Policy Template for Communicable Diseases of Public Health Importance Spread via the Airborne and Droplet Routes

1. Policy Templatefor Communicable Diseases of Public Health Importance Spread via the Airborne and Droplet Routes Marion A. Kainer MD, MPH Tennessee Department of Health marion.kainer@state.tn.us

2. Triage Protocol • Prompt recognition and isolation of a patient presenting to the Emergency Department (ED) or Clinic • Fever/rash or fever/respiratory illness • ? Communicable disease of public health concern (e.g., measles, meningococcal disease, SARS, avian influenza, smallpox, or plague)

3. Emergency Departments and Clinics • Important and vulnerable points of entry into a hospital • Effective strategies for triage applied in these settings will have great impact on minimizing nosocomial transmission within and beyond the ED and clinics.

4. TB Example

5. TB Case Example • 25 Year old Black Man • HIV – • 12/29/2005: PPD placed in medical correctional facility. Reading of 16mm. • 12/30/2005: Abnormal Chest X-Ray in same facility

6. TB Continued • 4/14/2006 Admitted to ER • Presented with: • Sore throat • Cough • Thick Yellow Sputum • Fever • Discharged that day. • Told to See PCP or return to ER if worsens or does not improve within 24 hours. • Diagnosed with Bronchitis and told to take OTC medicine.

7. TB Continued • 5/13/2006 Admitted to ER of same hospital early in morning • Presented with: • Fever • Chills • Weight loss • Malaise • Nose bleed • Chest pain • Hemoptosis (SP) • Cough • Smears ordered • Patient moved to ICU (Isolation unknown)

8. TB Continued • 5/14/2006 Patient died later in the evening. • Mycobacterium tuberculosis complex cultured • Autopsy revealed massive bleeding in chest, massive hemoptysis, necrosis of pulmonary vein, right lung, with alveolar hemorrhage.

9. Guidance Document • To assist hospitals in developing or updating their protocols for screening and isolation for potentially communicable diseases of public health concern (i.e., diseases with greater likelihood of spread to others, and with higher likelihoods of more severe morbidity or mortality

10. Objectives • Enhance early recognition of a patient who may have a communicable disease of public health concern upon arrival at the hospital ED or clinic • Prompt the rapid institution of infection control measures to minimize potential transmission to staff, patients and visitors. • Provide a template from which hospitals may operationalize their plans

11. Sections (1) Initial Patient Encounter (2) Infection Control Measures on Arrival (3) Notification (4) Identification and Management of Exposed Persons in ED/Clinics

12. Training and Drills • Essential to ensure compliance with these measures • Frontline staff (triage, reception, security as well as nursing and medical staff) • Measures outlined in this protocol, including notification procedures

13. Training and Drills • Expect staff from county/regional health departments to take part in assessment in local hospitals • Check-list of actions taken for the “fake” patient, including notification of ICP and PH • Measure time taken to complete all of these • Provide feedback to local hospital

14. OMS Update • Version 1.5 to be released early December • Training will be held: • January 30, 31 + February 1 at MCRO • Scenario: • (a) Shigella in a daycare • (b) Hepatitis A • Need input in designing the package • Laptops loaded with: MS SQL, SAS, OMS v 1.5