Hospital preparedness for pandemic. Objectives Pandemic definition Historical, Current & possible future pandemics The impacts of pandemics on communities.

Hospital preparedness for pandemic Hospital preparedness for pandemic

ObjectivesObjectives

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 preparedness & planning elements in

pandemic situations

Pandemic definitionPandemic 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.

http://en.wikipedia.org/wiki/Epidemic

http://en.wikipedia.org/wiki/Infectious_disease

http://en.wikipedia.org/wiki/Continents

Why Do We Care in pandemics?Why Do We Care in 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.

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

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

http://en.wikipedia.org/wiki/Hong_Kong_Flu

http://en.wikipedia.org/wiki/Seventh_cholera_pandemic

http://en.wikipedia.org/wiki/Indonesia

http://en.wikipedia.org/wiki/El_Tor

Current pandemicsCurrent 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.

http://en.wikipedia.org/wiki/2009_flu_pandemic

http://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H1N1

http://en.wikipedia.org/wiki/India

http://en.wikipedia.org/wiki/China

http://en.wikipedia.org/wiki/Africa

Concern about possible future pandemics

Concern about possible future pandemics

Viral hemorrhagic fevers

Antibiotic resistance

SARS

Influenza

H5N1 (Avian Flu)

What Have We Learned from Past Pandemics? (1)

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—including police, water, electricity, food supplies, banks, telephones, etc.

What Have We Learned from Past Pandemics? (2)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?What Will Life Be Like in a Severe Pandemic?

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.

Shortages of essential goods may occur—including food, water, fuel, medicines, and many more.

Available goods may be subject to personal consumption, looting, and hoarding.

A. Shortages of Essential GoodsA. Shortages of Essential Goods

http://www.mass.gov/

B. Disruption in Routine Services B. Disruption in Routine Services

Schools, government offices, the post office and some workplaces may need to close during the pandemicmay 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

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 MovementD. 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.




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.




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.




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.

GoalsGoals

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

ObjectivesObjectives

Keep maintenance of treatment capacity throughout the state.

Keep safety of responders, their families, and the public.

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 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 PrinciplesGeneral Principles

Even in a disaster situation hospitals have to..

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 pre-

hospital phase

Hospital Planning Elements Hospital Planning Elements

Determining criteria for distinguishing pandemics Predetermined thresholds for activating pandemic response plans Procedures to facilitate laboratory testing on site. Mechanisms for conducting surveillance in emergency departments Mechanisms for monitoring employee absenteeism Mechanisms for tracking emergency department visits and hospital

admission/discharges for suspected/confirmed pandemic patients Determine types of data reportable to state and local health

departments

10 main steps10 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)

Hospital Risk Communications 1 Hospital Risk Communications 1

Use guidance from state or local health departments for external communications.

Identify key topics for ongoing communications.

Determine how public inquiries would be handled.

Determine how to keep hospital personnel and patients informed.

Hospital Risk Communications 2 Hospital Risk Communications 2

Communicate effectively with community leaders and the media to maintain public awareness, avoid social disruption, and provide information on evolving pandemic response activities.

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

Hospital Education and Training 1Hospital 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.

Hospital Education and Training 2Hospital 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 non-clinical staff.

Develop educational materials for patients and family members.

Case managementHospital 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



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

Hospital Facility Access 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.

Hospital Security

Human resources 1 Planning for personnel


I. Remains biggest challenge we face in pandemicsII. Legal protections are key to recruiting personnelIII. Large number of non-clinical personnel also needed

12% of work force will be absent during the peak weeks (UK Planning Assumptions 2009)

Human resources 2Planning for personnel


Develop pandemic staffing contingency plans.

Potential sources of clinical surge personnel:Internal Hospital StrategiesvolunteersMedical Reserve Corps that are not included in hospital staffRetired, inactive health professionalsStudents (medical, nursing, pharmacy)

Staff list updated regularly



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.



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



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

Infection prevention and control 1Infection 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.

Infection prevention and control 2Infection prevention and control 2

Develop a strategy for prioritizing vaccinations to critical personnel.

Design units for case patient careShort distance to designated wards Transport to the wards distant from patient main

stream

Logistics Management 1Logistics Management 1

Estimation of quantities of essential patient careneeded 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

relativesBrochures and posters

Logistics Management 2Logistics Management 2

Estimates are shared with the provincial health authorities and regional hospitals

Stockpiling agreements Contingency plan for an increased need for post

mortem careInvolvement of local morticians

Hospital Surge Capacity 1Hospital 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).


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


Develop transfer agreements. Establish policies/procedures for shifting patients

between nursing units. Expand bed capacity during times of crisis. Identify areas of facility that can be dedicated to extra

patients. Stockpile consumable resources. Identify “triggers” for ordering extra supplies.


Develop a strategy for ensuring uninterrupted provision of medications.

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

Fatality Management Hospital Mortuary Issues

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

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 medical and veterinary surge

capacity

Disaster Management CyclePreparedness


Preparedness on a hospital level

A local preparedness plan was developed Based on:

WHO documents, national and provincial Pandemic Plan

In collaboration with other hospitals





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



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.



4- Resource stockpiling :

Vaccines

Drugs & …. national and state stockpiles of medications will be necessary to support response activities.

Planning – What does it Require?

Surge capacity for beds, personnel, morgue

Personnel protective equipmentVentilators, gloves & …..

Major isolation planStaff education

Develop internal rationing plan

Facilities

Supplies

Infection control

Vaccine/Drugs

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.

60



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.



3- Needs assessment:• Meeting health care needs• Basic societal needs

Law enforcement Food deliveries Fuel deliveries Utilities Monetary system Power plants Continuity of government



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.



5- Control of the Pandemic (Activate Surveillance and laboratory testing): Activate prevention and control activitiesDefine the magnitude and severity of pandemicEpidemiologic surveillance Provide front-line pathology labs Provide definitive reference labs and epidemiologic

surveillance/informationmonitor circulating strains



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



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.



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.



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.

پاندمی وقوع بحران با بیمارستانی مقابله طرحها :

منطقه اي و بیمارس.تانی را م.ورد . ط.رح ه.اي بح.ران کش.وري،1را خ.ود ب.ا .بیم.ا.رس.تان اق.دام.ات. .مرتب.ط و د.اده. ب.ررس.ي .ق.را.ر

مورد. تو.جه قرار .دهيد ..

ت.وان 2 و تع.داد ک.اهش وج.ود ب.ا بیمارس.تان ک.ار ادام.ه جهت .شاغلين برنامه ريزي نماييد .

. توان.ايي ت.أمين کنن.دگان تجه.يزات و ملزوم.ات جهت ادام.ه ک.ار 3در زمان .بحر.ان را مو.رد بر.رسي قرار. دهيد . .

. سياس.تگذاري وي.ژه اس.تراحت پزش.کي مبتالي.ان ب.ه بيم.اري 4انجام پذيرد

و 5 احتم.الي بيم.اران ب.ا کارمن.دان از ي.ک ه.ر تم.اس م.يزان .مراجعين مورد ارزيابي قرار گيرد .

. آي.ا امک.ان انج.ام وظ.ايف کارکن.ان در م.نزل وج.ود دارد ؟ ) اين 6ام.ر ممک.ن اس.ت ني.از .ب.ه ت.أم.ين. ت.جه.يز.ا.ت .مخ.ابرات.ي وي.ژه اي. داش.ته

باشد . (

. مش.اغل حي.اتي در بیمارس.تان را شناس.ايي نمايي.د و ب.راي اين 7مش.ا.غل .س.ه ي.ا. چ.ه.ار ف.رد .ج.انش.ين ر.ا مع.رفي. .نم.وده .ي.ا آم.وزش ل در عملک.رد ادام.ه ده.ي.د چنا.ن.ک.ه ب.توا.ن.ن.د آن ش.غل را .ب.دون اخ.تال.ادام.ه .حي.ا.ت .بیمارس.تان .ب.دون ب.راي. را.هه.ايي ه.مچ.ن.ين . د.هن.د.

وجو.د اين مش.اغل پ.يش بيني .کنيد. .

- تجه.يزات و ملزوم.ات ک.افي ) از قبي.ل دس.تمال کاغ.ذي و ص.ابون 8انب.ار را ) الز.م و. .تجه.يزات .پ.زش.کي ش.وينده .و .غ.يره ل.وازم و. نم.و.ده .و .ب.ه .ت.ا.ري.خ .م.ص.رف ل.وا.زم. ن.يز .توج.ه. نم.اي.ي.د .. در. مص.رف

تج.هيزا.ت .ابتد.ا لو.از.م .قديمي. .تر مور.د .ا.ستفاده. قرار گ.يرد .

در بحران با بیمارستانی مقابله طرحها : پاندمی وقوع خصوص


. اطمينان حاصل نماييد که طرح بحران 9 (Disaster Plan کليه شاغلين و مراجعين و )

جمعيت عمومي منطقه را تحت حمايت قرار مي دهد .

- سياستهايي جهت افرايش فاصله ميان 10شاغلين و مراجعين و سايرين اتخاذ نماييد .

تماسهاي چهره به چهره را کاهش داده و سياستهاي اشتغال از راه دور را توسعه دهيد .

. تيم مرکزي جهت اطالع رساني به کارمندان 11و مشتريان تشکيل دهيد تا اطالعات صحيح به

موقع در اختيار همگان قرار گيرد .



. با کليه شاغلين ) استخدامي ، قراردادي ، 12پيمانکاري و غيره ( مسائلي از قبيل ، مسافرت ،

حمل و نقل ، استراحت پزشکي ، مراقبت از افراد خانواده و ساير مسائل مربوط به نيروي

انساني را مورد حالجي قرار دهيد .

- لوازم کنترل عفونت ) لوازم محافظتي مانند 13 ماسک و دستکش و لوازم بهداشتي مانند صابون و دستمال کاغذي ( به مقدار کافي در محل کار

تعبيه نماييد .

. اطالعات و آموزشهاي الزم را بطور مداوم و 14به صورت قابل فهم به کليه پرسنل و جمعيت

تحت پوشش خود ارائه دهيد .



با بیمارستانی مقابله طرحپاندمی وقوع خصوص در بحران

: ها

با بیمارستانی مقابله طرحپاندمی وقوع خصوص در بحران

: ها. هماهنگي الزم با سازمانهاي خدماتي 15

بهداشتي و درماني و سازمانهاي بيمه گر در زمينه چگونگي ارائه خدمات حين بحران را

انجام دهيد .

. به شاغلين سازمان جهت مديريت ساير 16عوامل استرس زا حين بحران )مانند مراقبت

از بستگان ، کمبود لوازم ، فوت نزديکان و موارد مشابه ( کمک نماييد .

. جهت حمايت از شاغلين در برابر ابتال به 17بيماري و کاهش ريسک انتقال بيماري در

محيط کار برنامه ريزي نماييد .

ExampleExample

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

Essential support services Infection prevention and control Case management Surveillance: early warning and monitoring Laboratory services



Don’t Remember:

a pandemic will NOT stop other diseases or

disasters

Tank you!Tank you!

Hospital preparedness for pandemic. Objectives Pandemic definition Historical, Current & possible future pandemics The impacts of pandemics on communities.

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