning for personnel
I. Remains biggest challenge we face in pandemics
II. Large number of non-clinical personnel also needed
 12% of work force will be absent during the peak
weeks (UK , 2009)
E. Human resources 2
Planning for personnel
 Develop pandemic staffing contingency plans.
Potential sources of clinical surge personnel:
Internal Hospital Strategies
volunteers
Medical Reserve Corps that are not included in
hospital staff
Retired, inactive health professionals
Students (medical, nursing, pharmacy)
Staff list updated regularly
E. Human resources 3
Planning for personnel
 Identify mental health, psychological support
programs and faith-based resources for counseling
personnel.
 Develop a strategy to support healthcare workers’
needs for rest and recuperation.
 Create a strategy for housing and feeding personnel.
E. Human resources 4
Planning for personnel
 Develop a strategy for supporting personnel family
needs.
 Establish policies for managing healthcare workers
with disease symptoms.
 Create a plan to protect personnel at high risk for
complications from exposure.
 Encourage staff to stay at home when ill
E. Human resources 5
Planning for personnel
Pay attention:
 Professional qualifications must be checked and verified
ahead of time
 Volunteers cannot be assigned to take care of patients until
their specific knowledge and skills are understood
 It takes time to do this – volunteers who have not been
pre-registered and pre-credentialed may be delayed in
receiving an assignment
F. Infection prevention and control 1
 Develop a pandemic diseases vaccination plan.
 Develop a strategy for rapidly vaccinating or providing
prophylaxis to personnel.
 Ensure documenting vaccination for personnel.
F. Infection prevention and control 2
 Develop a strategy for prioritizing vaccinations to
critical personnel.
 Design units for case patient care
Short distance to designated wards
Transport to the wards distant from patient main
stream
Logistics Management 1
 Estimation of quantities of essential patient care
needed Materials and equipment (masks, gowns,
gloves etc.)
 Provide estimates of the quantities of vaccine & drugs
needed for hospital staff and patients
 Instructional materials for affected patients and their
relatives
Brochures and posters
Logistics Management 2
 Estimates are shared with the provincial health
authorities and regional hospitals
Stockpiling agreements
 Contingency plan for an increased need for post
mortem care
Involvement of local morticians
Hospital Surge Capacity 1
 Alternate care spaces will need to be identified to
expand hospital capacity
 Estimate minimum number of needed personnel and
determine categories for surge capacity of personnel
 Recruit retired health care personnel.
 Use trainees.
 Use patients’ family members.
 health care personnel from other settings (e.g.,
medical offices and same day surgery centers).
 Expand bed capacity during times of crisis.
Hospital Surge Capacity 2
 Surge Capacity & Hospital Admissions:
 Establish admissions criteria for when bed capacity
is limited.
 May need to cancel elective admissions during
triage phase
 Identify “triggers” for canceling elective
procedures.
 Develop policies/procedures for expediting patient
discharge (Early discharge of patients)
 Use non-acute beds for acute patients
Hospital Surge Capacity 3
 Determine main agencies have identified key
components of surge capacity and response to the
demand
 Applying Telemedicine
 Consider telemedicine capability and privileges so
physicians not required to attend hospital
Hospital Surge Capacity 4
 Develop transfer agreements.
 Establish policies/procedures for shifting patients
between nursing units.
 Identify areas of facility that can be dedicated to extra
patients.
 Stockpile consumable resources.
 Identify “triggers” for ordering extra supplies.
Fatality Management
Hospital Mortuary Issues
 Ensure fatality management plans include a
partnership with the local coroner’s office in the event
the hospital morgue capacity is exceeded.
 Assess current refrigeration capacity for deceased
persons.
 Develop a mass fatality plan.
 Identify temporary morgue sites.
 Determine scope and volume of
supplies needed for deceased persons.
Hospital Preparedness &
Response
Disaster Management Cycle
Preparedness
 Preparedness:
 State and community level planning
 Build and distribution plan
 Work with WHO and other international orgs
 Build and exercise plans at all levels of gov.
 Plan for surge capacity
Disaster Management Cycle
Preparedness
Preparedness on a hospital level
 A local preparedness plan can develope Based on:
 WHO documents, national and provincial
Pandemic Plan
 In collaboration with other hospitals
Disaster Management Cycle
Preparedness
1- Training:
 The targeted audiences include decision makers and
other key elected and appointed officials, first
responders, local health department personnel, and
health care system personnel.
 Some of the more important topics to be covered:
plans and procedures familiarization, media relations,
and pandemic characteristics and history
Disaster Management Cycle
Preparedness
2- Exercises:
 Tabletop exercises must be conducted for various
audiences, including those who will implement the state’s
response plans, response partners and other stakeholders.
 roles and main operational concepts have been
established and tested via tabletop exercises, functional
and/or full-scale exercises may be needed to test the
emergency response organizational structure in “real time”
Disaster Management Cycle
Preparedness
3- Planning for Risk communication :
 Timely, accurate, consistent and useful information
must be regularly provided to the public, health care
providers, local officials and the news media.
Disaster Management Cycle
Preparedness
4- Resource stockpiling :
 Vaccines
 Drugs & ….
 national and state stockpiles of medications will be
necessary to support response activities.
Planning – What does it Require?
Facilities
Surge capacity for beds, personnel, morgue
Supplies
Personnel protective equipment
Ventilators, gloves & …..
Infection
control
Vaccine/
Drugs
Major isolation plan
Staff education
Develop internal rationing plan
Coordinate with State/County
Disaster Management Cycle
Response
1- Coordination and management:
The main thrust is to keep state partners in the response
effort informed through briefings, conference calls, and
other updating and shared decision making mechanisms.
Disaster Management Cycle
Response
2- First and foremost: “Scene” safety!!!
 Research has shown that a significant percentage of
health care workers, and, by extension, other priority
personnel who will come in contact with the public, such
as law enforcement, will not come to work in a pandemic
out of fear of self contamination or contamination of their
families. Plans will need to be made to provide
protection to these personnel, or very little else will go
according to plan.
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Disaster Management Cycle
Response
3- Needs assessment:
• Meeting health care needs
• Basic societal needs
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Law enforcement
Food deliveries
Fuel deliveries
Utilities
Monetary system
Power plants
Continuity of government
Disaster Management Cycle
Response
4- collaborate with the World Health Organization
(WHO) and other nations in all related pandemic
efforts
Work with counties/cities in the designation of quarantine and
isolation sites, and provide enforcement where necessary.
Disaster Management Cycle
Response
5- Control of the Pandemic (Activate Surveillance and
laboratory testing):
 Activate prevention and control activities
 Define the magnitude and severity of pandemic
 Epidemiologic surveillance
 Provide front-line pathology labs
 Provide definitive reference labs and epidemiologic
surveillance/information
 monitor circulating strains
Disaster Management Cycle
Response
6- Vaccine delivery:
 Once vaccine becomes available, major activities will
consist of distributing vaccine to public and/or private
sector vaccinators, appropriate storage, handling and
vaccination, dose tracking, safety monitoring, and also
using
Disaster Management Cycle
Response
7- Medication distribution:
 Coordinate distribution of pharmaceuticals, vaccines and
other critical medical supplies and equipment to states of key
medical supplies and personnel
 This is primarily a logistical operation.
Disaster Management Cycle
Response
8- Risk communications:
A sufficient quantity of spokespersons should receive
media training, instruction in crisis and risk
communications and guidance on public health measures
and messages prior to the onset of a pandemic.
Technology, including Internet Websites, faxes, electronic
mass mailing systems, satellite uplinks and telephone
hotlines will play key roles in keeping the public and the
health care community informed.
Disaster Management Cycle
Response
9- Review and modify Plans and procedures:
Plans and procedures must be adjusted to reflect any
emergency legislation or administrative rule changes. In
addition, response partners must review and modify plans
and procedures to reflect changing conditions and needs.
‫طرح مقابله بیمارستانی با بحران وقوع پاندمی ها ‪:‬‬
‫قرار داده ‌و‬
‫‪1‬ـ طرح هاي بحران کشوري‪ ،‬منطقه‌اي ‌و بیمارستانی را مورد بررس ي ‌‬
‫قراردهيد ‪.‬‬
‫اقدامات مرتبط با بیمارستان خود را مورد توجه ‌‬
‫کاربیمارستان با وجود کاهش تعداد ‌و توان شاغلين برنامه ريزي‌ نماييد ‪.‬‬
‫‪2‬ـ جهت ادامه ‌‬
‫در زمان بحران را مورد‬
‫کار ‌‬
‫‪3‬ـ توانايي تأمين کنندگان تجهيزات ‌و ملزومات جهت ادامه ‌‬
‫قراردهيد ‪.‬‬
‫بررس ي ‌‬
‫‪ 4‬ـ سياستگذاري‌ ويژه استراحت پزشکي مبتاليان به بيماري‌ انجام پذيرد‬
‫قر ‌ارگيرد ‪.‬‬
‫هريک ‌ازکارمندان با بيماران احتمالي ‌و مراجعين مورد ارزيابي ‌‬
‫‪5‬ـ ميزان تماس ‌‬
‫طرح مقابله بیمارستانی با بحران در خصوص وقوع‬
‫پاندمی ها ‪:‬‬
‫نياز به‬
‫امر ممکن است ‌‬
‫در منزل‌ وجود دارد ؟ ( اين ‌‬
‫‪6‬ـ آيا امکان انجام وظايف کارکنان ‌‬
‫تأمين تجهيزات مخابراتي ويژه‌اي داشته باشد ‪) .‬‬
‫در بیمارستان را شناسايي نماييد ‌و براي اين مشاغل سه يا چه ‌ار فرد‬
‫‪ 7‬ـ مشاغل حياتي ‌‬
‫در‬
‫جانشين را معرفي نموده يا آموزش دهيد چنانکه بتوانند آن شغل را بدون‌ اختالل ‌‬
‫عملکرد ادامه دهند ‪ .‬همچنين راههايي براي ادامه حيات بیمارستان بدون‌ وجود اين‬
‫مشاغل پيش بيني کنيد ‪.‬‬
‫ن ‌و لوازم شوينده ‌و غيره ‌و‬
‫‪ -8‬تجهيزات ‌و ملزومات کافي ( ‌از قبيل دستمال کاغذي ‌و صابو ‌‬
‫در‬
‫نيز توجه نماييد ‪‌ .‬‬
‫انبار نموده ‌و به تاريخ مصرف لوازم ‌‬
‫تجهيزات پزشکي الزم ) را ‌‬
‫قرارگيرد ‪.‬‬
‫ترمورد استفاده ‌‬
‫مصرف تجهيزات ابتدا لوازم قديمي ‌‬
‫طرح مقابله بیمارستانی با بحران در خصوص وقوع‬
‫پاندمی ها ‪:‬‬
‫‪9‬ـ‌اطمينان‌حاصل‌نماييد‌که‌طرح‌بحران‌( ‪ )Disaster Plan‬کليه‌شاغلين‌و‌‬
‫مراجعين‌و‌جمعيت‌عمومي‌منطقه‌را‌تحت‌حمايت‌قرار‌مي‌دهد‌‪.‬‬
‫‪ -10‬سياستهايي‌جهت‌افرايش‌فاصله‌ميان‌شاغلين‌و‌مراجعين‌و‌سايرين اتخاذ‌‬
‫‌سياستهاي‌اشتغال‌ازراه‌دور‌‬
‫‌‬
‫نماييد‌‪ .‬تماسهاي‌چهره‌به‌چهره‌را‌کاهش‌داده‌و‬
‫را‌توسعه‌دهيد‌‪.‬‬
‫‪11‬ـ‌تيم‌مرکزي‌جهت‌اطالع‌رساني‌به‌کارمندان‌و‌مشتريان‌تشکيل‌دهيد‌تا‌اطالعات‌‬
‫صحيح‌به‌موقع‌در‌اختيار‌همگان‌قرار‌گيرد‌‪.‬‬
‫طرح مقابله بیمارستانی با بحران در خصوص وقوع‬
‫پاندمی ها ‪:‬‬
‫‪ 12‬ـ‌با‌کليه‌شاغلين‌( استخدامي‌‪‌،‬قراردادي‌‪‌،‬پيمانکاري‌و‌غيره‌) مسائلي‌از‌قبيل‌‪‌،‬‬
‫مسافرت‌‪‌،‬حمل‌و‌نقل‌‪‌،‬استراحت‌پزشکي‌‪‌،‬مراقبت‌از‌افراد‌‌خانواده‌و‌ساير‌مسائل‌‬
‫مربوط‌به‌نيروي‌انساني‌را‌مورد‌حالجي‌قرار‌دهيد‌‪.‬‬
‫‪ -13‬لوازم‌کنترل‌عفونت‌( لوازم‌محافظتي‌مانند‌ماسک‌و‌دستکش‌و‌لوازم‌بهداشتي‌‬
‫مانند‌صابون‌و‌دستمال‌کاغذي‌) به‌مقدار‌کافي‌در‌محل‌کار‌تعبيه‌نماييد‌‪.‬‬
‫‪14‬ـ‌اطالعات‌و‌آموزشهاي‌الزم‌را‌بطور‌مداوم‌و‌به‌صورت‌قابل‌فهم‌به‌کليه‌پرسنل‌و‌‬
‫جمعيت‌تحت‌پوشش‌خود‌ارائه‌دهيد‌‪.‬‬
‫طرح مقابله بیمارستانی با بحران در خصوص‬
‫وقوع پاندمی ها ‪:‬‬
‫‪15‬ـ‌هماهنگي‌الزم‌با‌سازمانهاي‌خدماتي‌بهداشتي‌و‌درماني‌و‌سازمانهاي‌بيمه‌گر‌در‌‬
‫زمينه‌چگونگي‌ارائه‌خدمات‌حين‌بحران‌را‌انجام‌دهيد‌‪.‬‬
‫‪16‬ـ‌به‌شاغلين‌سازمان‌جهت‌مديريت‌ساير‌عوامل‌استرس‌زا‌حين‌بحران‌(مانند‌‬
‫مراقبت‌از‌بستگان‌‪‌،‬کمبود‌لوازم‌‪‌،‬فوت‌نزديکان‌و‌موارد‌مشابه‌) کمک نماييد‌‪.‬‬
‫‪17‬ـ‌جهت‌حمايت‌از‌شاغلين‌در‌برابر‌ابتال‌به‌بيماري‌و‌کاهش‌ريسک‌انتقال‌بيماري‌‬
‫در‌محيط‌کار‌برنامه‌ريزي‌نماييد‌‪.‬‬
Example
 In planning for a possible influenza pandemic, the WHO
published a document on pandemic preparedness
guidance in 1999, revised in 2005 and in February
2009, defining phases and appropriate actions for each
phase in an aide memoir entitled WHO pandemic phase
descriptions and main actions by phase. The 2009
revision, including definitions of a pandemic and the
phases leading to its declaration, were finalized in
February 2009.
Example. Key components of the hospital preparedness
checklist for pandemic influenza
Incident pharmaceuticals command system:
 Communication
 Continuity of essential health services and patient
care
 Surge capacity
 Human resources
 Logistics and management of supplies, including
pharmaceuticals
Example. Key components of the hospital preparedness
checklist for pandemic influenza
 Essential support services
 Infection prevention and control
 Case management
 Surveillance: early warning and monitoring
 Laboratory services
Don’t Forget:
a pandemic will NOT stop
other diseases or
disasters
Tank you!
10 main steps
 1. Surveillance and Detection
 2. Laboratory Testing
 3. Antiviral and Vaccine Purchase and Distribution
 4. Restriction of Movement or Activities to Control
Disease Spread
 5. Emergency and Risk Communication
 6. Fatality Management
 7. Training and Exercise Schedule and Plan
 8. Public Health and Medical Surge
 9. Infection Control and Personal Protective Equipment
(PPE)